Preserved Efficacy of Oral Metronidazole for Severe Clostridium difficile Infection

Shi Nae Yu,Eun Jung Lee 순천향대학교 순천향의학연구소 2018 Journal of Soonchunhyang Medical Science Vol.24 No.1

Objective: Although clinical practice guidelines recommend oral vancomycin for hospitalized patients with severe Clostridium difficile infection (CDI), oral metronidazole is still the preferred regimen due to its tolerability and low cost. In this study, we aimed to compare the clinical efficacy based on clinical cure, recurrence, and 30-day mortality of oral metronidazole and oral vancomycin in treating severe CDI. Methods: The medical records of patients with the diagnosis of severe CDI in a tertiary hospital in South Korea, between June, 2006 and December, 2013, were analyzed. Results: A total of 162 severe CDI patients were enrolled for this study: 139 received oral metronidazole and 23 received oral vancomycin. The rate of clinical cure was not significantly different between treatments (79.86% for oral metronidazole and 82.61% for oral vancomycin, P>0.99). The rate of recurrence was comparable (20.77% vs. 18.18% for metronidazole and vancomycin, respectively; P>0.99), as was the rate of 30-day mortality (9.35% vs. 4.35%, P=0.69). Risk factors for treatment failure were histamine-2 antagonist treatment (odds ratio [OR], 4.34; 95% confidence interval [CI], 1.64–11.51; P=0.0032) and fever (OR, 2.43; 95% CI, 1.0–5.8; P=0.049). Conclusion: The clinical efficacy of oral metronidazole for severe CDI was no difference from oral vancomycin, in a real world setting. Oral metronidazole can be a reasonable option for treating severe CDI.

Diagnostic Usefulness of IFN-Gamma Releasing Assays Compared With Conventional Tests in Patients With Disseminated Tuberculosis

Yu, Shi Nae,Jung, Jiwon,Kim, Yong-Kyun,Lee, Ju Young,Kim, Sun-Mi,Park, Su Jin,Lee, Sang-Oh,Choi, Sang-Ho,Kim, Yang Soo,Woo, Jun Hee,Kim, Sung-Han Williams & Wilkins Co 2015 Medicine Vol.94 No.28

<P><B>Abstract</B></P><P>IFN-gamma releasing assays (IGRAs) such as T-SPOT.<I>TB</I> assay and QuantiFERON-TB In-Tube (QFT-GIT) have yielded promising results for the diagnosis of tuberculosis (TB). However, little is known about the usefulness of these assays for diagnosing disseminated TB. We therefore compared their usefulness with traditional tests in patients with disseminated TB. All adult patients with suspected disseminated TB were prospectively enrolled at a tertiary hospital in an intermediate TB-burden country during a 6-year period. Disseminated TB was defined as involvement of the bone marrow or ≥2 noncontiguous organs, or presence of miliary lung lesions. A total of 101 patients with confirmed and probable disseminated TB were finally analyzed. Of these 101 patients, 52 (52%) had miliary TB and the remaining 49 (48%) had nonmiliary disseminated TB. In addition, 63 (62%) had no underlying disease. Chronic granuloma with/without necrosis, acid-fast bacillus staining, <I>Mycobacterium tuberculosis</I> PCR, and culture for <I>M tuberculosis</I> were positive in 77% (41/53), 43% (43/101), 70% (67/96), and 72% (73/101), of the patients, respectively. The T-SPOT.<I>TB</I> assay was positive in 90% (91/101) of them. The sensitivity of the T-SPOT.<I>TB</I> assay in patients with miliary TB (90%) was similar to that in patients with nonmiliary TB (90%) (<I>P</I> > 0.99). In a subgroup analysis of the 58 patients in whom both QFT-GIT and the T-SPOT.<I>TB</I> results were available, the sensitivity of QFT-GIT (67%) was lower than that of T-SPOT.<I>TB</I> (95%) (<I>P</I> < 0.001).</P><P>In conclusion, T-SPOT.TB assay may be a helpful adjunct test for disseminated TB.</P>

Incidence and Risk Factors of Ocular Infection Caused by <i>Staphylococcus aureus</i> Bacteremia

Jung, Jiwon,Lee, Junyeop,Yu, Shi Nae,Kim, Yong Kyun,Lee, Ju Young,Sung, Heungsup,Kim, Mi-Na,Kim, Sung-Han,Lee, Sang-Oh,Choi, Sang-Ho,Woo, Jun Hee,Lee, Joo Yong,Kim, Yang Soo,Chong, Yong Pil American Society for Microbiology 2016 Antimicrobial Agents and Chemotherapy Vol.60 No.4

<P>Staphylococcus aureus bacteremia (SAB) often leads to ocular infections, including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcomes of ocular infections complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infections as endophthalmitis or chorioretinitis. During the 5-year study period, 1,109 patients had SAB, and data for 612 (55%) who underwent ophthalmic examinations within 14 days after SAB onset were analyzed. Of those 612 patients, 56 (9% [95% confidence interval [CI], 7 to 12%]) had ocular involvement, including 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In a multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74 [95% CI, 2.25 to 14.64]) and metastatic infection (aOR, 2.38 [95% CI, 1.29 to 4.39]) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbances. Two-thirds of the patients with endophthalmitis (10/15 patients) were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all of the patients with chorioretinitis were treated only with systemic antibiotics. No patients became blind. Among 42 patients for whom follow-up assessments were available, the ocular lesions improved in 29 (69%) but remained the same in the others. Ocular involvement was independently associated with death within 30 days after SAB onset. Ocular involvement is not uncommon among patients with SAB. Routine ophthalmic examinations should be considered for patients with infective endocarditis or metastatic infections caused by SAB.</P>

Multisystem Inflammatory Syndrome in an Adult after COVID-19 Vaccination: a Case Report and Literature Review

Park Jung Wan,Yu Shi Nae,Chang Sung Hae,Ahn Young Hyeon,Jeon Min Hyok 대한의학회 2021 Journal of Korean medical science Vol.36 No.45

As the number of people vaccinated increases, people who complain of adverse reactions continue to occur. We experienced a case characterized by low blood pressure, persistent fever, edema due to increased systemic vascular permeability, and systemic inflammation confirmed by image and laboratory examinations after ChAdOx1 coronavirus disease 2019 (COVID-19) vaccination. The diagnostic criteria for multisystem inflammatory syndrome (MIS) in adults are known as fever of 3 days or more in adults, 2 or more mucocutaneous/ gastrointestinal/neurologic symptoms, elevation of inflammatory markers, and clinical/ imaging diagnosis of heart failure. A 67-year-old man who was medicated for hypertension and diabetes was admitted complaining of fever, maculopapular rash, diarrhea, headache, chills, and dizziness 6 days after the first vaccination of ChAdOx1 nCoV-19 in Korea. The COVID-19 test was negative but with low blood pressure, leukocytosis, skin rash, pulmonary edema, and increased inflammation markers. His lab findings and clinical course were consistent with those of MIS after COVID-19 vaccination. He was medicated with methylprednisolone 1 mg/kg and diuretics and recovered rapidly. He was discharged after 2 weeks and confirmed cure at outpatient clinic. We report an MIS case after COVID-19 vaccination in Korea.

Case of Staphylococcus schleiferi Vascular Access Infections with a Hemodialysis Patient

Joon Won Chae,Shi Nae Yu,Eun Jung Lee 순천향대학교 순천향의학연구소 2018 Journal of Soonchunhyang Medical Science Vol.24 No.1

Staphylococcus schleiferi has been infrequently reported as a human pathogen. We experienced the case of vascular access infection by Staphylococcus schleiferi in a 65-year-old hemodialysis patient. Metastatic infection occurred despite the removal of infected focus and appropriate antibiotic therapy. This case highlights the importance of considering Staphylococcus schleiferi as a true pathogen in vascular access infection with hemodialysis patients.

S-647 Does size matter in therapeutic outcome of tuberculous lymphadenitis?

( Yun Jae Seol ),( Se Yoon Park ),( Shi Nae Yu ),( Tark Kim ),( Eun Jung Lee ),( Min Huok Jeon ),( Eun Ju Choo ),( Tae Hyong Kim ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Introduction:?There was little data on how lymph node (LN) size is changed during treatment in tuberculous lymphadenopathy (TB LAP). This study aims to provide data on LN changing during treatment.?Methods:?Between Mar 2014 and Dec 2015, 20 patients who were diagnosed with cervical TB LAP were enrolled at the Soonchunhyang University Bucheon Hospital, Bucheon, South Korea. The size of LN was determined by multiplying longest length and breadth. Treatment completion was defined as administration of anti-TB regimens at least 6 months without interruption.?Results:?Of enrolled patients, LN size of eight (40%) patients was 9 cm2 or more. In a half (8/4) of these patients, LN size was increased within 2 month during treatment and 75% (3/4) of patients received LN excision. In 12 patients with LN size less than 9 cm2, only one patient experienced increased LN size during treatment and no one received LN excision. LN was more frequently increased within 2 month (50%, 4/8 vs. 8.3%, 1/12; p=0.04) and excised in patients with initial LN size ≥ 9 cm2 (50%, 4/8 vs. 0%, 0/12; p=0.01).?Conclusions:?In conclusion, initial LN size may be associated with paradoxical response and need of excision during treatment.

증례 : 혈액종양; 비호지킨림프종 환자에서 자가조혈모세포이식 후 발생한 자가면역질환

이민영 ( Min Young Lee ),유시내 ( Shi Nae Yu ),김경하 ( Kyoung Ha Kim ),이상철 ( Sang Cheol Lee ),이남수 ( Nam Su Lee ),박희숙 ( Hee Sook Park ),원종호 ( Jong Ho Won ) 대한내과학회 2013 대한내과학회지 Vol.85 No.4

자가조혈모세포이식은 재발성 또는 고위험군의 비호지킨 림프종 환자에게 효과적인 치료방법이지만 기본적으로 면역 체계를 방해한다. 이에 따라 지난 수년간 자가조혈모세포이식 후의 자가면역체계에 대한 관찰이 이루어졌고 다양한 질환에서 자가조혈모세포이식 후에 새롭게 발생한 자가면역질환 환자들의 하나 혹은 여러 개의 사례가 보고되었다. 저자들은 비호지킨림프종으로 진단받아 고용량 항암화학치료와 자가조혈모세포이식을 받은 54명의 환자들 중에서 자가면역질환이 나타났던 3명의 환자에 대해 보고하는 바이다. Autologous hematopoietic stem cell transplantation (HSCT) is an effective treatment for patients with relapsed or high-risk Non-Hodgkin`s lymphoma (NHL). HSCT fundamentally interferes with the immune system. As a consequence, development of autoimmunity after HSCT has been observed during the past several decades. Most evidence is derived from single case reports or studies on small series of patients who developed novel-onset autoimmune diseases after use of HSCT to treat various conditions. We treated 3 NHL patients with autoimmune disease among 54 NHL patients who received high-dose chemotherapy and autologous HSCT. (Korean J Med 2013;85:430-434)

Right Common Iliac Artery Occlusion in a Patient with Severe COVID-19

Park Jung Wan,Lyu Jiwon,Ji Tae Hyun,Yu Shi Nae,Jeon Min Hyok 대한감염학회 2023 Infection and Chemotherapy Vol.55 No.2

In patients with coronavirus disease 2019 (COVID-19), thromboembolism is a frequently reported complication. However, it is reported that the incidence of arterial occlusion is rare. We experienced a case of 70-year-old male patient who developed a complication of Right common iliac arterial occlusion while treating him for confirmed COVID-19 who did not have any risk factors, such as diabetes or smoking. As in our case, it is necessary to carefully observe whether this complication occurs while treating COVID-19 patients.

Etiology, Characteristics, and Outcomes of Community-Onset Pyomyositis in Korea: A Multicenter Study

김탁,Park Seong Yeon,Kwak Yee Gyung,정지원,Kim Min-Chul,최성호,Yu Shi Nae,Hong Hyo-Lim,Kim Yong Kyun,Park Se Yoon,Song Eun Hee,Park Ki-Ho,조오현,Choi Sang-Ho,The Korean SSTI Study Group 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.1

Background: Pyomyositis (PM) is a serious soft tissue infection and despite its clinical importance, previous studies have not been able to fully determine the clinical characteristics and microbial epidemiology of PM in Korea, which we therefore aimed to investigate. Materials and Methods: We retrospectively identified 140 adult patients diagnosed with PM from 13 general hospitals between January 2012 and December 2015. We analyzed the clinical and microbial characteristics of community-onset PM and compared them with communityacquired (CA) and healthcare-associated (HCA) PM. Results: One hundred eleven organisms were isolated from 96 (68.6%) patients with PM. Staphylococcus aureus (38 patients) was the most common pathogen, followed by streptococci (24 patients), and enteric Gram-negative organisms (27 patients). Methicillin-resistant S. aureus (MRSA) was identified in four (2.9%) patients and in-hospital mortality reached 8.6% (12/140). Enterococci isolates were identified in the HCA PM subgroup only The proportion of MRSA isolates was not comparable between CA and HCA PM subgroups. In the 83 patients with PM infected by monomicrobial pathogens, isolates of Gram-negative organisms were more commonly found in HCA PM subgroup than in CA PM subgroup (47.6% [10/21] of patients with HCA PM vs. 20.7% [12/58] of patients with CA PM; P = 0.01). Conclusion: Gram-positive cocci such as S. aureus and streptococci were dominant etiologies in community-onset PM, whereas MRSA appears to an uncommon causative organism of PM in Korea. Enteric Gram-negative organisms should also be considered as major etiologies, especially in HCA PM patient population in Korea.

Characteristics of Device-Associated Cerebrospinal Fluid Infection in Adults

So My Koo,Eun Jung Lee,Se Yoon Park,Shi Nae Yu,Min Young Lee,Tae Hyong Kim,Eun Ju Choo,Min Huok Jeon 순천향대학교 순천향의학연구소 2013 Journal of Soonchunhyang Medical Science Vol.19 No.2

Objective: Device-associated infections in the central nervous system are serious complications of procedures involving indwelling devices among neurosurgical patients. In this study, the clinical characteristics and outcome of microbiologically confirmed deviceassociated cerebrospinal fluid (CSF) infection were evaluated. Methods: We performed a retrospective analysis of adult patients found to have a positive CSF culture result during a hospital admission between 1 January 2005 through 2 October 2010 in Soonchunhyang University Hospital. Results: During the study period, all episodes (n=161 CSF specimens, 87 patients) involving a culture-positive CSF were enrolled. Thirty-two episodes of device-associated CSF infection were included in the analysis among the study group. Most device-associated infections were ventriculo-peritoneal shunt infections (14/32, 44%). Fever (>38°C) was present in 17 episodes (53%). Overall, the most common microorganism was coagulase-negative staphylococcus (7/32 [22%]). Gram-negative rods (Pseudomonas aeruginosa 6/32 [19%], Acinetobacter baumannii/haemolyticus 5/32 [16%]) were identified in culture in 16/32 (50%). Device was removed for the control of device-associated infection in 30/32 (94%). Cure rate was 69% (22/32). All patients with treatment failure (10/32, 34%) expired. Conclusion: It is difficult to diagnosis device-associated CSF infections early since those are frequently presented with nonspecific clinical signs and symptoms. In our study, gram-negative infections accounted for 50% of cases and the empiric antibiotics initially chosen were found to not be effective against the final identified pathogen in many cases. Device-associated CSF infections should be strongly considered a serious risk factor associated with CSF infections, and prompt initiation of broad coverage antibiotics should be started after appropriate assessment.