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배경 Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of COVID-19. This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. 방법 A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The study hospital consists of three main categories: ward, outpatient clinic(OPD), and emergency room(ER).The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. We assumed exposed and infectious people from the patient and caregiver group came into the ER and OPD. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients,early testing of suspected infected people, and personal protective equipment(PPE) for both medical staff and visitors were evaluated. We set worse and best cases based on different parameters and performed sensitivity analysis for the vulnerability of results for each intervention. 결과 The model suggested that the early testing (within eight hours) of infected cases and operating the quarantine ward for newly hospitalized patients are effective measures for decreasing incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. Reinforcement of PPE for medical staff does not show an expected improvement of effectiveness. The effectiveness of front door screening and use of a quarantine unit are higher in the best case while the probability of control by testing and protection devices is higher in worst cases. 결론 This model suggests under the assumed conditions, some measures have a great influence on the incidence of COVID-19 within a hospital. Detecting the patients with COVID-19 from the ER and in wards before inflow to a hospital is effective in low transmission settings, and control by PPE is important in high transmission settings. Above all, the implementation of the preventive measures could reduce the size of a hospital outbreak. [ABSTRACT FROM AUTHOR]

Background: The incidence of Proteus mirabilis antimicrobial resistance, especially that mediated by extended-spectrum β-lactamases (ESBLs), has increased. We investigated the impact of ESBL production on the mortality of patients with P. mirabilis bacteremia in Korea.Methods: Patients diagnosed with P. mirabilis bacteremia between November 2005 and December 2013 at a 2000-bed tertiary care center in South Korea were included in this study. Phenotypic and molecular analyses were performed to assess ESBL expression. Characteristics and treatment outcomes were investigated among ESBL-producing and non-ESBL-producing P. mirabilis bacteremia groups. A multivariate analysis of 28-day mortality rates was performed to evaluate the independent impact of ESBLs.Results: Among 62 P. mirabilis isolates from 62 patients, 14 expressed ESBLs (CTX-M, 2; TEM, 5; both, 6; other, 1), and the 28-day mortality rate of the 62 patients was 17.74%. No clinical factor was significantly associated with ESBL production. The 28-day mortality rate in the ESBL-producing group was significantly higher than that in the non-ESBL-producing group (50% vs. 8.3%, p = 0.001). A multivariate analysis showed that ESBL production (odds ratio [OR], 11.53, 95% confidence interval [CI], 2.11-63.05, p = 0.005) was independently associated with the 28-day mortality rate in patients with P. mirabilis bacteremia.Conclusions: ESBL production is significantly associated with mortality in patients with bacteremia caused by P. mirabilis. Rapid detection of ESBL expression and prompt appropriate antimicrobial therapy are required to reduce mortality caused by P. mirabilis bacteremia. [ABSTRACT FROM AUTHOR]