Antimicrobial Susceptibility Trends and Risk Factors for Antimicrobial Resistance in Pseudomonas aeruginosa Bacteremia: 12-Year Experience in a Tertiary Hospital in Korea

Kang Jin Suk,Moon Chisook,문석준,Lee Jeong Eun,Lee Soon Ok,Lee Shinwon,Lee Sun Hee 대한의학회 2021 Journal of Korean medical science Vol.36 No.43

Background: Infections caused by multidrug-resistant Pseudomonas aeruginosa (MDRPA) have been on the rise worldwide, and delayed active antimicrobial therapy is associated with high mortality. However, few studies have evaluated increases in P. aeruginosa infections with antimicrobial resistance and risk factors for such antimicrobial resistance in Korea. Here, we analyzed changes in antimicrobial susceptibility associated with P. aeruginosa bacteremia and identified risk factors of antimicrobial resistance. Methods: The medical records of patients with P. aeruginosa bacteremia who were admitted to a tertiary hospital between January 2009 and October 2020 were retrospectively reviewed. Antibiotic resistance rates were compared among the time periods of 2009–2012, 2013–2016, and 2017–2020 and between the intensive care unit (ICU) and non-ICU setting. Empirical antimicrobial therapy was considered concordant, if the organism was susceptible to antibiotics in vitro, and discordant, if resistant. Results: During the study period, 295 patients with P. aeruginosa bacteremia were identified. The hepatobiliary tract (26.8%) was the most common primary site of infection. The rates of carbapenem-resistant P. aeruginosa (CRPA), MDRPA, and extensively drug-resistant P. aeruginosa (XDRPA) were 24.7%, 35.9%, and 15.9%, respectively. XDRPA showed an increasing trend, and CRPA, MDRPA, and XDRPA were also gradually increasing in non-ICU setting. Previous exposure to fluoroquinolones and glycopeptides and urinary tract infection were independent risk factors associated with CRPA, MDRPA, and XDRPA. Previous exposure to carbapenems was an independent risk factor of CRPA. CRPA, MDRPA, and XDRPA were associated with discordant empirical antimicrobial therapy. Conclusion: The identification of risk factors for antimicrobial resistance and analysis of antimicrobial susceptibility might be important for concordant empirical antimicrobial therapy in patients with P. aeruginosa bacteremia.

Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults

Yoon Young Kyung,Moon Chisook,Kim Jieun,Heo Sang Taek,이미숙,Lee Shinwon,Kwon Ki-Tae,Kim Shin-Woo 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.4

The guidelines are intended to provide practical information for the correct use of antibiotics for intra-abdominal infections in Korea. With the aim of realizing evidence-based treatment, these guidelines for the use of antibiotics were written to help clinicians find answers to key clinical questions that arise in the course of patient care, using the latest research results based on systematic literature review. The guidelines were prepared in consideration of the data on the causative pathogens of intra-abdominal infections in Korea, the antibiotic susceptibility of the causative pathogens, and the antibiotics available in Korea.

S-617 Painless rupture of mycotic aneurysm in a patient with Klebsiella pneumoniae bacteremia

( Hyo Jin Kim ),( Jeong Hun Song ),( Sung Hyun Kim ),( Yu-mi Lee ),( Chisook Moon ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Mycotic aneurysm is a serious clinical condition associated with significant morbidity and mortality. The etiology of mycotic aneurysm development has commonly been Staphylococcus aureus and Salmonella species, but has infrequently been associated with Klebsiella pneumonia. We report a painless rupture of mycotic aneurysm in a diabetic patient related to K. pneumonia bacteremia. A 71-year-old man was admitted to a hospital because of a 3-day history of fever. The patient had no meaningful symptoms and signs. He complained of chronic stiffness on both hip joints, but the degree of discomfort had not become worse than before. His past medical history included type 2 diabetes mellitus, hypertension, chronic kidney disease (GFR, 24.4 mL/min/1.73 m2) and osteoarthritis of both hip joints. The blood culture yielded K. pneumoniae, but the primary focus was not identified. Chest X-ray, and abdominal ultrasonography did not reveal any abnormal inflammatory lesion. Despite antibiotic therapy (intravenous 2g of ceftriaxone) for 5 days, the patient was still febrile. To find infectious focus, we conducted the enhanced CT of abdomen and pelvis with the consent of the patient. Enhanced CT revealed the mycotic aneurysm at the right common iliac artery with intramural hematoma and extravasation of contrast media into arterial wall. A transthoracic echocardiogram did not reveal any evidence of infective endocarditis. Uni-iliac endovascular aneurysm repair (EVAR) with femoro-femoral artery bypass was immediately performed. Day 3 after surgery, the patient had no fever and laborato￢ry data showed an improvement. Enhanced CT performed on day 7 after surgery revealed no serious complica￢tions. Clinicians should maintain a high index of suspicion for vascular complication in evaluating patients with primary K. pneumoniae bacteremia refractory to antibiotics. Delays in diagnosis and treatment might lead to fulminant process.

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

Yoon Young Kyung,Kwon Ki Tae,Jeong Su Jin,Moon Chisook,Kim Bongyoung,Kiem Sungmin,Kim Hyung-sook,Heo Eunjeong,Kim Shin-Woo 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.3

These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.

Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals

Cheong Hae Suk,Park Kyung-Hwa,Kim Hong Bin,김신우,Kim Bongyoung,Moon Chisook,이미숙,Yoon Young Kyung,Jeong Su Jin,Kim Yong Chan,Eun Byung Wook,Lee Hyukmin,Shin Ji-Yeon,Kim Hyung-Sook,Hwang In Sun,Park Choon 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.4

Currently, antimicrobial resistance (AMR) is a major threat to global public health. The antimicrobial stewardship program (ASP) has been proposed as an important approach to overcome this crisis. ASP supports the optimal use of antimicrobials, including appropriate dosing decisions, administration duration, and administration routes. In Korea, efforts are being made to overcome AMR using ASPs as a national policy. The current study aimed to develop core elements of ASP that could be introduced in domestic medical facilities. A Delphi survey was conducted twice to select the core elements through expert consensus. The core elements for implementing the ASP included (1) leadership commitment, (2) operating system, (3) action, (4) tracking, (5) reporting, and (6) education. To ensure these core elements are present at medical facilities, multiple departments must collaborate as teams for ASP operations. Establishing a reimbursement system and a workforce for ASPs are prerequisites for implementing ASPs. To ensure that ASP core elements are actively implemented in medical facilities, it is necessary to provide financial support for ASPs in medical facilities, nurture the healthcare workforce in performing ASPs, apply the core elements to healthcare accreditation, and provide incentives to medical facilities by quality evaluation criteria.

The clinical and economic burden of communityonset complicated skin and skin structure infections in Korea

Yong Kyun Cho,Heung Jeong Woo,Shin-Woo Kim,In-Gyu Bae,Young Goo Song,Hee Jin Cheong,Hyuck Lee,Sang Hoon Han,Hee Jung Choi,Chisook Moon,Seong Yeol Ryu,Jian Hur,Jacob Lee,Yu Mi Jo,Young Joo Kim 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.6

Background/Aims: To investigate epidemiologic characteristics, clinical and economic burdens, and factors associated with mortality in complicated skin and skin structure infection (cSSSI) patients in Korea. Methods: A retrospective, observational, nationwide study was conducted between April to July 2012 at 14 tertiary-hospitals in Korea. Eligible patients were hospitalized adults with community acquired cSSSI, who underwent surgical intervention and completed treatment between November 2009 and October 2011. Data on demography, clinical characteristics, outcomes and medical resource utilization were collected through medical record review. Direct medical costs were calculated by multiplying quantities of resources utilized by each unit price in Korea. Results: Of 473 patients enrolled, 449 patients (except 24 patients with no record on surgical intervention) were eligible for analysis. Microbiological testing was performed on 66.1% of patients and 8.2% had multiple pathogens. Among culture confirmed pathogens (n = 297 patients, 340 episodes), 76.2% were gram-positive (Staphylococcus aureus; 41.2%) and 23.8% were gram-negative. The median duration of hospital stay was 16 days. Among treated patients, 3.3% experienced recurrence and 4.2% died in-hospital. The mean direct medical costs amounted to $4,195/ person, with the greatest expenses for hospitalization and antibiotics. The in-hospital mortality and total medical costs were higher in combined antibiotics therapy than monotherapy (p < 0.05). Charlson’s comorbidity index ≥ 3, standardized early warning scoring ≥ 4, sub-fascia infections and combined initial therapy, were all found to be associated with higher mortality. Conclusions: Korean patients with community-onset cSSSI suffer from considerable clinical and economic burden. Efforts should be made to reduce this burden through appropriate initial treatment.

Developing Core Elements and Checklist Items for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals: A Modified Delphi Survey

Cheong Hae Suk,Park Kyung-Hwa,Kim Bongyoung,Eun Byung Wook,Kim Hyung-Sook,Kim Yong Chan,Lee Hyukmin,Jeong Su Jin,Moon Chisook,Kim Shin-Woo,Yoon Young Kyung,Hwang In Sun,Park Choon-Seon,Lee Mi Suk,Kim 대한감염학회 2023 Infection and Chemotherapy Vol.55 No.1

Background: Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use by minimizing the spread of antimicrobial resistance. The core elements for implementing ASPs in healthcare facilities have been developed by the World Health Organization, international research group and government agencies of various countries. However, to date, there is no documented core elements for implementation of ASP in Korea. This survey aimed to establish a national consensus on a set of core elements and their related checklist items for the implementation of ASPs in Korean general hospitals. Materials and Methods: The survey was conducted from July 2022 to August 2022 by the Korean Society for Antimicrobial Therapy with support from the Korea Disease Control and Prevention Agency. A literature review was conducted by searching Medline and relevant websites to retrieve a list of core elements and checklist items. These core elements and checklist items were evaluated by a multidisciplinary panel of experts using a structured modified Delphi consensus procedure, using two-step survey included online in-depth questionnaires and in-person meeting. Results: The literature review identified 6 core elements (Leadership commitment, Operating system, Action, Tracking, Reporting, and Education) and 37 related checklist items. Fifteen experts participated in the consensus procedures. Ultimately, all 6 core elements were retained, and 28 checklist items were proposed, all with ≥80% agreement; in addition 9 items were merged into 2 items, 2 items were deleted, and 15 items were rephrased. Conclusion: This Delphi survey provides useful indicators for the implementation of ASP in Korea and suggests national policy improvement about the barriers (e.g., shortage of staffing and financial support) existing in Korea for optimal implementation of ASPs.

Prevention of Cytomegalovirus Infection in Solid Organ Transplant Recipients: Guidelines by the Korean Society of Infectious Diseases and the Korean Society for Transplantation

Huh Kyungmin,Lee Sang-Oh,Kim Jungok,Lee Su Jin,Choe Pyoeng Gyun,Kang Ji-Man,Yang Jaeseok,Sung Heungsup,Kim Si-Ho,Moon Chisook,Seok Hyeri,Shi Hye Jin,Wi Yu Mi,Jeong Su Jin,Park Wan Beom,Kim Youn Jeong 대한감염학회 2024 Infection and Chemotherapy Vol.56 No.1

Cytomegalovirus (CMV) is the most important opportunistic viral pathogen in solid organ transplant (SOT) recipients. The Korean guideline for the prevention of CMV infection in SOT recipients was developed jointly by the Korean Society for Infectious Diseases and the Korean Society of Transplantation. CMV serostatus of both donors and recipients should be screened before transplantation to best assess the risk of CMV infection after SOT. Seronegative recipients receiving organs from seropositive donors face the highest risk, followed by seropositive recipients. Either antiviral prophylaxis or preemptive therapy can be used to prevent CMV infection. While both strategies have been demonstrated to prevent CMV infection post-transplant, each has its own advantages and disadvantages. CMV serostatus, transplant organ, other risk factors, and practical issues should be considered for the selection of preventive measures. There is no universal viral load threshold to guide treatment in preemptive therapy. Each institution should define and validate its own threshold. Valganciclovir is the favored agent for both prophylaxis and preemptive therapy. The evaluation of CMV-specific cell-mediated immunity and the monitoring of viral load kinetics are gaining interest, but there was insufficient evidence to issue recommendations. Specific considerations on pediatric transplant recipients are included.