Influenza and Pneumococcal Vaccine Coverage Rates among Patients Admitted to a Teaching Hospital in South Korea

Yang, Tae Un,Song, Joon Young,Noh, Ji Yun,Cheong, Hee Jin,Kim, Woo Joo The Korean Society of Infectious Diseases and Kore 2015 Infection and Chemotherapy Vol.47 No.1

<P><B>Background</B></P><P>Influenza and pneumococcal vaccinations can reduce morbidity and mortality especially in the elderly and patients with chronic medical disease. The purpose of this study was to estimate vaccination coverage of these populations in a hospital setting.</P><P><B>Materials and Methods</B></P><P>We conducted a cross-sectional, descriptive study involving adult patients admitted to a 1,000-bed teaching hospital on April 15, 2013. We ascertained the information on whether the patient had received influenza vaccination within a year prior to admission or pneumococcal vaccination by interviewing each patient.</P><P><B>Results</B></P><P>A total of 491 eligible patients aged ≥50 years or with chronic medical illnesses were analyzed. The overall vaccination rate for influenza was 57.2%, and that of pneumococcus was 17.6% among the vaccine-eligible subjects. Influenza/pneumococcal vaccination rates of patients by disease were 62.8%/17.2% for diabetes, 53.3%/15.6% for malignancy, 67.6%/23.5% for chronic pulmonary disease, 66.7%/15.3% for chronic cardiovascular disease, 68.7%/26.9% for chronic renal disease, and 51.2%/18.6% for chronic hepatic disease. Young adult patients with chronic medical conditions were consistently less likely to receive influenza and pneumococcal vaccines irrespective of the underlying disease.</P><P><B>Conclusion</B></P><P>The influenza and pneumococcal vaccine coverage rates among hospitalized patients were low in South Korea. This was especially the case for young adult patients with chronic medical illnesses.</P>

Clinical Presentation and Outcomes of Middle East Respiratory Syndrome in the Republic of Korea

Choi, Won Suk,Kang, Cheol-In,Kim, Yonjae,Choi, Jae-Phil,Joh, Joon Sung,Shin, Hyoung-Shik,Kim, Gayeon,Peck, Kyong Ran,Chung, Doo Ryeon,Kim, Hye Ok,Song, Sook Hee,Kim, Yang Ree,Sohn, Kyung Mok,Jung, You The Korean Society of Infectious Diseases and Kore 2016 Infection and Chemotherapy Vol.48 No.2

<P><B>Background</B></P><P>From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015.</P><P><B>Materials and Methods</B></P><P>We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay.</P><P><B>Results</B></P><P>The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death.</P><P><B>Conclusion</B></P><P>The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.</P>

Clinical Usefulness of Arbekacin

Lee, Jae Hoon,Lee, Chang-Seop The Korean Society of Infectious Diseases and Kore 2016 Infection and Chemotherapy Vol.48 No.1

<P>Arbekacin is a broad-spectrum aminoglycoside used to treat methicillin-resistant <I>Staphylococcus aureus</I> (MRSA). Arbekacin has antibacterial activities against high-level gentamicin-resistant <I>Enterococci</I>, multidrug-resistant <I>Pseudomonas aeruginosa</I>, and <I>Acinetobacter baumannii</I> et al. Here, we reviewed <I>in vitro</I> data on arbekacin in <I>Staphylococci</I> and Gram-negative microorganisms. We also reviewed clinical studies for clinical efficacy and microbiologic efficacy data in patients with identified MRSA and suspected MRSA infections. The overall clinical efficacy ranged from 66.7% to 89.7%. The microbiologic efficacy rate ranged from 46.2% to 83%. In comparative studies between arbekacin and glycopeptides, arbekacin was similar to other glycopeptides with respect to clinical and microbiological efficacy rates. Combination trials with other antibiotics suggest that arbekacin will be a promising strategy to control <I>Enterococcus</I> spp. multi-drug resistant <I>P. aeruginosa</I>. The major adverse reaction was nephrotoxicity/hepatotoxicity, but patients recovered from most adverse reactions without any severe complications. Based on these results, arbekacin could be a good alternative to vancomycin/teicoplanin in MRSA treatment. Finally, therapeutic drug monitoring is recommended to maximize clinical efficacy and decrease nephrotoxicity.</P>

<i>In vitro</i> Comparison of Anti-Biofilm Effects against Carbapenem-Resistant <i>Acinetobacter baumannii</i> : Imipenem, Colistin, Tigecycline, Rifampicin and Combinations

Song, Joon Young,Cheong, Hee Jin,Noh, Ji Yun,Kim, Woo Joo The Korean Society of Infectious Diseases and Kore 2015 Infection and Chemotherapy Vol.47 No.1

<P><B>Background</B></P><P>Multi-drug resistant (MDR) <I>Acinetobacter baumannii</I> has emerged as one of the most important nosocomial pathogens. In addition to the diverse resistance mechanisms, some <I>A. baumannii</I> strains are known to have biofilm-producing capacity, thereby decreasing antibiotic effectiveness.</P><P><B>Materials and Methods</B></P><P>This study was designed to assess biofilm-producing capacity of three different MDR <I>A. baumannii</I> strains with diverse resistance mechanisms (OXA-51, IMP-1 and VIM-2 type β-lactamases), and intended to compare the effect of each antibiotic regimen (rifampicin, colistin, imipenem, tigecycline, rifampicin-imipenem and rifampicin-colistin) on mature <I>A. baumannii</I> biofilms using <I>in vitro</I> polystyrene plate biofilm assay.</P><P><B>Results</B></P><P>Among three MDR <I>A. baumannii</I> strains, only VIM-2 strain produced strong biofilm compared to the controls (optical density, 8.04 ± 2.16 vs. 0.49 ± 0.26). Regarding VIM-2 strains, none of imipenem, colistin and rifampicin reduced biofilm formation alone at MIC of each antibiotic agent (inhibition of biofilm synthesis, less than 30%). In comparison, tigecyclin (0.76 ± 0.23), imipenem-rifampicin (1.07 ± 0.31) and colistin-rifampicin (1.47 ± 0.54) showed a significant inhibition of biofilm synthesis compared to the positive controls at 48 hours after incubation (<I>P</I><0.01). Tigecycline inhibited biofilm formation even at the one fourth level of MIC (1.17 ± 0.21). Likewise, both imipenem and colistin were also effective even with the reduced concentrations when those were combined with rifampicin. Such biofilm-inhibiting effects with those antibiotic regimens sustained up to 96 hours after incubation.</P><P><B>Conclusion</B></P><P>Tigecycline, imipenem-rifampicin and colistin-rifampicin would be effective for the prevention or reduction of biofilm formation caused by <I>A. baumannii</I> strains.</P>

Fecal Transplantation using a Nasoenteric Tube during an Initial Episode of Severe <i>Clostridium difficile</i> Infection

Jeon, Yong Duk,Hong, Namki,Kim, Jung Ho,Park, Se Hee,Kim, Sung Bae,Song, In Ji,Ann, Hea Won,Ahn, Jin Young,Kim, Sun Bean,Ku, Nam Su,Lee, Kyungwon,Yong, Dongeun,Kim, June Myung,Choi, Jun Yong The Korean Society of Infectious Diseases and Kore 2016 Infection and Chemotherapy Vol.48 No.1

<P>The incidence of <I>Clostridium difficile</I> infection is increasing worldwide, and its severity and resulting mortality are also on the rise. Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. Furthermore, antibiotic therapy results in recurrence rates of at least 20%. Fecal transplantation may be a feasible treatment option for recurrent <I>C. difficile</I> infection; moreover, it may be an early treatment option for severe <I>C. difficile</I> infection. We report a case of severe <I>C. difficile</I> infection treated with fecal transplantation using a nasoenteric tube during an initial episode. This is the first reported case of fecal transplantation using a nasoenteric tube during an initial episode of <I>C. difficile</I> infection in Korea.</P>

A Survey of Serum Bactericidal Antibodies against <i>Neisseria meningitidis</i> Serogroups A, C, W and Y in Adolescents and Adults in the Republic of Korea

Kang, Jin-Han,Miao, Yan,Lee, SooYoung,Kim, Jong-Hyun,Lee, Kyung-Yil,Ma, Sang Hyuk,Jo, Dae Sun,Song, HyoYoung,Haag, Mendel The Korean Society of Infectious Diseases and Kore 2016 Infection and Chemotherapy Vol.48 No.1

<P><B>Background</B></P><P>This descriptive epidemiological study aimed to assess the prevalence of serum bactericidal antibodies against <I>Neisseria meningitidis</I> serogroups A, C, W and Y in adolescents and adults in the Republic of Korea.</P><P><B>Materials and Methods</B></P><P>In total, 987 subjects aged 11-55 years from five geographical regions of Korea were included in the study. Human serum bactericidal assay (hSBA) was used to measure hSBA titres for serogroups A, C, W and Y. Percentages of subjects with hSBA titres ≥4 and ≥8, geometric mean titres (GMTs), and associated 95% confidence intervals (CIs), were estimated. Analysis was performed for the entire study population and stratified by age group or region. No statistical hypotheses were tested.</P><P><B>Results</B></P><P>The highest percentage of subjects with hSBA titres ≥8 was observed for serogroup W (74%), was similar for serogroups C (34%) and Y (36%), and was lowest for serogroup A (9%). The percentages of subjects with hSBA titres ≥4 were similar to those with hSBA titres ≥8 for all serogroups. GMTs were 2.56 µg/mL (serogroup A), 5.14 µg/mL (serogroup C), 22.63 µg/mL (serogroup W) and 5.28 µg/mL (serogroup Y). Similar trends in GMTs across serogroups were seen for individual regions and age groups. The highest GMTs for serogroups A, W and Y were recorded in the >19-29 years group, and for serogroup C in the >49-55 years group. Across all regions, GMTs were very similar for serogroups A, C and Y, while more variation was seen for serogroup W.</P><P><B>Conclusion</B></P><P>In the Korean population, among <I>Neisseria meningitidis</I> serogroups A, C, W and Y, serum bactericidal antibodies were most prevalent against serogroup W and least prevalent against serogroup A. These trends were maintained across age groups and regions. The highest GMTs for serogroups A, W and Y were observed in the >19-29 years group. The reasons behind the observed differences in prevalence of bactericidal antibodies against the serogroups are currently not understood, although carriage and cross-reactivity of the assay may be important influences.</P>