Core Elements for Successful Implementation of Antimicrobial Stewardship Programs

Hwang Soyoon,Kwon Ki Tae 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.3

Antimicrobial resistance has emerged as a serious global public health threat. One of the countermeasures to increased antibiotic-resistant bacterial infections is the use of an integrative intervention strategy for the selection and administration of appropriate antibiotics and for the monitoring of antibiotic use, collectively known as “Antimicrobial Stewardship Programs” (ASPs). However, since the medical environment and policies vary by country and medical facilities, ASPs also need to be applied to each facility and condition accordingly. The United States Centers for Disease Control and Prevention announced the core elements for hospital ASPs, which outlines the specific structural and procedural components required to implement ASPs in 2014. As multidrug-resistant bacterial infections and use of broad-spectrum antibiotics in Korea are on the rise, ASPs must be urgently applied to medical facilities for appropriate management of antibiotic use. However, there is an ongoing limitation to the immediate adoption and application of ASPs in Korean medical facilities due to the lack of medical workforce and related financial resources. To address this issue, efforts of medical professionals and government are required, and core elements that match the characteristics and circumstances of Korean medical facilities must be urgently developed.

A Fatal Case of Bacteremia Caused by Vibrio cholerae Non-O1/O139

Hwang Soyoon,Kim Yoonjung,Jung Hyejin,장현하,김수정,Park Han-Ki,Lee Jong-Myung,Kim Hye-In,Kim Shin-Woo 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.2

Vibrio cholerae is a pathogen known to cause the waterborne epidemic disease cholera. Overall, V. cholerae O1 or O139 strains produce the cholera toxin that cause gastroenteritis, resulting in watery diarrhea. Most of the enterocolitis caused by V. cholerae can be easily treated with fluid therapy and conservative care. However, V. cholerae non-O1/O139 strains can cause extraintestinal infections, such as wound infection or sepsis, in immunocompromised patients. The clinical course of these infections is very similar to that of V. vulnificus infection. We report about a 52-year-old man without previous underlying disease who was diagnosed with V. cholerae non-O1/O139 infection and died within 72 hours after admission to the intensive care unit.

레녹스 가스토 증후군을 가진 소아에서 Rufinamide의 효과 및 안전성

민소윤(Soyoon Min),조태경(Taekyoung Jo),서효림(Hyorim Suh),노다은(Daeun Roh),황수경(Su-Kyeoung Hwang),이윤정(Yunjeong Lee),권순학(Soonhak Kwon) 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.2

Purpose: Rufinamide (RFM) is known to be effective for children with Lennox-Gastaut syndrome (LGS). The aim of this study is to evaluate its efficacy and tolerability of Korean children with LGS. Methods: This is a single center, open label, retrospective study. Patients with LGS who received rufinamide as adjunctive therapy were enrolled in this study. Their baseline clinical characteristics, the percent change in the seizure frequency per 4 weeks, and adverse events were evaluated. Results: Among 32 children, 20 were males and the mean age was 11.3±6.6 years. After 1 month of rufinamide medication, the frequency of seizures was reduced by more than 50% in 31.3% of patients and 6.3% of patients had no seizures. After 6 months of rufinamide administration, patients with a 50% or less decrease in seizure frequency remained in a state of reduced seizure frequency and 3.1% of patients had no seizures. Side effects such as nausea, vomiting, anorexia, less active, somnolence, aggression, drooling were noted in 28.1% of patients. Conclusion: This study suggests that rufinamide can be considered as an effective and safe treatment option for intractable epileptic children such as LGS. 목적: 레녹스-가스토 증후군은 소아기에 발생하는 뇌전증 중 가장 심한 형태의 뇌전증성 뇌병증으로 알려져 있으며 여러 항경련 제 치료에도 불구하고 잘 조절되지 않아 난치성 뇌전증으로 분류된다. 본 연구의 목적은 레녹스-가스토 증후군 소아에서 rufina-mide의 효율성 및 내약성을 분석하고자하였다. 방법: 본 연구는 레녹스-가스토 증후군으로 진단되어 경북대학교 소아청소년과에서 진료받은 환자 중 2011년 1월 1일부터 2014년 12월 31일까지 rufinamide를 새로 처방 받은 32명을 대상으로 rufina-mide 투여 전과 투여 후 4주 간격으로 임상적 특징과 약효와 부작용에 대해 후향적으로 분석하였다. 결과: 남자는 20명 여자는 12명 이었으며 평균연령은 11.3세±6.6세 였다. Rufinamide 처방 1달 후 31.3%의 환자에서 발작 빈도가 50% 이상 감소하였으며 6.3%의 환자에서 완전히 발작이 없어진 것 을 확인하였다. 발작 빈도가 50% 이상 감소한 환자군은 처방 6달 후 에도 50% 이상 감소한 상태로 유지되었고, 6개월 후 3.1%의 환자에서 완전히 발작이 없어진 것을 확인하였다. 28.1%의 환자에서 부작용 이 나타났으며 부작용은 구역, 구토, 식욕부진, 활동도 저하, 기면, 공격성향, 타액분비 등이었다. 결론: 본 연구를 통해 레녹스-가스토 증후군과 같은 난치성 뇌전증을 가진 소아에서 rufinamide를 효과적이고 안전하게 사용할 수있다는 것을 확인하였다.

Severe congenital neutropenia mimicking chronic idiopathic neutropenia: a case report

( Juhyung Kim ),( Soyoon Hwang ),( Narae Hwang ),( Yeonji Lee ),( Hee Jeong Cho ),( Joon Ho Moon ),( Sang Kyun Sohn ),( Dong Won Baek ) 영남대학교 의과대학 2023 Yeungnam University Journal of Medicine Vol.40 No.4

Severe chronic neutropenia is classified as severe congenital, cyclic, autoimmune, or idiopathic. However, there is a lot of uncertainty regarding the diagnosis of severe congenital neutropenia (SCN) and chronic idiopathic neutropenia, and this uncertainty affects further evaluations and treatments. A 20-year-old man presented with fever and knee abrasions after a bicycle accident. On admission, his initial absolute neutrophil count (ANC) was 30/μL. He had no medical history of persistent severe neutropenia with periodic oscillation of ANC. Although his fever resolved after appropriate antibiotic therapy, ANC remained at 80/μL. Bone marrow (BM) aspiration and biopsy were performed, and a BM smear showed myeloid maturation arrest. Moreover, genetic mutation test results showed a heterozygous missense variant in exon 4 of the neutrophil elastase ELANE: c597+1G>C (pV190-F199del). The patient was diagnosed with SCN. After discharge, we routinely checked his ANC level and monitored any signs of infection with minimum use of granulocyte colony-stimulating factor (G-CSF), considering its potential risk of leukemic transformation. Considering that SCN can be fatal, timely diagnosis and appropriate management with G-CSF are essential. We report the case of a patient with SCN caused by ELANE mutation who had atypical clinical manifestations. For a more accurate diagnosis and treatment of severe chronic neutropenia, further studies are needed to elucidate the various clinical features of ELANE.

Severe congenital neutropenia mimicking chronic idiopathic neutropenia: a case report

( Juhyung Kim ),( Soyoon Hwang ),( Narae Hwang ),( Yeonji Lee ),( Hee Jeong Cho ),( Joon Ho Moon ),( Sang Kyun Sohn ),( Dong Won Baek ) 영남대학교 의과대학 2023 Yeungnam University Journal of Medicine Vol.40 No.3

Severe chronic neutropenia is classified as severe congenital, cyclic, autoimmune, or idiopathic. However, there is a lot of uncertainty regarding the diagnosis of severe congenital neutropenia (SCN) and chronic idiopathic neutropenia, and this uncertainty affects further evaluations and treatments. A 20-year-old man presented with fever and knee abrasions after a bicycle accident. On admission, his initial absolute neutrophil count (ANC) was 30/μL. He had no medical history of persistent severe neutropenia with periodic oscillation of ANC. Although his fever resolved after appropriate antibiotic therapy, ANC remained at 80/μL. Bone marrow (BM) aspiration and biopsy were performed, and a BM smear showed myeloid maturation arrest. Moreover, genetic mutation test results showed a heterozygous missense variant in exon 4 of the neutrophil elastase ELANE: c597+1G>C (pV190-F199del). The patient was diagnosed with SCN. After discharge, we routinely checked his ANC level and monitored any signs of infection with minimum use of granulocyte colony-stimulating factor (G-CSF), considering its potential risk of leukemic transformation. Considering that SCN can be fatal, timely diagnosis and appropriate management with G-CSF are essential. We report the case of a patient with SCN caused by ELANE mutation who had atypical clinical manifestations. For a more accurate diagnosis and treatment of severe chronic neutropenia, further studies are needed to elucidate the various clinical features of ELANE.

Does oral doxycycline treatment affect eradication of urine vancomycin-resistant Enterococcus? A tertiary hospital study

Yoonjung Kim,Sohyun Bae,Soyoon Hwang,권기태,장현하,Sujeong Kim,Han-Ki Park,이종명,김신우 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.2

Background: Vancomycin-resistant Enterococcus (VRE) has become more common in nosocomial infections, especially in urine samples. However, until now, no treatment regimen has been proven to effectively eradicate urine VRE colonization. Therefore, to evaluate the efficacy of doxycycline in eradicating urine VRE and shortening VRE isolation period, we compared VRE colony detection period between doxycycline-treated and untreated patients. Methods: A retrospective cohort study of 83 patients with VRE colonization in urine cultures was conducted at a tertiary academic hospital from January 2011 to February 2018. Kaplan-Meier survival analysis was used to evaluate eradication rates in the treatment and non-treatment groups. Factors affecting urine VRE colonization persistence were analyzed by multiple logistic regression analysis. Results: The overall rate of VRE eradication during the entire hospital stay was higher in the doxycycline treatment group (90.5%) than in the non-treatment group (58.1%, p=0.014). Survival analysis showed that the 5-, 10-, and 20-day cumulative eradication rates were 78.3%, 100%, and 100% in the doxycycline treatment group, and 18.5%, 45.7%, and 67.8% in the non-treatment group, respectively, thereby indicating that eradication rates were higher in the doxycycline treatment group than in the non-treatment group (p

Clinical Significance of p53 Protein Expression, Beta-catenin Expression and HER2 Expression for Epstein-Barr Virus-associated Gastric Cancer

Baek, Dong Won,Kang, Byung Woog,Hwang, Soyoon,Kim, Jong Gwang,Seo, An Na,Bae, Han Ik,Kwon, Oh Kyoung,Lee, Seung Soo,Chung, Ho Young,Yu, Wansik Chonnam National University Medical School 2017 CMJ Vol.53 No.2

<P>This study assessed the expression of the p53 protein, beta-catenin, and HER2 and their prognostic implications in patients with EBV-associated gastric cancer (EBVaGC). After reviewing 1318 consecutive cases of surgically resected or endoscopic submucosal dissected gastric cancers, 117 patients were identified as EBV-positive using EBV-encoded RNA in-situ hybridization. The immunohistochemistry results were interpreted as follows: strong p53 nuclear expression in at least 50% of tumor nuclei was interpreted as a positive result, strong beta-catenin expression in at least 10% of cytoplasmic nuclei was interpreted as a positive result, and moderate or strong complete or basolateral membrane staining in 10% of tumor cells was interpreted as a positive result for HER2. Immunohistochemical staining for p53 was performed on tumor tissue from 105 patients, among whom 25 (23.8%) tested positive. Meanwhile, beta-catenin expression was positive in 10 patients (17.5%) and HER2 expression was positive in 8 patients (6.8%). The positive expression of p53 was significantly associated with a high T stage (p=0.006). More patients with lymph node metastasis were p53-positive (p=0.013). In the univariate analysis, the p53-positive patients showed significantly decreased disease-free survival (DFS) when compared with the p53-negative patients (p=0.022), although the p53 status was only marginally associated with overall survival (OS) (p=0.080). However, p53 expression showed no prognostic significance on DFS in the multivariate analysis. Moreover, beta-catenin and HER2 showed no association with DFS and OS in the survival analysis. The current study found a significant correlation between p53 expression and tumor progression and lymph node metastases in patients with EBVaGC.</P>

Psychological Effects of COVID-19 Patient Management Experience among Paramedics and Emergency Medical Technicians: A Nationwide Survey in Korea

Kim Bongyoung,Kwon Ki Tae,Hwang Soyoon,Ryoo Hyun Wook,Chung Un Sun,Lee So Hee,Lee Ju-Yeon,Park Hye Yoon,Shin Ji-Yeon,Bae Sang-geun 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.2

Background Throughout the coronavirus disease 2019 (COVID-19) pandemic, not only medical personnel but also paramedics or emergency medical technicians (EMT) have faced multiple physical and psychological challenges while performing their duties. The current study aimed to evaluate the psychological effects of managing patients with COVID-19 on the paramedics and EMT. Materials and Methods A survey targeting paramedics and EMT in Korea was conducted in December 2020. An official letter requesting participation and with the link to an online-based survey was sent to the Public Emergency Medical Services. Only one response was accepted from each participant. Results A total of 326 paramedics and EMT responded to the survey. Among them, 66.3% (216/326) had experience in managing patients with COVID-19. No differences in the distribution of sex, age, working area, duration of working experience, and underlying comorbidities were observed between those who did (COVID-19 group) and did not (non-COVID-19 group) experience managing patients with COVID-19. The percentage of participants who showed severe posttraumatic stress disorder (PTSD) symptoms was significantly higher in the COVID group than in the non-COVID group (11.1% vs. 3.6%, P = 0.029). The participants in the COVID group had a significantly higher mean Global Assessment of Recent Stress Scale score than those in the non-COVID group (18.7 ± 11.1 vs. 16.1 ± 9.9, P = 0.042). The proportion of paramedics and EMT willing to leave their job if given a chance was higher in the COVID group than the non-COVID group (24.1% vs. 9.1%, P = 0.001). Additionally, paramedics and EMT in the COVID group tended to show concern regarding exposure to COVID-19 infection. Conclusion The experience of managing patients with COVID-19 resulted in psychological distress among paramedics and EMT in Korea. Background Throughout the coronavirus disease 2019 (COVID-19) pandemic, not only medical personnel but also paramedics or emergency medical technicians (EMT) have faced multiple physical and psychological challenges while performing their duties. The current study aimed to evaluate the psychological effects of managing patients with COVID-19 on the paramedics and EMT. Materials and Methods A survey targeting paramedics and EMT in Korea was conducted in December 2020. An official letter requesting participation and with the link to an online-based survey was sent to the Public Emergency Medical Services. Only one response was accepted from each participant. Results A total of 326 paramedics and EMT responded to the survey. Among them, 66.3% (216/326) had experience in managing patients with COVID-19. No differences in the distribution of sex, age, working area, duration of working experience, and underlying comorbidities were observed between those who did (COVID-19 group) and did not (non-COVID-19 group) experience managing patients with COVID-19. The percentage of participants who showed severe posttraumatic stress disorder (PTSD) symptoms was significantly higher in the COVID group than in the non-COVID group (11.1% vs. 3.6%, P = 0.029). The participants in the COVID group had a significantly higher mean Global Assessment of Recent Stress Scale score than those in the non-COVID group (18.7 ± 11.1 vs. 16.1 ± 9.9, P = 0.042). The proportion of paramedics and EMT willing to leave their job if given a chance was higher in the COVID group than the non-COVID group (24.1% vs. 9.1%, P = 0.001). Additionally, paramedics and EMT in the COVID group tended to show concern regarding exposure to COVID-19 infection. Conclusion The experience of managing patients with COVID-19 resulted in psychological distress among paramedics and EMT in Korea.

Workload of Healthcare Workers During the COVID-19 Outbreak in Korea: A Nationwide Survey

Cheong Hae Suk,Kwon Ki Tae,Hwang Soyoon,Kim Shin-Woo,Chang Hyun-Ha,Park Se Yoon,Kim Bongyoung,이신원,Park Jiho,Heo Sang Taek,Oh Won Sup,Kim Yeonjae,Park Kyung-Hwa,Kang Chang Kyung,Oh NamHee,Lim Su Jin,Yu 대한의학회 2022 Journal of Korean medical science Vol.37 No.6

Background: As the coronavirus disease 2019 (COVID-19) pandemic is ongoing, heavy workload of healthcare workers (HCWs) is a concern. This study investigated the workload of HCWs responding to the COVID-19 outbreak in South Korea. Methods: A nationwide cross-sectional survey was conducted from September 16 to October 15, 2020, involving 16 healthcare facilities (4 public medical centers, 12 tertiary-care hospitals) that provide treatment for COVID-19 patients. Results: Public medical centers provided the majority (69.4%) of total hospital beds for COVID-19 patients (n = 611), on the other hand, tertiary care hospitals provided the majority (78.9%) of critical care beds (n = 57). The number of beds per doctor (median [IQR]) in public medical centers was higher than in tertiary care hospitals (20.2 [13.0, 29.4] versus 3.0 [1.3, 6.6], P = 0.006). Infectious Diseases physicians are mostly (80%) involved among attending physicians. The number of nurses per patient (median [interquartile range, IQR]) in tertiarycare hospitals was higher than in public medical centers (4.6 [3.4–5] vs. 1.1 [0.8–2.1], P = 0.089). The median number of nurses per patient for COVID-19 patients was higher than the highest national standard in South Korea (3.8 vs. 2 for critical care). All participating healthcare facilities were also operating screening centers, for which a median of 2 doctors, 5 nurses, and 2 administrating staff were necessary. Conclusion: As the severity of COVID-19 patients increases, the number of HCWs required increases. Because the workload of HCWs responding to the COVID-19 outbreak is much greater than other situations, a workforce management plan regarding this perspective is required to prevent burnout of HCWs.

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.