Changing trends in clinical characteristics and antibiotic susceptibility of Klebsiella pneumoniae bacteremia

( Miri Hyun ),( Chang In Noh ),( Seong Yeol Ryu ),( Hyun Ah Kim ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.3

Background/Aims: Klebsiella pneumoniae is second most common organism of gram-negative bacteremia in Korea and one of the most common cause of urinary tract infection, and intra-abdominal infection. Methods: We compared clinical and microbiological characteristics about K. pneumoniae bacteremia in a tertiary hospital between 10 years. Group A is who had K. pneumoniae bacteremia at least one time from January 2004 to December 2005. Group B is from January 2012 to December 2013. We also analyzed antibiotic resistance, clinical manifestation of the K. pneumoniae bacteremia divided into community-acquired infections, healthcare associated infections, and nosocomial infections. Results: The resistance for ampicillin, aztreonam, cefazolin, and cefotaxime significantly increased compared to 10 years ago. Extended spectrum β-lactamase positivity surged from 4.3% to 19.6%. Ten years ago, 1st, 2nd cephalosporin, and aminoglycoside were used more as empirical antibiotics. But these days, empirical antibiotics were broad spectrum such as 3rd and 4th cephalosporin. In treatment outcome, acute kidney injury decreased from 47.5% to 28.7%, and mortality decreased from 48.9% to 33.2%. In community-acquired infections, there was similar in antimicrobial resistance and mortality. In healthcare-associated and nosocomial infections, there was significantly increasing in antibiotic resistance, decreasing in mortality, and acute kidney injury. Conclusions: In community-acquired infections, broader antibiotics were more used than 10 years ago despite of similar antimicrobial resistance. When K. pneumoniae bacteremia is suspected, we recommend to use the narrow spectrum antibiotics as initial therapy if there are no healthcare-associated risk factors, because the antibiotic resistance is similar to 10 years ago in community-acquired infections.

S-628 A case of acute pyelonephritis by Streptococcus parasanguinis in Korea

( Miri Hyun ),( Ji-yeon Lee ),( Hyun Ah Kim ),( Seong-yeol Ryu ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Background: It is unusual but, gram-positive bacteria also cause urinary tract infection. Typical Gram-positive uropathogen is Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. Symptoms associated with uncomplicated urinary tract infection caused by Gram-positive uropathogens are similar to those caused by Gram-negative organisms. S. agalactiae is common inhabitant of the lower gastrointestinal and female reproductive tracts. S. agalactiae is estimated to cause approximately 1% to 2% of all monomicrobial urinary tract infections. However, viridans Streptococcus is common organism cause infective endocarditis and a rare cause of urinary tract infection. Case report: A 82-year old female patient with fever and general weakness was admitted to hospital with the diagnosis of acute pyelonephritis. She had urinary frequency and residual urine sensation for 7 days. Blood culture reported Streptococcus parasanguinis. The 16s rRNA sequencing was used confirm the organism. Abdominal computed tomography revealed acute left pyelonephritis (Figure 1). She was treated by ceftriaxone and discharged from hospital as symptoms improved. Conclusions: Herein, we report a first case of urinary tract infection by S. parasanguinis, belonged to the viridians streptococcus in Korea. Figure 1. Abdominal CT reveals subtle decreased enhancement in left kidney.

Healthcare Workforce Response to The Coronavirus Disease Outbreak in Daegu, Korea: A Multi-Center, Cross-Sectional Survey

Kwon Hyun Hee,Kim Hye In,Kwon Ki Tae,Hwang Soyoon,Kim Shin-Woo,Kim Yoonjung,Kim Hyun ah,Hyun Miri,Hong Hyo-Lim,Kim Min Jung,Hur Jian,Hong Kyung Soo 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.2

Background Securing an available healthcare workforce is critical to respond to coronavirus disease 2019 (COVID-19); however, research investigating Korea’s COVID-19 staffing response is rare. To present the fundamental data of healthcare staff in response to the surge in COVID-19 cases, we investigated the healthcare workforce response in Daegu, South Korea, which experienced the first largest outbreak of COVID-19 outside of China. Materials and Methods In response to the COVID-19 outbreak, this retrospective cross-sectional study analyzed data on the scale and characteristics of healthcare workers (HCWs). Additionally, it analyzed the clinical and epidemiological characteristics of HCWs infected with COVID-19 in six major teaching hospitals (five tertiary and one secondary) in Daegu from January 19 to April 30, 2020. Results During this study period, only 1.3% (n = 611) of the total hospitalized patients (n = 48,807) were COVID-19 inpatients, but they occupied 6.0% (n = 303) of the total hospital beds (n = 5,056), and 23.7% (n = 3,471) of all HCWs (n = 14,651) worked in response to COVID-19. HCWs participating in COVID-19-related works comprised 50.6% (n = 1,203) of doctors (n = 2,379), 26.3% (n = 1,571) of nurses (n = 5,982), and 11.4% (n = 697) of other HCWs (n = 6,108). Only 0.3% (n = 51) of HCWs (n = 14,651) developed COVID-19 infections from community-acquired (66.7%) or hospital-acquired (29.4%). Nurses were affected predominantly (33.3%), followed by doctors (9.8%), caregivers (7.8%), radiographers (5.9%), and others (45.1%), including nurse aides and administrative, facility maintenance, telephone appointment centers, and convenience store staff. All HCWs infected with COVID-19 recovered completely. The 32.7% (n = 333) of individuals (n = 1,018) exposed to HCWs who had COVID-19 were quarantined, and only one case of secondary transmission among them occurred. Conclusion The COVID-19 pandemic has necessitated significant staffing and facility usage, which is disproportionate to the relatively low number of COVID-19 inpatients, imposing a substantial burden on healthcare resources. Therefore, beyond the current reimbursement level of the Korean National Health Insurance, a new type of rewarding system is needed to prepare hospitals for the emerging outbreaks of infectious diseases. Keeping HCWs safe from COVID-19 is crucial for maintaining the healthcare workforce during a sudden massive outbreak. Further studies are needed to determine the standards of required HCWs through detailed research on the working hours and intensity of HCWs responding to COVID-19.

증례 : 감염; 쯔쯔가무시병에 동반된 면역성 혈소판 감소증 1예

김현아 ( Hyun Ah Kim ),이지연 ( Ji Yeon Lee ),현미리 ( Miri Hyun ),류성열 ( Seong Yeol Ryu ) 대한내과학회 2014 대한내과학회지 Vol.86 No.3

Thrombocytopenia is a common manifestation of rickettsial disease. However, the pathogenesis of thrombocytopenia in many rickettsial diseases is poorly understood. Thrombocytopenia may be associated with consumption due to widespread endothelial damage or disseminated intravascular coagulation, hypersplenism, decreased marrow production, and immune-mediated platelet destruction. Some reports have found anti-platelet antibodies detected in thrombocytopenic patients with rickettsial disease. addition to thrombocytopenia, facial palsy and Guillain-Barre syndrome were also reported as immune-mediated phenomena scrub typhus. Here we report a case diagnosed as immune-mediated thrombocytopenia associated with scrub typhus. This is the first report of immune thrombocytopenic purpura (ITP) associated with scrub typhus in Korea. The patient exhibited eschar with a high titer of anti-tsutsugamushi antibody, thrombocytopenia, severe gastrointestinal hemorrhage, and purpura on the lower region both legs. After steroid treatment, the sustained thrombocytopenia recovered.

Taurine Alleviates the Progression of Diabetic Nephropathy in Type 2 Diabetic Rat Model

Koh, Jang Hyun,Lee, Eun Soo,Hyun, Miri,Kim, Hong Min,Choi, Yoon Jung,Lee, Eun Young,Yadav, Dhananjay,Chung, Choon Hee Hindawi Publishing Corporation 2014 International Journal of endocrinology Vol.2014 No.-

<P>The overexpression of vascular endothelial growth factor (VEGF) is known to be involved in the pathogenesis of diabetic nephropathy. In this study, the protective effects of taurine on diabetic nephropathy along with its underlying mechanism were investigated. Experimental animals were divided into three groups: LETO rats as normal group (<I>n</I> = 10), OLETF rats as diabetic control group (<I>n</I> = 10), and OLETF rats treated with taurine group (<I>n</I> = 10). We treated taurine (200 mg/kg/day) for 20 weeks and treated high glucose (HG, 30 mM) with or without taurine (30 mM) in mouse cultured podocyte. After taurine treatment, blood glucose level was decreased and insulin secretion was increased. Taurine significantly reduced albuminuria and ACR. Also it decreased glomerular volume, GBM thickness and increased open slit pore density through decreased VEGF and increased nephrin mRNA expressions in renal cortex. The antioxidant effects of taurine were confirmed by the reduction of urine MDA in taurine treated diabetic group. Also reactive oxygen species (ROS) levels were decreased in HG condition with taurine treated podocytes compared to without taurine. These results indicate that taurine lowers glucose level via increased insulin secretion and ameliorates the progression of diabetic nephropathy through antifibrotic and antioxidant effects in type 2 diabetes rat model.</P>

노인에서 코로나19 감염 중증도와 관련된 요인

Seung Wan Hong,Ji yeon Lee,Miri Hyun,Jae Seok Park,Jae Hyuck Lee,Young Sung Suh,Hyun ah Kim,Dae Hyun Kim 대한임상노인의학회 2021 대한임상노인의학회지 Vol.22 No.1

Background: The coronavirus disease 2019 (COVID-19) has been rapidly spreading globally since its outbreak in December 2019 at Wuhan, Hubei Province, China. The mortality rate of the older population with COVID-19 is particularly high. Therefore, investigating risk factors related to severe outcomes in older COVID-19 patients is important for effective management of the disease. This study aimed to assess the epidemiological and medical factors in older patients to investigate the risk factors related to the severe outcomes of COVID-19. Methods: We collected clinical and demographic data and assessed the laboratory parameters, radiologic findings, symptoms, and outcomes of older patients with COVID-19. Among the 248 older patients with COVID-19, of whom 99 had severe COVID-19. Results: The mortality rate was 6.5%. Older and male patients have more severe COVID-19 outcomes. White blood cell counts and creatine phosphokinase, C-reactive protein, procalcitonin, aspartate transaminase, lactate dehydrogenase, and creatinine levels were higher in the severe outcome group. Age, sex, chest X-ray findings, neutrophil count, C-reactive protein level, lactate dehydrogenase level, and albumin level, total number of symptoms, within-family exposure history, and in-hospital exposure history were associated with severe outcomes in the logistic regression model. Conclusions: Age, C-reactive protein and lactate dehydrogenase levels, and the total number of symptoms were important risk factors among older patients with COVID-19. Therefore, older patients with these factors require more careful attention and medical care.

The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019

Kim In-Cheol,Song Jin Eun,Lee Hee Jung,Park Jeong-Ho,Hyun Miri,Lee Ji Yeon,Kim Hyun Ah,Kwon Yong Shik,Park Jae Seok,윤종찬,Hwang Jongmin,Lee Cheol Hyun,Cho Yun-Kyeong,Park Hyoung-Seob,Yoon Hyuck-Jun,Nam 대한의학회 2020 Journal of Korean medical science Vol.35 No.39

Backgrounds: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. Methods: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. Results: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). Conclusion: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.

Clinical Characteristics and Risk Factors for Mortality in Critical Coronavirus Disease 2019 Patients 50 Years of Age or Younger During the Delta Wave: Comparison With Patients > 50 Years in Korea

Shi Hye Jin,Nham Eliel,Kim Bomi,Joo Eun-Jeong,Cheong Hae Suk,Hong Shin Hee,Hyun Miri,Kim Hyun ah,Jang Sukbin,Rhee Ji-Young,Kim Jungok,Kim Sungmin,Cho Hyun Kyu,Wi Yu Mi,Cheon Shinhye,Kim Yeon-Sook,Lim 대한의학회 2022 Journal of Korean medical science Vol.37 No.22

Background: Numerous patients around the globe are dying from coronavirus disease 2019 (COVID-19). While age is a known risk factor, risk analysis in the young generation is lacking. The present study aimed to evaluate the clinical features and mortality risk factors in younger patients (≤ 50 years) with a critical case of COVID-19 in comparison with those among older patients (> 50 years) in Korea. Methods: We analyzed the data of adult patients only in critical condition (requiring high flow nasal cannula oxygen therapy or higher respiratory support) hospitalized with PCR confirmed COVID-19 at 11 hospitals in Korea from July 1, 2021 to November 30, 2021 when the delta variant was a dominant strain. Patients’ electronic medical records were reviewed to identify clinical characteristics. Results: During the study period, 448 patients were enrolled. One hundred and forty-two were aged 50 years or younger (the younger group), while 306 were above 50 years of age (the older group). The most common pre-existing conditions in the younger group were diabetes mellitus and hypertension, and 69.7% of the patients had a body mass index (BMI) > 25 kg/m2 . Of 142 younger patients, 31 of 142 patients (21.8%, 19 women) did not have these pre-existing conditions. The overall case fatality rate among severity cases was 21.0%, and it differed according to age: 5.6% (n = 8/142) in the younger group, 28.1% in the older group, and 38% in the ≥ 65 years group. Age (odds ratio [OR], 7.902; 95% confidence interval [CI], 2.754–18.181), mechanical ventilation therapy (OR, 17.233; 95% CI, 8.439–35.192), highest creatinine > 1.5 mg/dL (OR, 17.631; 95% CI, 8.321–37.357), and combined blood stream infection (OR, 7.092; 95% CI, 1.061–18.181) were identified as independent predictors of mortality in total patients. Similar patterns were observed in age-specific analyses, but most results were statistically insignificant in multivariate analysis due to the low number of deaths in the younger group. The full vaccination rate was very low among study population (13.6%), and only three patients were fully vaccinated, with none of the patients who died having been fully vaccinated in the younger group. Seven of eight patients who died had a pre-existing condition or were obese (BMI > 25 kg/m2 ), and the one remaining patient died from a secondary infection. Conclusion: About 22% of the patients in the young critical group did not have an underlying disease or obesity, but the rate of obesity (BMI > 25 kg/m2 ) was high, with a fatality rate of 5.6%. The full vaccination rate was extremely low compared to the general population of the same age group, showing that non-vaccination has a grave impact on the progression of COVID-19 to a critical condition. The findings of this study highlight the need for measures to prevent critical progression of COVID-19, such as vaccinations and targeting young adults especially having risk factors.

Onychopapilloma: A Report of Three Cases Presenting with Various Longitudinal Chromonychia

( Miri Kim ),( Eun Young Sun ),( Haw Young Jung ),( Baik Kee Cho ),( Hyun Jeong Park ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.5

P028 : Recombinant erythroid differentiation regulator 1 (erdr1) inhibits both inflammation and angiogenesis in a mouse model of rosacea

( Miri Kim ),( Kyung Eun Kim ),( Haw Young Jung ),( Baik Kee Cho ),( Dae Ho Cho ),( Hyun Jeong Park ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.2

Background: Rosacea is a chronic inflammatory skin disease characterized by erythema of the central face. Erythroid differentiation regulator 1 (Erdr1) is an anti-metastatic factor and negatively regulated by IL-18. IL-18 is a well-known proinflammatory cytokine and functions as an angiogenic mediator in inflammation. To our knowledge, this is the first report on an association between Erdr1 and an inflammatory skin disease. Objectives: To investigate the expression of Erdr1 in rosacea and the effect of rErdr1 on rosacea-like skin lesions induced by LL-37 in mouse. Methods: An immunohistochemical staining of Erdr1 was performed in 5 normal subjects and 11 rosacea patients to compare the expression level of Erdr1 between rosacea and the normal skin. To determine the influence of Erdr1 on rosacea, a rosacea-like BALB/c mouse model induced by LL-37 was used. Balb/c mice were intradermally injected with cathelicidin peptide LL-37 (40 μl, 320 μM) four times every 12 hours. Immunohistochemical analysis was performed for CD4, CD8, CD34 and vascular endothelial growth factor (VEGF). Results: We found that epidermal Erdr1 expression was significantly lower in rosacea patients than in normal controls. LL-37 injection induced typical rosacea features, including erythema, telangiectasia, and inflammation. The treatment with rErdr1 resulted in a significant reduction of erythema, inflammatory cell infiltration, including CD4+ and CD8+ T cells and microvessel density with VEGF. Conclusion: These results suggest that rErdr1 has the potential for the treatment of rosacea.