Explore the vast range of titles available.

In 2015, a large outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection occurred following a single patient exposure in an emergency room at the Samsung Medical Center, a tertiary-care hospital in Seoul, South Korea. We aimed to investigate the epidemiology of MERS-CoV outbreak in our hospital. We identified all patients and health-care workers who had been in the emergency room with the index case between May 27 and May 29, 2015. Patients were categorised on the basis of their exposure in the emergency room: in the same zone as the index case (group A), in different zones except for overlap at the registration area or the radiology suite (group B), and in different zones (group C). We documented cases of MERS-CoV infection, confirmed by real-time PCR testing of sputum samples. We analysed attack rates, incubation periods of the virus, and risk factors for transmission. 675 patients and 218 health-care workers were identified as contacts. MERS-CoV infection was confirmed in 82 individuals (33 patients, eight health-care workers, and 41 visitors). The attack rate was highest in group A (20% [23/117] vs 5% [3/58] in group B vs 1% [4/500] in group C; p<0·0001), and was 2% (5/218) in health-care workers. After excluding nine cases (because of inability to determine the date of symptom onset in six cases and lack of data from three visitors), the median incubation period was 7 days (range 2–17, IQR 5–10). The median incubation period was significantly shorter in group A than in group C (5 days [IQR 4–8] vs 11 days [6–12]; p<0·0001). There were no confirmed cases in patients and visitors who visited the emergency room on May 29 and who were exposed only to potentially contaminated environment without direct contact with the index case. The main risk factor for transmission of MERS-CoV was the location of exposure. Our results showed increased transmission potential of MERS-CoV from a single patient in an overcrowded emergency room and provide compelling evidence that health-care facilities worldwide need to be prepared for emerging infectious diseases. None.

Cytomegalovirus (CMV) infections in liver transplant recipients are common and result in significant morbidity and mortality. Intravenous ganciclovir or oral valganciclovir are the standard treatment for CMV infection. The present study investigates the efficacy of oral valganciclovir in CMV infection as a preemptive treatment after liver transplantation. Between 2012 and 2013, 161 patients underwent liver transplantation at Samsung Medical Center. All patients received tacrolimus, steroids, and mycophenolate mofetil. Patients with CMV infection were administered oral valganciclovir (VGCV) 900mg/day daily or intravenous ganciclovir (GCV) 5mg/kg twice daily as preemptive treatment. Stable liver transplant recipients received VGCV. Eighty-three patients (51.6%) received antiviral therapy as a preemptive treatment because of CMV infection. The model for end-stage liver disease (MELD) score and the proportions of Child-Pugh class C, hepatorenal syndrome, and deceased donor liver transplantation in the CMV infection group were higher than in the no CMV infection group. Sixty-one patients received GCV and 22 patients received VGCV. The MELD scores in the GCV group were higher than in the VGCV group, but there were no statistical differences in the pretransplant variables between the two groups. AST, ALT, and total bilirubin levels in the GCV group were higher than in the VGCV group when CMV infection occurred. The incidences of recurrent CMV infection in the GCV and VGCV groups were 14.8% and 4.5%, respectively (P=0.277). Oral valganciclovir is feasible as a preemptive treatment for CMV infection in liver transplant recipients with stable graft function.

Systemic inflammatory response syndrome (SIRS) is a serious condition that can cause organ failure as an exaggerated immunoresponse to the infection or other causes. Recently, autophagy was reported as a key process that regulates inflammatory responses in macrophages. Vancomycin is one of the most commonly prescribed antibiotics for sepsis treatment or following surgery. However, there are no studies on how vancomycin affects autophagy or inflammation. Here, we treated macrophage cell lines with vancomycin and lipopolysaccharides and found that vancomycin blocks autophagy and increases inflammatory responses. This finding suggests that vancomycin should be more cautiously administered in order to prevent unwanted SIRS during sepsis.

Background Carriage of methicillin-resistant Staphylococcus aureus (MRSA) is an important risk factor of subsequent infection. The purpose of our study was to compare the rates of subsequent infection among newly-admitted patients carrying MRSA between community-genotype and hospital-genotypes Methods In this retrospective cohort study, we compared the rates of subsequent MRSA infection, time to subsequent infection and mortality in the following 6 months between the community-genotype ST72 MRSA cohort and the hospital-genotypes ST5 / ST239 MRSA cohort. Results We identified 198 patients carrying ST72 and 156 patients carrying ST5 or ST239. There was no difference in the rates of subsequent infection between ST72 cohort and ST5 / ST239 cohort (13.1% vs. 12.8%; P  = 0.931). The median time to development of subsequent infection was not significantly different (27 days vs. 88 days; P  = 0.0877). The Kaplan-Meier method showed no difference in the cumulative rate of being free of subsequent infection between the cohorts ( P  = 0.9209). Overall mortality rates at 6 months did not differ (1.5% vs. 1.9%; P  = 1.000) Conclusions We found no evidence that rates of subsequent MRSA infection were different between newly-admitted patients carrying community-genotype ST72 MRSA and those whom carrying hospital-genotypes ST5 or ST239 MRSA.

To evaluate the effects of demographic and perceptive factors on the knowledge, perception, and behavior regarding antibiotic use in the general public, we conducted three serial telephone interview surveys in 2010, 2012, and 2015. Computer-aided telephone interview was conducted, with a predetermined quota stratified by sex, age, and geographic location. Respondents who answered correctly to four or more questions were categorized as having better knowledge. A total of 3013 respondents participated. Better knowledge was associated with age < 60 years (OR 1.37, 95% CI 1.04–1.82), college education (OR 1.57, 95% CI 1.26–1.97), healthcare-related occupation or education (OR 2.26, 95% CI 1.52–3.36), and media exposure (OR 1.25, 95% CI 1.02–1.54). In contrast, correct antibiotic use behavior was associated with male sex (OR 1.48, 95% CI 1.27–1.73), older age (OR 1.63, 95% CI 1.34–1.99), and being married (OR 1.26, 95% CI 1.04–1.52), along with better knowledge (OR 1.43, 95% CI 1.19–1.71). However, multifaceted analysis indicated that better knowledge was associated with correct behavior in all subgroups. Other demographic factors were associated only in respondents with poor knowledge. Various factors other than knowledge on antibiotics, many of them traditionally underappreciated, affect antibiotic use behavior.

Stenotrophomonas maltophilia (SM) has emerged as an important nosocomial pathogen with high morbidity and mortality. Because of its unique antimicrobial susceptibility pattern, appropriate antimicrobial therapy for SM bacteremia is still challenging, especially in immunocompromised patients. The present study was performed to assess clinical predictors of SM bacteremia in adult patients with hematologic malignancy. From 2006 through 2016, a case-control study was performed at a tertiary-care hospital. Case patients were defined as SM bacteremia in patients with hematologic malignancy. Date- and location-matched controls were selected from among patients with gram-negative bacteremia (GNB) other than SM. A total of 118 cases of SM bacteremia were identified and compared to 118 controls. While pneumonia was the most common source of SM bacteremia, centralline-associated infection was most common in the controls. The overall 30-day mortality rate of cases with SM bacteremia was significantly higher than that of the controls (61.0 and 32.2%, respectively; P < 0.001). A multivariable analysis showed that polymicrobial infection, previous SM isolation, the number of antibiotics previously used ≥ 3, and breakthrough bacteremia during carbapenem therapy were significantly associated with SM bacteremia (all P < 0.01). Previous use of trimethoprim/sulfamethoxazole (TMP/SMX) was negatively association with SM bacteremia (P = 0.002). Our data suggest that SM is becoming a significant pathogen in patients with hematologic malignancy. Several clinical predictors of SM bacteremia can be used for appropriate antimicrobial therapy in hematologic patients with suspected GNB.

Background: Fluoroquinolones are antibiotics commonly used in the treatment of infections caused by Streptococcus pneumoniae . However, rates of fluoroquinolone resistance are increasing with their frequent use. We designed this study to verify current fluoroquinolone resistance rates and risk factors for community-onset pneumococcal pneumonia. Methods: A retrospective case–control study was conducted in a tertiary referral hospital. The study population comprised patients admitted for pneumococcal pneumonia between January 2011 and May 2017. The case group included community-onset pneumonia caused by levofloxacin-nonsusceptible S. pneumoniae . The control group consisted of two patients with levofloxacin-susceptible S. pneumoniae who were admitted around the same time as each case. Results: A total of 198 pneumococcal pneumonia cases were identified during the study period. Twenty-five levofloxacin-resistant S. pneumoniae cases and 3 levofloxacin-intermediate S. pneumoniae cases were included in the case group (nonsusceptibility rate = 14.1%). Multivariate analysis showed that healthcare-associated factors (odds ratio [OR] 4.78, 95% confidence interval [CI] 1.39–16.43, p  = 0.013), bronchopulmonary disease (OR 3.79, 95% CI 1.07–13.40, p  = 0.039), cerebrovascular disease (OR 6.08, 95% CI 1.24–29.75, p  = 0.026), and exposure to fluoroquinolones within the previous 3 months (OR 5.89, 95% CI 1.21–28.68, p  = 0.028) were associated with nonsusceptibility to levofloxacin. Conclusion: Independent risk factors for levofloxacin-nonsusceptible pneumococcal pneumonia were recent hospitalization, bronchopulmonary disease, cerebrovascular disease, and prior antibiotic use within 3 months. Careful selection of empirical antibiotics is thus needed in at-risk patients. Similarly, efforts to prevent the interpersonal spread of drug-resistant pathogens in long-term care facilities and to restrict unnecessary fluoroquinolone prescriptions are important.

8 days after the start of chemotherapy, she developed a fever and oral mucositis with profound neutropenia (absolute neutrophil count 30 cells/μL) and was given several broad-spectrum antibiotics (cefepime, meropenem, piperacillin-tazobactam, and vancomycin) over a period of 36 days. 22 days after chemotherapy initiation she developed oral candidiasis-like white patches over her tongue, and was treated with fluconazole (400 mg intravenously every 24 h). The case reported here emphasises the importance of different diagnostic approaches in immunocompromised patients with lesions resembling oral candidiasis that are not responsive to antifungal agents.

Background Infections caused by multidrug-resistant (MDR) organisms are associated with poorer clinical outcomes and higher economic burden. However, there has been limited data on the impact of MDR infection on the performance status of patients. Methods Patients with bloodstream infections by S. aureus, E. faecium, E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii have been identified prospectively as a part of a multicenter nationwide surveillance for antimicrobial resistance. Medical records of the patients enrolled from July 2015 through December 2016 were reviewed for demographic, clinical, microbiologic characteristics, and patient outcome. MDR was defined as MRSA, VRE, and nonsusceptibility to one or more agents in three or more different classes of antibiotics for Gram-negative bacteria. Performance status was evaluated by Eastern Cooperative Oncology Group (ECOG) Performance Status before admission and at discharge. Primary outcome was any decline in ECOG at discharge. Multiple logistic regression was used to identify independent risk factors for ECOG decline. Results A total of 19 hospitals participated to the network. The numbers of subjects were 410 for S. aureus, 392 for E. faecium, 708 for E. coli and K. pneumoniae, and 678 for P. aeruginosa and A. baumannii. In univariate analysis, bacteremia by MDR organisms was associated with ECOG decline only in patients with P. aeruginosa (18.4% vs. 10.3%, OR 1.962, 95% CI 1.132–3.399) and A. baumannii (27.6% vs. 11.8%, OR 2.834, 95% CI 1.328–6.045) infections. Patients with MDR K. pneumoniae infection had lower risk of ECOG decline (6.6% vs. 15.8%, OR 0.378, 95% CI 0.183–0.780). Multivariable analysis also showed that infection by MDR organism was independently associated with ECOG decline in patients with P. aeruginosa or A. baumannii infections (OR 2.068, 95% CI 1.478–2.895), but not with other MDR organisms. Comorbidities and initial ECOG showed higher effect size in patients with S. aureus and E. faecium infections. Conclusion In this large multicenter nationwide study, bloodstream infections caused by MDR P. aeruginosa and A. baumannii were associated with higher risk of decline in performance status at discharge. MDR status did not show association in infections by other species. Disclosures All authors: No reported disclosures.

Background Information on the most current status of antimicrobial resistance (AMR) in local and national levels has critical importance. However, collection and analysis of a large number of antimicrobial susceptibility test (AST) results often results in additional workload in healthcare facilities and latency in final reporting. We sought to develop an automated nationwide surveillance network in Korea. Methods Data collection servers were set up at each participating institutions, which collects AST results of every bacterial isolate from blood, cerebrospinal fluids, urine, and respiratory specimens. Collected results are anonymized and transmitted to central data server every day without human input. End-user can perform various analyses using data warehouse server through web interface. Only first isolates of same species from individual patients were included in analysis. Results A total of 19 hospitals located in various regions in Korea participated to the network. From January 2015 through December 2017, AST results of 347,356 isolates were collected. The proportion of MRSA among S. aureus (n = 17,761) was 65.3%, which declined gradually from 71.5 to 62.3% during study period (P < 0.001). The proportion of VRE increased from 29.3 to 36.3% (P = 0.001). Resistance rates of E. coli (n = 63,628) to third and fourth generation cephalosporins, fluoroquinolone, and piperacillin–tazobactam were 31.6, 23.0, 44.0, and 4.2%, respectively. Resistance rates of K. pneumoniae (n = 16,875) to same classes were 32.2, 28.1, 31.0 and 19.1%, respectively. Among E. coli and K. pneumoniae, 0.4 and 4.3% were resistant to carbapenem. Resistance rates of P. aeruginosa (n = 12,895) to carbapenem was 30.5%. However, 72.7% of A. baumannii isolates (n = 9,885) were resistant to carbapenem. Colistin resistance rate was still low at 0.5%. Conclusion We have established a fully automated nationwide surveillance network for AMR in Korea. Our system provided data on the most current status of AMR, which revealed increase in resistance rates among major Gram-negative pathogens compared with previous studies. Disclosures All authors: No reported disclosures.