Prognostic Value of Serum Procalcitonin level for the Diagnosis of Bacterial Infections in Critically-ill Patients

Apichot So-Ngern,Sombat Leelasupasri,Suvatna Chulavatnatol,Chalermsri Pummangura,Pakwan Bunupuradah,Preecha Montakantikul 대한감염학회 2019 Infection and Chemotherapy Vol.51 No.3

Background: Procalcitonin (PCT) is a diagnostic biomarker for bacterial infections in critically-ill patients. However, the cut-off value of PCT for the diagnosis of bacterial infections is unclear and unreliable. This study aimed to determine the optimal cut-off value of PCT for the diagnosis of bacterial infections in critically-ill patients. Materials and Methods: We conducted a retrospective study involving 311 adult patients who had been admitted to the medical or surgical intensive care unit for more than 24 hours from 2013 to 2015. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection. Results: One hundred and fifty-seven patients had bacterial infections, while 154 did not. Patients with bacterial infections had a significantly higher median PCT level than those without bacterial infections (1.90 ng/mL vs. 0.16 ng/mL, P <0.001). The area under the receiver operating characteristic curve of PCT for discriminating between bacterial and nonbacterial infections was 0.874 (95% confidence interval: 0.834, 0.914; P <0.001). The optimal cut-off value of PCT for differentiating between fevers due to bacterial infections from those due to non-bacterial infections was 0.5 ng/mL, with a sensitivity of 84.7%, specificity of 79.9%, positive predictive value of 81.1%, and negative predictive value of 83.7%. Conclusion: PCT was found to be an accurate biomarker for the diagnosis of bacterial infections among patients admitted to medical and surgical intensive care units. The optimal cut-off value of PCT for the diagnosis of bacterial infections was 0.5 ng/mL.

최근 10년간 Microsporum canis의 감염 상태(1983-1992)

최성관,오수희,김성화,서순봉 대한의진균학회 1996 대한의진균학회지 Vol.1 No.1

ackground: Microsporum(M) canis infection was first discovered in 1957 in Korea, but it did not spread and disappeared after 1960. It was discovered again in 1975, and rapidly spread all over the country. In the 1980's, M. canis became one of the most important dermatophytes that infected humans. Objective: The purpose of this study is to evaluate the clinical and epidemiological characteristics of M. canis infections. Methods: We observed the clinical and epidemiological status in 2,256 cases of M. canis infections that were mycologically diagnosed at the Catholic Skin Disease Clinic from 1983 to 1992. Results: The rate of M. canis infections compared to total dermatophytoses(25,907 patients) was 8.7%. The annual number of patients with M. canis infection increased gradually from 1983 and was highest frequency in 1986. Then the number of patients with M. canis infection was markedly decreased till 1992. The ratio of male to female patients was 0.85: 1(male:1,039,female:1,217), but the ratio in children (age≤ 15) was 1.02: 1 and in adults(age≥16) was 0.33: 1. Children were chiefly involved as 82.6% of the patients. There were more patients in winter(35.3%)and followed by fall, summer and spring. M. canis infections were mostly composed of tinea(T.) capitis(64.2%), T.faciale(17.7%) and T. corporis(14.6%). In the seasonal distribution of M. canis infections, T. capitis was the most common in winter(38.8%) and was the lowest in summer(15.4%),but T. corporis was the most common in summer(42%). There was a difference in disease pattern between children and adults in M. canis infections; In children, M. canis infections were T. capitis(73.6%), T. faciale(16.3%), T. corporis(9%), but in adults, those were T. corporis(41.3%), T. faciale(24.5%), T, capitis(19.4%) in the order of decreasing frequency. Conclusion: We observed a gradual decrease in number of patient with M. canis infection after 1986. We suggest that M. canis infections would decrease more and more in the future in Korea.

비만과 감염의 연관성

이철진,김민정,안상준 대한임상건강증진학회 2020 Korean Journal of Health Promotion Vol.20 No.1

비만과 감염은 서로 상호작용하는 관계이다. 감염은 비만을 야기시키고, 비만은 감염의 발생 및 악화에 기여한다. 비만을 일으키는 감염원에는 아데노바이러스, 장내 바이러스등의 바이러스, 장내 미생물 등의 세균, 기생충이 포함되며이러한 미생물들의 변화를 초래하는 항생제도 영향을 미친다. 위의 위험인자들이 인체의 만성 염증 반응을 일으켜 비만을 유발시키고, 이와 더불어 나쁜 식생활 습관이 동반되면 비만이 더욱 가속화된다. 비만한 사람에서 잘 발생하고상태를 악화되는 감염으로는 인플루엔자바이러스, 코로나바이러스 등의 각종 바이러스 감염과 요로 감염이나 치주감염을 유발하는 세균 감염이 있으며, 기관지염, 폐렴 등의호흡기 감염, 원내 감염, 수술 부위의 감염이 있다. 비만에서감염이 동반되면 합병증을 증가시키고, 항생제와 백신의 효과를 떨어뜨린다. 비만과 감염 사이의 기전은 만성 염증 증가에 따른 면역력의 저하이다. 비만과 감염이 서로 원인과결과가 되며 상호작용을 한다는 근거에 따라 비만의 예방및 치료에도 이를 활용할 수 있겠다. 비만 백신의 개발과 건강한 장내 미생물 유지와 연관된 연구들이 진행되고 있어향후 비만 감소와 예방을 위한 효과가 기대된다. 결과적으로 비만이 줄게 되면 감염의 위험성과 악화를 줄일 수 있을 것이다. Obesity and infection are interacting with each other. Infection causes obesity, and obesity contributes to the occurrence and deterioration of infection. The sources of infection that cause obesity include viruses such as adenovirus, intestinal viruses, bacteria such as intestinal microbes, parasites, and the antibiotics that cause these microbes to change. The above risk factors cause chronic inflammatory reactions in the body, and in addition, obesity is further accelerated when bad eating habits are accompanied. Among the infections that occur often in obese people and worsen their condition are various viral infections such as influenza viruses and coronavirus, bacterial infections that cause urinary tract infections or periodontal infections, respiratory infections such as bronchitis, pneumonia, floor infections and infections in surgical areas. Infection in obesity increases complications, and reduces the effectiveness of antibiotics and vaccines. The mechanism between obesity and infection is a decrease in immunity resulting from increased chronic inflammation. Based on the evidence that obesity and infection cause and effect each other and interact with each other, it can be used for prevention and treatment of obesity. Studies related to the development of obesity vaccines and the maintenance of healthy intestinal microbes are under way, which is expected to reduce obesity and prevent future prevention. As a result, reducing obesity will reduce the risk and deterioration of infection.

병원내 감염 대응을 위한 공법적 고찰 - 프랑스 사례를 중심으로 -

김지영 ( Ji-young Kim ) 한국법정책학회 2018 법과 정책연구 Vol.18 No.3

최근 병원 내에서 발생한 감염 사고가 점증하는 추세에 있어서, 사회적으로 병원내 감염에 대한 관심이 증가하고 있다. 병원내 감염은 병을 치료하기 위해 방문한 의료기관에서 이환된 감염으로, 병원내 감염사고가 발생하면, 환자의 입장에서는 국가보건의료시스템 및 의료기관에 대해 강한 불신을 가질 수밖에 없다. WHO 보고서에 따르면 연간 10% 이상의 환자에게서 병원내 감염이 나타나고, 병원내 감염에 이환된 환자의 10%는 이로 인해 사망에 이르게 된다. 즉 병원내 감염은 일부 제한적인 영역에 국한되어 나타나는 특수한 문제가 아니라, 의료기술의 발전과 인구의 고령화와 결합하여 심각한 공공 보건상 위험 요인이 되고 있다. 사안의 심각성과 중대성에도 불구하고, 이 영역에서 우리나라의 대응은 아직 초보적 단계에 머무르고 있는 것으로 판단된다. “의료법”과 “감염병의 예방 및 관리에 관한 법률”에 일부 규정이 있음에도, 여전히 국가적 차원에서 현황 파악이 제대로 이루어지지 않고 있고, 병원내 감염 문제와 관련하여 의료기관은 경영상의 곤란함을 이유로 형식적으로 대응하고 있을 뿐이다. 더구나 프랑스와 달리, 병원내 감염 사고가 발생하면, 여전히 민사법적으로 이를 해결하고 있어서, 병원내 감염에 이환된 환자의 피해 구제에 있어서 문제점을 노출시키고 있는 실정이다. 무엇보다 중요한 것은 병원내 감염의 경우에 충분히 예방하고 관리하면, 발생빈도를 현격히 낮출 수 있다는 점에서 이에 대한 구체적인 대응 체계의 마련이 필요하다 하겠다. 이러한 측면에서, 병원내 감염에 대응하기 위한 의료기관과 국가가 조직적인 체계를 구축하고 있으며, 판례를 통해 확립된, 병원내 감염에 대한 의료기관의 “결과채무로서의 안전성 의무”를 입법화 하고 있는 프랑스의 사례는 비교법적으로 충분히 검토할 만한 필요성이 있다. 특히 병원내 감염이 가지는 특수성, 즉 전문성, 밀실성, 재량성에 비추어, 병원급 의료기관의 책임을 강화하고, “국가적 연대(solidarite nationale)”에 기초한 피해의 구제를 체계화 하고 있는 프랑스의 사례는 책임법제와 피해구제를 이분화 하여 접근하고 있다는 점에서 향후 우리나라 관련 판례와 법제 발전에 유의미한 시사점을 제공해 주고 있다. Etant donne que nombreux accidents de “infections nosocomiales(IN)” se sont produits en Coree, ces incidents ont suscite la vigilance de tous. Les infections nosicomiales sont les linfections contractees dans un etablissement de sante. Si les infections nosocomiales est survenues, elles constituent une menace permanente pour le bon fonctionnement des systemes de sante et ont une incidence negative sur la qualite de la prestation des services de sante. Selon Rapport de OMS, les infections nosocomiales constituent l’un des evenements indesirables les plus courants dans la prestation de soins et un probleme de sante publique majeur ayant un impact sur la morbidite, la mortalite et la qualite de vie. A un moment, au moins 10% dans les pays en developpement contracteront au moins une IN. Ces infections constituent egalement une charge economique importante au niveau social. Cependant, un pourcentage eleve des IN peut etre evite par des mesures efficaces de prevention et de controle des infections. Les infections nosocomiales ne sont plus le probleme specifique dans le domaine limite, elles provoquent une menace de sante publique en combinaison du vieillissement de la population et le developpement medical. En depit de la gravite, la prevention et de controle est en Coree a ses debuts et imperfectionne. Si la legislation coreenne a adopte certaines dispositions, ses effectivite sont sujettes a discussion. Au niveau nationale, les donnees exhaustives n’ont pas ete recensees, au niveau hospitalier, les difficultes financieres font obstacle a la prevention des infections. De ce point de vue, on peut tirer la lecon des experiences francaises. La politique et systeme francais est en train d’orienter ses efforts sur la recherche des causes et sur les traitements adaptes aux pathologies infectieuses afin, en ameliorant les connaissances sur ce phenomene, de mieux en maîtriser l’apparition et les consequences. Par adoption de la loi n° 2002-303 du 4 mars 2002 et la loi n° 2002-1577 du 30 decembre 2002, le legislateur avait pour objectifs de simplifier les regles d'indemnisation des victimes d'infections nosocomiales. Les resultats desires semblent partiellement atteints dans la mesure où le regime legal est parvenu a trouver des compromis et solutions jusque-la non realises alors qu'il demeure encore plusieurs ordres de difficultes a resoudre.

Emergence of Community-Genotype Methicillin-Resistant Staphylococcus aureus in Korean Hospitals: Clinical Characteristics of Nosocomial Infections by Community-Genotype Strain

주은정,정두련,김소현,백진영,이남용,조선영,하영은,강철인,백경란,송재훈 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.2

Background: As community-genotype methicillin-resistant Staphylococcus aureus (MRSA) strains spread into hospitals, the genotypes of the MRSA strains causing hospital-acquired (HA) infections have become more diverse. We describe clinical characteristics of nosocomial MRSA infections by a community-genotype of sequence type (ST) 72. Materials and Methods: A case-control study was designed among patients with HA-MRSA infections. Forty patients with infections caused by ST72-MRSA SCCmec type IV were selected as cases. Cases were matched to the controls with 106 patients infected with ST5/ST239 MRSA, which are representative hospital genotypes in Korea. Results: Patients infected with ST72 isolates were younger than those with ST5/ST239 isolates. Female gender predominated among ST72 MRSA group compared to ST5/ST239 MRSA group. Solid tumor was a more frequent underlying disease in MRSA infections by ST72 isolates, whereas underlying renal, lung, heart, and neurologic diseases were more frequently found in those by ST5/ST239 isolates. The most common type of infection was pneumonia in both ST72 and ST5/ST239 groups (45.0% vs. 51.9%), followed by skin and soft tissue infection (SSTI). Female gender and underlying solid tumor were identified to be independent predictors for MRSA infections by ST72 isolates. All-cause mortality rates (20.0% vs. 30.2%) were not different between the groups. Conclusion: A community-genotype MRSA, ST72 isolate has emerged as a nosocomial pathogen presenting as hospital-acquired pneumonia and SSTI. Although differences in underlying disorders were found, the distribution of infection type and mortality rate did not differ between the groups.

혈액투석 도관 감염의 임상적 특성과 치료 결과

박세윤,이은정,김태형,전민혁,추은주 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.4

Background: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. Materials and Methods: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. Results: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28(12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%)had a temporary central catheter. The mean±SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6±36.9 days, tunneled cuffed catheter 180.3±168.8 days, AV fistulas 928.6±1,299.7 days, and AV graft 1,066.3±1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%;methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%),tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12,33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. Conclusions: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.

Clinical Characteristics and Causative Pathogens of Infective Arthritis and Risk Factors for Gram-Negative Bacterial Infections

Lee Yongseop,Cho Yun Suk,Sohn Yu Jin,Hyun Jong Hoon,Ahn Sang Min,Lee Woon Ji,Kim Jung Ho,Seong Hye,Kim Junhyoung,Jeong Su Jin,Ku Nam Su,Yeom Joon Sup,Ahn Jin Young,Choi Jun Yong 대한감염학회 2020 Infection and Chemotherapy Vol.52 No.4

Background: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and Methods: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion: Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.

Comparative Effects of Bivalent, Quadrivalent, and Nonavalent Human Papillomavirus Vaccines in The Prevention of Genotype-Specific Infection: A Systematic Review and Network Meta-Analysis

Kim Jimin,Choe Young June,Park Jungeun,Cho Jahyun,Cheong Chelim,Oh Jin-Kyoung,Park Mihai,Shim Eunha,Yu Su-Yeon 대한감염학회 2024 Infection and Chemotherapy Vol.56 No.1

Background Human papillomavirus (HPV) infection is a major global disease burden and the main cause of cervical cancer. Certain HPV genotypes, with are the most common etiologic pathogens and cause a significant disease burden, are being targeted for vaccine development. However, few studies have focused on the comparative effectiveness of the bivalent HPV (2v-HPV), quadrivalent HPV (4v-HPV), and nonavalent HPV (9v-HPV) vaccines against HPV strain-specific infection. This study investigated the comparative effects of these vaccines against genotype-specific infection. Materials and Methods We conducted a pairwise and network meta-analysis of published randomized clinical trials of HPV vaccines according to sex and HPV infection status for nine HPV genotypes (HPV 6/11/16/18/31/33/45/52/58). Results Overall, 10 randomized controlled trials (12 articles) were included in this study. In the network meta-analysis, no statistically significant differences were observed in the prevention of carcinogenic HPV strains (16/18/31/33/45/52/58) between the 2v-HPV and 4v-HPV vaccines in female HPV infection–naïve populations. However, the 9v-HPV vaccine showed a significantly superior effect compared with 2v-HPV and 4v-HPV vaccines in preventing HPV 31/33/45/52/58 infections. Although 2v-HPV and 4v-HPV vaccines provided some cross-protection against HPV 31/33/45/52/58 infections, the effect was significant only on HPV 31 infection. For HPV 16 and 18, neither statistically significant nor small differences were found in the prevention of HPV infection among the 2v-HPV, 4v-HPV, and 9v-HPV vaccines. Conclusion Our study complements previous understanding of how the effect of HPV vaccines differs according to the HPV genotype. This is important because HPV genotype prevalence varies among countries. We advocate for continued efforts in vaccinating against HPV, while public health agencies should consider the difference in the vaccine effect and HPV genotype prevalence when implementing HPV vaccination in public vaccination programs. Background Human papillomavirus (HPV) infection is a major global disease burden and the main cause of cervical cancer. Certain HPV genotypes, with are the most common etiologic pathogens and cause a significant disease burden, are being targeted for vaccine development. However, few studies have focused on the comparative effectiveness of the bivalent HPV (2v-HPV), quadrivalent HPV (4v-HPV), and nonavalent HPV (9v-HPV) vaccines against HPV strain-specific infection. This study investigated the comparative effects of these vaccines against genotype-specific infection. Materials and Methods We conducted a pairwise and network meta-analysis of published randomized clinical trials of HPV vaccines according to sex and HPV infection status for nine HPV genotypes (HPV 6/11/16/18/31/33/45/52/58). Results Overall, 10 randomized controlled trials (12 articles) were included in this study. In the network meta-analysis, no statistically significant differences were observed in the prevention of carcinogenic HPV strains (16/18/31/33/45/52/58) between the 2v-HPV and 4v-HPV vaccines in female HPV infection–naïve populations. However, the 9v-HPV vaccine showed a significantly superior effect compared with 2v-HPV and 4v-HPV vaccines in preventing HPV 31/33/45/52/58 infections. Although 2v-HPV and 4v-HPV vaccines provided some cross-protection against HPV 31/33/45/52/58 infections, the effect was significant only on HPV 31 infection. For HPV 16 and 18, neither statistically significant nor small differences were found in the prevention of HPV infection among the 2v-HPV, 4v-HPV, and 9v-HPV vaccines. Conclusion Our study complements previous understanding of how the effect of HPV vaccines differs according to the HPV genotype. This is important because HPV genotype prevalence varies among countries. We advocate for continued efforts in vaccinating against HPV, while public health agencies should consider the difference in the vaccine effect and HPV genotype prevalence when implementing HPV vaccination in public vaccination programs.

Infection patterns during the first year after adult liver transplantation: a retrospective analysis

Yun Ji Seon,정재심,이상오,황신 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.3

Background: Infection is one of the most significant possible complications after liver transplantation (LT). This study identified patterns of infection and compared the characteristics of patients with and without infections during the first year after LT. Methods: This retrospective cohort study reviewed adult patients’ electronic medical records to identify infections occurring up to 1 year after LT. The criteria for identifying infections in the first year after LT were either a positive laboratory test or recorded clinical signs or symptoms meeting the accepted criteria for each infection. Results: The overall incidence of infection during the posttransplant year was 17.3%. The highest infection rate (8.2%) was identified in the first month after LT, with rates of 1.9% and 7.2% at 1–3 months and 3 months to 1 year after LT, respectively. Respiratory tract infections were the most common type of infection, and bacteria were the most common causal agents in the first month post-LT. Conclusions: It is difficult to compare the posttransplant incidence of infection in the present study with previous studies due to differences in study designs and definitions of infection. This study revealed that respiratory tract infections were the most common type of overall posttransplant infection, especially during the period from 3 months to 1 year after LT.

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran

Salman Khazaei,Erfan Ayubi,Ensiyeh Jenabi,Saeid Bashirian,Masud Shojaeian,Leili Tapak 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections. METHODS: This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models. RESULTS: In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females). CONCLUSIONS: We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.