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The Korean National Healthcare-associated Infections Surveillance System (KONIS) monitors multidrug-resistant (MDR) bacterial infections in intensive care units (ICUs). However, simultaneously monitoring hundreds of ICUs remains challenging. Our study aimed to visualize the trends of MDR gram-negative bacterial infections in ICUs monitored by KONIS. We evaluated KONIS data from 137 ICUs (2006-2011) and from 368 ICUs (2017-2022). Pneumonia, urinary tract infection, and bloodstream infection caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were analyzed. Transformation was employed to convert the infection rate graphs of each ICU into arrows. The length and angle of the arrows reflect changes in carbapenem susceptibility and infection rate, respectively. ICUs are categorized into red (rapid shift from susceptible to resistant bacteria and increased infection rate), yellow (slow shift from susceptible to resistant bacteria and decreased infections rate), and green (shift from resistant to susceptible bacteria) groups. The proportional changes in each ICU category were compared during the first and last five years of the study periods. For K. pneumoniae, the proportion of red category ICUs increased (0% to 17%, p-value 0.586), while the proportions of yellow (33.3% to 7%, p-value 0.288) and green category ICUs (66.6% to 36%, p-value 0.290) decreased. For P. aeruginosa, the proportions of red (12% to 27%, p-value 0.016) and green category ICUs (38% to 46%, p-value 0.358) increased, while the proportion of yellow category ICUs decreased (8% to 2%, p-value 0.043). For A. baumannii, the proportions of red (19% to 14%, p-value 0.649) and yellow category ICUs (5% to 1%, p-value 0.187) decreased, while the proportion of green category ICUs increased (19% to 72%, p-value <0.001). Graph transformation allowed the observation of MDR Gram-negative bacterial infection trends in ICUs. Further studies should aim to confirm whether our arrow indicators are useful for infection control and in identifying factors for reducing infections.

TRIM family proteins play integral roles in the innate immune response to virus infection. MG53 (TRIM72) is essential for cell membrane repair and is believed to be a muscle-specific TRIM protein. Here we show human macrophages express MG53, and MG53 protein expression is reduced following virus infection. Knockdown of MG53 in macrophages leads to increases in type I interferon (IFN) upon infection. MG53 knockout mice infected with influenza virus show comparable influenza virus titres to wild type mice, but display increased morbidity accompanied by more accumulation of CD45+ cells and elevation of IFNβ in the lung. We find that MG53 knockdown results in activation of NFκB signalling, which is linked to an increase in intracellular calcium oscillation mediated by ryanodine receptor (RyR). MG53 inhibits IFNβ induction in an RyR-dependent manner. This study establishes MG53 as a new target for control of virus-induced morbidity and tissue injury. TRIM proteins are known to play critical roles in the context of viral infection. Here the authors establish MG53 (TRIM72) suppresses IFN and inflammation by modulation of ryanodine receptor related intracellular calcium induction.

Necrotizing fasciitis (NF) is a serious skin and soft tissue infection causing high mortality. Investigating region specific epidemiologic factors associated with NF is important for establishing appropriate treatment strategies. This multicenter study was done to provide an update of the microbial etiology, clinical characteristics, and outcomes of NF in Korea. A retrospective cohort of adult patients with NF was established using patient data from 13 general hospitals between January 2012 and December 2015 in Korea. We evaluated microbial etiology and clinical characteristics to identify risk factors associated with in-hospital mortality; analyses were performed using binary logistic regression models. A total of 161 patients with NF were included. The most common underlying disease was diabetes mellitus (66 cases, 41.0%). A total of 148 organisms were isolated from 119 (73.9%) patients. Enteric Gram-negative organisms (36 patients) were the most common pathogen, followed by Staphylococcus aureus (30 patients) and streptococci (28 patients). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 6.2% (10/161) of patients. Of 37 enteric Gram-negative isolates tested, 26 (70.3%) isolates were susceptible to ceftriaxone. The in-hospital mortality rate was 22.4%. Intensive care unit admission, septic shock, and Gram-negative organism infections were significantly associated with in-hospital mortality, and surgery was not a favorable prognostic factor. As initial empirical antibiotics, glycopeptides against MRSA and broad-spectrum antibiotics against third-generation cephalosporin-resistant organisms should be considered for patients with community-onset NF in Korea.

Empiric antibiotic therapy for suspected hematogenous vertebral osteomyelitis (HVO) should be initiated immediately in seriously ill patients and may be required in those with negative microbiological results. The aim of this study was to inform the appropriate selection of empiric antibiotic regimens for the treatment of suspected HVO by analyzing antimicrobial susceptibility of isolated bacteria from microbiologically proven HVO. We conducted a retrospective chart review of adult patients with microbiologically proven HVO in five tertiary-care hospitals over a 7-year period. The appropriateness of empiric antibiotic regimens was assessed based on the antibiotic susceptibility profiles of isolated bacteria. In total, 358 cases of microbiologically proven HVO were identified. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (33.5%), followed by methicillin-resistant S. aureus (MRSA) (24.9%), Enterobacteriaceae (19.3%), and Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and anaerobes accounted for only 1.7% and 1.4%, respectively, of the causative pathogens. Overall, 73.5% of isolated pathogens were susceptible to levofloxacin plus rifampicin, 71.2% to levofloxacin plus clindamycin, and 64.5% to amoxicillin-clavulanate plus ciprofloxacin. The susceptibility to these oral combinations was lower in cases of healthcare-associated HVO (52.6%, 49.6%, and 37.6%, respectively) than in cases of community-acquired HVO (85.8%, 84.0%, and 80.4%, respectively). Vancomycin combined with ciprofloxacin, ceftriaxone, ceftazidime, or cefepime was similarly appropriate (susceptibility rates of 93.0%, 94.1%, 95.8%, and 95.8%, respectively). Based on our susceptibility data, vancomycin combined with a broad-spectrum cephalosporin or fluoroquinolone may be appropriate for empiric treatment of HVO. Fluoroquinolone-based oral combinations may be not appropriate due to frequent resistance to these agents, especially in cases of healthcare-associated HVO.

Despite the improved outcomes in patients with hematological malignancies, infections caused by multidrug-resistant organisms (MDROs) pose a new threat to these patients. We retrospectively reviewed the patients with hematological cancer and bacterial bloodstream infections (BSIs) at a tertiary hospital between 2003 and 2022 to assess the impact of MDROs on outcomes. Among 328 BSIs, 81 (24.7%) were caused by MDROs. MDRO rates increased from 10.3% (2003–2007) to 39.7% (2018–2022) ( P  < 0.001). The 30-day mortality rate was 25.0%, which was significantly higher in MDRO-infected patients than in non-MDRO-infected patients (48.1 vs. 17.4%; P  < 0.001). The observed trend was more pronounced in patients with newly diagnosed diseases and relapsed/refractory disease but less prominent in patients in complete remission. Among MDROs, carbapenem-resistant Gram-negative bacteria exhibited the highest mortality, followed by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus , and extended-spectrum β-lactamase-producing Enterobacteriaceae . Multivariate analysis identified independent risk factors for 30-day mortality as age ≥ 65 years, newly diagnosed disease, relapsed/refractory disease, MDROs, polymicrobial infection, CRP ≥ 20 mg/L, and inappropriate initial antibiotic therapy. In conclusion, MDROs contribute to adverse outcomes in patients with hematological cancer and bacterial BSIs, with effects varying based on the underlying disease status and causative pathogens. Appropriate initial antibiotic therapy may improve patient outcomes.

The aim of this study was to investigate the correlation between craniofacial morphology, temporomandibular joint (TMJ) characteristics, and condylar functional movement in patients with facial asymmetry using an up-to-date automated real-time jaw-tracking system. A total of 30 patients with mandibular asymmetry and prognathism were included. Three-dimensional (3D) craniofacial and TMJ morphometric variables were analyzed in images captured using cone-beam computed tomography. Three-dimensional condylar movements were recorded during the opening, protrusion, and laterotrusion of the jaw and divided into those for deviated and non-deviated sides. Overall functional and morphometric variables were compared between the sides by a paired t-test. Pearson’s correlation analysis and factor analysis were also performed. As a result, significant differences were found between the sides in morphometric and functional variables. The condylar path length was significantly longer and steeper on the deviated side during protrusion and lateral excursion. TMJ morphometric asymmetry, more so than the craniofacial morphologic asymmetry, seemed to be reflected in the functional asymmetry, representing different correlations between the sides, as supported by factor analysis. This study provides evidence explaining why the asymmetric condylar path remained unchanged even after orthognathic surgery for the correction of craniofacial asymmetry.

Purpose To provide an updated analysis of the long-term outcomes of patients with acute primary angle closure (APAC) and to investigate the risk factors for visual field (VF) loss progression. Study Design Retrospective, clinical cohort study Methods One hundred and forty-six APAC patients with a minimum of 1-year follow-up were included. The presenting features and the treatment utilized were recorded. The visual and intraocular pressure (IOP) outcomes were analyzed. The main outcome measures were the proportion of blindness and IOP at the final visit. A subset of patients with sufficient VF results was divided into a stable and progressive group based on mean deviation (MD) loss rate. Univariate and multivariate logistic regression analyses were performed to identify predictors of progression. Results Nine patients (6.2%) were blind, and 76.0% (111/146) had final decimal visual acuity greater than or equal to 0.5. All patients had normal final IOP, and 65.1% (95/146) were medication-free. 64.4% (94/146) underwent cataract surgery at a median 4 months after their APAC attack. The use of topical hypotensive medications (OR = 8.029, P = 0.012) was the only significant predictor of fast MD loss in the multivariate regression. Conclusions The long-term outcomes of APAC in recent years have been more promising. All patients maintained normal IOP several years following their APAC attack, and fewer than half required hypotensive agents. The incidence of blindness was low. These findings suggest that current practice patterns in the management of APAC are beneficial.

PurposeTo report the 2-year effective and safety profile of integrated phacoemulsification with intraocular lens implantation (PEI), goniosynechialysis (GSL) and 120° goniotomy (GT) in advanced primary angle-closure glaucoma (PACG) and cataracts.DesignMulticentre prospective study.Methods201 eyes of 196 patients who received combined PEI+GSL+ GT were assessed at baseline and re-evaluated at days 1, 7, and at 1, 3, 6, 12 and 24 months postsurgery. The intraocular pressure (IOP), the number of topical hypotensive medications, surgical complications and achievements of surgery success were also evaluated.ResultsAll participants were followed up for a 2-year period. The average IOP declined from 33.0±10.7 mm Hg to 13.6±2.9 mm Hg, and the number of topical hypotensive medication decreased from an average of 2.4 types to 0.4 at month 24. For the safety profile, the major complications were hyphema (n=14, 7.0%), IOP spike (n=9, 4.9%) and transit corneal oedema (n=23, 11.4%). The complete success was achieved in 72.6% of the eyes (146 out of 201), and the qualified success rate was 91.5% (184 out of 201). Only one eye required tube shunt surgery while no one developed severe vision-threatening complications. The best-corrected visual acuity increased from 0.80±1.08 to 0.54±0.78 LogMAR.ConclusionsPEI+GSL+GT is shown to be effective and safe in treating advanced PACG with cataract over a 2-year follow-up period. The combined surgery may be considered as an alternative for patients with advanced PACG.

Otitis media is one of the most common diseases in children, with 80% of children experiencing it by the age of three years. Therefore, the resulting social burden is enormous. In addition, many countries still suffer from complications due to otitis media. Meanwhile, COVID-19 has affected many diseases, with otitis media being one of the most strongly affected. This review aims to find out how COVID-19 has affected otitis media and its significance. A series of measures brought about by COVID-19, including emphasis on personal hygiene and social distancing, had many unexpected positive effects on otitis media. These can be broadly classified into four categories: first, the incidence of otitis media was drastically reduced. Second, antibiotic prescriptions for otitis media decreased. Third, the incidence of complications of otitis media was reduced. Fourth, the number of patients visiting the emergency room due to otitis media decreased. The quarantine measures put in place due to COVID-19 suppressed the onset and exacerbation of otitis media. This has great implications for the treatment and prevention of otitis media.

The management of fracture-related infections (FRIs) is complex and requires collaboration among various specialists, including trauma and orthopedic surgeons, infectious disease (ID) specialists, and microbiologists. This study aimed to investigate the effects of ID consultations on antibiotic treatment and FRI outcomes. We conducted a retrospective chart review of data from adult patients with microbiologically diagnosed FRIs at a tertiary care hospital. In total, 123 patients with FRIs were included in the study, with a median follow-up period of 31 months. Sixty-five patients (52.8%) received continuous ID consultations until the completion of their treatment, whereas 58 patients (47.2%) either did not receive any ID consultations or had their consultations terminated prematurely. The patients who received continuous ID consultations were more likely to receive pathogen-directed oral antibiotics (76.9% vs. 36.2%; P  < 0.001) and biofilm-active antibiotics (52.3% vs. 8.6%; P  < 0.001) than those who did not receive such consultations. The multivariate analysis results indicated that Gustilo–Anderson grade 3 open fractures (adjusted odds ratio [aOR], 3.89; P  = 0.002), implant retention (aOR, 2.44; P  = 0.04), and absence or early termination of ID consultations (aOR, 2.84; P  = 0.02) were independent predictors of treatment failure. Recurrence was less frequent in the patients who received biofilm-active agents than in those who did not (11.8% vs. 33.8%; P  = 0.03). In patients with FRI, appropriate ID consultations were associated with frequent use of biofilm-active antibiotics and improved outcomes.