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Background@#We compared the antimicrobial resistance rates (AMRs) of major glucose nonfermenting gram-negative bacilli, Acinetobacter baumannii and Pseudomonas aeruginosa, under different clinical conditions. The purpose of the study was to provide useful background data to set up infection control strategies for infection-vulnerable patients. @*Methods@#The AMRs of blood isolates were compared in various clinical conditions, using data from the Antimicrobial Resistance Surveillance System in Korea. @*Results@#A. baumannii blood isolates from patients with healthcare-associated infections, inpatients, or intensive care unit (ICU)-admitted patients consistently exhibited higher AMRs to most antimicrobials, except minocycline, tigecycline, and colistin, compared with those from patients with community-acquired infections, outpatients, or non-ICU-admitted patients, respectively. P. aeruginosa blood isolates from patients with healthcare-associated infections showed higher AMRs to most antimicrobials, except ceftazidime and aztreonam, compared with those from patients with community-acquired infections, but not compared to those from inpatients or ICU-admitted patients. @*Conclusion@#Higher AMRs were associated with A. baumannii bloodstream infections under various clinical conditions, such as healthcare-associated infections and infections in inpatients and ICU-admitted patients. Considering the high AMRs and the limited number of treatment options of A. baumannii, vigorous efforts should be used to prevent the spreading of A. baumannii infections in patients with vulnerable conditions.
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Background@#The application of genotypic antimicrobial sensitivity tests (ASTs) is dependent on the reliability of the predictions of phenotypic resistance. In this study, routine AST results and the presence of corresponding antimicrobial resistance genes were compared. @*Methods@#Eighty-four extended-spectrum-β-lactamase-producing Escherichia coli isolates from poultry-related samples were included in the study. The disk diffusion method was used to test for susceptibility to antimicrobial compounds, except colistin susceptibility, which was tested using the agar dilution method. Whole-genome sequencing (WGS) was performed using a NextSeq 550 instrument (Illumina, USA). Antimicrobial resistance genes were detected using ResFinder 4.1. @*Results@#Concordance rates between the genotype and phenotype ranged from 35.7% (ciprofloxacin) to 96.4% (tetracycline). The presence of tet was a good predictor of phenotypic resistance. @*Conclusion@#The genotype was a good predictor of tetracycline phenotypic resistance, but there was a gap in the prediction of phenotypic ASTs for trimethoprim-sulfamethoxazole, chloramphenicol, gentamicin, and ciprofloxacin. We concluded that WGS-based genotypic ASTs are inadequate to replace routine phenotypic ASTs.
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Background@#There has been a marked increase in the mortality rate associated with Clostridioides difficile infection (CDI) globally since 2003, with the emergence of binary toxinproducing ribotype 027 strains. However, the molecular epidemiology of C. difficile shows regional differences and ribotype 027 is not common in Korea. In this study, the risk factors for severe CDI were evaluated, while considering the region-specific molecular epidemiology. @*Methods@#A retrospective case-control study was performed. Cases (n = 149) included patients with severe CDI or severe complicated CDI. Controls (n = 155) consisted of patients with nonsevere CDI. @*Results@#Advanced age (odds ratio [OR] = 1.017, P = 0.0358), a history of chemotherapy (OR = 2.695, P = 0.0464), and ribotype 002 (OR = 3.406, P = 0.0231) were statistically significant factors associated with severe CDI in a multivariate analysis. @*Conclusion@#Ribotype 002 was found to be a significant risk factor for severe CDI in this study.Therefore, the surveillance of C. difficile ribotypes is recommended to monitor the spread of high-risk clones.
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Objective@#Isotretinoin should not be used during pregnancy because of the risk of birth defects. Most pregnant women exposed to isotretinoin choose voluntary pregnancy termination due to concerns about birth defects. However, birth outcome data supporting the termination of pregnancy are lacking. This study aimed to evaluate pregnancy and neonatal outcomes after periconception exposure to isotretinoin. @*Methods@#This was a prospective cohort study. We evaluated pregnancy and neonatal outcomes after exposure to isotretinoin in 151 pregnant women. Among 1,026 callers at the Korean Teratology Information Service from 2001 to 2017 exposed to isotretinoin during the periconception period, 151 pregnant women who received counseling on teratogenic risk after visiting the clinic were included. @*Results@#Among the 151 participants who visited the clinic, only 42 were evaluated using ultrasonography until approximately 20 weeks of gestation. Ultimately, 23 patients were included in the study. The average gestation period during the last exposure to the drug was 2 weeks, and the average daily exposure dose was 12 mg. There were two cases of major birth defects in the exposure group. Spontaneous abortion rates were 17.7% and 8.7% in the exposure and nonexposure groups, respectively (P=0.035). There was no significant difference between the exposure and non-exposure groups in terms of pregnancy and neonatal outcomes. @*Conclusion@#There was no significant difference in pregnancy and neonatal outcomes, including birth defects, between the exposure and non-exposure groups. Further studies with larger sample sizes are required to validate our findings.
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Background@#Recently, CrpP enzymes have been described as a novel cause of ciprofloxacin resistance. The crpP gene encodes a novel protein that specifically confers resistance to ciprofloxacin through an adenosine triphosphate-dependent mechanism that phosphorylates the antimicrobial. In this study, the current prevalence of the crpP gene in carbapenemaseproducing Pseudomonas aeruginosa blood isolates was evaluated. @*Methods@#During the study of the Antimicrobial Resistance Surveillance System in Korea, 22 blood isolates of carbapenemase-producing P. aeruginosa were collected from nine general hospitals and two nursing homes in the year 2020. Resistance genes and phylogenic trees were analyzed with the whole genome sequencing data. @*Results@#A total of 11 P. aeruginosa blood isolates coharbored the crpP and carbapenemase genes (nine IMP-6 producers and two GES-5-producers). Nine NDM-1-producers coharbored aac(6')-Ib-cr and qnrVC1 . One GES-9-producer also carried aac(6')-Ib-cr, and one NDM-1-producer also carried qnrVC1. The phylogenic tree showed no epidemiologic link among the 22 carbapenemase-producing P. aeruginosa isolates. @*Conclusion@#This is the first report on the current prevalence of the crpP gene in carbapenemaseproducing P. aeruginosa blood isolates in Korea.
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Background@#The incidence of community-associated (CA) Clostridioides difficile infection (CDI) has increased in Korea. In this study, we evaluated CA-CDI risk factors in terms of clinical features and ribotype considering its region-specific molecular epidemiology. @*Methods@#A retrospective case-control study was performed on two groups of CDI patients:127 subjects with CA-CDI and 265 subjects with healthcare-associated (HA)-CDI. Risk factors for CA-CDI were evaluated in terms of clinical and microbiological features such as toxin type and ribotype. @*Results@#A comparison of the two groups of CDI patients revealed that inflammatory bowel disease, diarrhea, abdominal pain, and fever were more closely associated with CA-CDI. The toxin types and ribotypes of C. difficile were similar between the two groups. After adjusting for variables, no risk factors were identified for CA-CDI compared with HA-CDI. @*Conclusion@#Specific risk factors for CA-CDI were not identified in this study.
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Objective@#This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors. @*Methods@#A total of 96 participants with ASD (mean age=14.30 years; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants’ parents completed the Child Behavior Checklist (CBCL). Pearson’s correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson’s correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants’ age and IQ. @*Results@#The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors. @*Conclusion@#Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.
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Objective@#Adults with autism spectrum disorders (ASD) experience significant difficulties with executive functioning (EF) and related adaptive skills, yet the lack of interventions in South Korea targeting these areas has resulted in a heightened need to develop an evidence- based program. Therefore, we developed a novel intervention aiming to enhance everyday EF and daily adaptive skills in adults with high-functioning ASD and conducted a pilot study to evaluate the validity and feasibility of the program. @*Methods@#A behavioral intervention of 10-weekly sessions was developed based on literature searches and focus group interviews. Seven adults with high-functioning ASD (mean age=20.29) participated in a single-group pilot trial. We used self and parent-report questionnaires as well as skills measured by assessment instruments to analyze differences before and after the intervention. @*Results@#Significant improvements were shown in everyday EF, including time management, organization, self-restraint, and regulation of emotions. Additionally, results demonstrated an enhancement in adaptive functioning, especially in the subdomains of daily living skills. Analyses of parental outcomes only revealed a significant decrease in the scores of emotion regulation. @*Conclusion@#The current study provides good evidence for the validity and feasibility of an intervention to improve everyday EF and adaptive skills in adults with ASD.
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Objective@#Isotretinoin is among the most notorious human teratogens, documented originally as causing up to 30% of malformations. This systematic review and meta-analysis aimed to evaluate the rates of major malformation (MM) among isotretinoin-exposed pregnant women over the years through a systematic review and meta-analysis. @*Methods@#Eligible studies were searched and identified using various databases. Single-arm meta-analysis and meta-analysis of odd ratios among controlled studies were performed using Review Manager version 5.3. @*Results@#Ten eligible studies that combined 2,783 isotretinoin-exposed women were included in our study. The rate of MM weighted for the sample size was 15%. Three studies that included an unexposed comparison group were eligible for the meta-analysis. The pooled odds ratio of MM for isotretinoin-exposed women was 3.76. After 2006, the pooled odds ratio of MM for isotretinoin exposure was significantly lower at 1.04. @*Conclusion@#The current rate of MM in isotretinoin-exposed women was substantially lower after 2006.
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Background and Objectives@#Mesenchymal stem cells (MSCs) elicit therapeutic effects against liver fibrosis in animal models. Human liver stem cells (HLSCs) are cells isolated from human liver tissue that have mesenchymal morphology and express MSC markers. HLSCs also possess intrahepatic stem cell properties. We introduce a rat model of liver fibrosis and trans-portal transplantation of HLSC to demonstrate alleviation of liver fibrosis. @*Methods@#and Results: Liver fibrosis was induced by intraperitoneal injection of Carbon tetrachloride (CCl 4 ). Sprague Dawley rats underwent simultaneous partial hepatectomy of the left hepatic lobe and HLSC transplantation via the portal vein. Gross appearance of the liver observed following CCl 4 injection showed cholestasis and surface nodularity. Sirius red staining revealed deposition of collagen fibers in the extracellular matrix (ECM). Following HLSC transplantation, human albumin secreting cells were detected by immunohistochemistry in liver specimens. Quantitative measurements of fibrosis area stained by Sirius red were compared between baseline and post-HLSC transplant (1×10 7 cells) following 10 weeks of CCl 4treatment liver specimens. Fibrosis area (p＜0.05), serum markers of liver inflammation and fibrosis (AST, ALT levels and APRI, p＜0.05) significantly decreased from baseline after HLSC transplantation. RNA expression in liver tissues revealed significant decrease in tissue inhibitor of matrix metalloproteinase 1 (TIMP1), TIMP2 expression and increase in hepatocyte growth factor expression following HLSC transplantation (p＜0.05). @*Conclusions@#HLSC transplantation effectively reduced the area of liver fibrosis with increased expression of factors promoting ECM degradation. These findings suggest the potential therapeutic role of HLSCs in various liver diseases presenting with liver fibrosis.
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Background@#One health is a flexible concept with many facets, including the environment, community, and the nosocomial super-bacteria resistance network. We investigated the molecular prevalence of extended-spectrum-β-lactamase-producing Escherichia coli (ESBL-EC) in workers, livestock, and the farm environment in Korea. @*Methods@#ESBL-EC isolates were obtained from samples from 19 swine farms, 35 retail stores, seven slaughterhouses, and 45 related workers throughout Korea from August 2017 to July 2018, using ChromID ESBL (BioMérieux, Marcy l’Etoile, France) agar and enrichment broth. The presence of ESBL and mobilized colistin resistance (mcr) genes and antimicrobial resistance were determined. Clonality was evaluated with pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). @*Results@#In total, 232 ESBL-EC isolates were obtained from 1,614 non-duplicated samples (14.4% positive rate). The ESBL-EC isolates showed regional and source-related differences. blaCTX-M-55 (N = 100), blaCTX-M-14 (N = 65), blaCTX-M-15 (N = 33), and blaCTX-M-65 (N = 23) were common ESBL types. The ESBL-EC isolates showed high resistance rates for various antimicrobial classes; however, all isolates were susceptible to carbapenem. One swine-originating colistin-resistant isolate did not carry any known mcr gene. PFGE was successful for 197 of the 232 isolates, and most PFGE types were heterogeneous, except for some dominant PFGE types (O, R, T, U, and V). MLST of 88 isolates was performed for representative PFGE types; however, no dominant sequence type was observed. @*Conclusions@#The proportion of ESBL-EC in swine industry-related samples was significant, and the isolates harbored common clinical ESBL gene types. These molecular epidemiologic data could provide important evidence for antimicrobial-resistance control through a one health approach.
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Background@#The purpose of this study was to analyze the clinical and microbiological characteristics of recurrent urinary tract infection (UTI) caused by Escherichia coli— the most common etiological agent. @*Methods@#Cases of recurrent and single episodes of UTI caused by E. coli were evaluated retrospectively for a period of 6 months (January-June 2019) to analyze the clinical and molecular characteristics of this disease. @*Results@#Healthcare-associated UTI, E. coli bacteremia, and poor microbial clearance 7 days post infection were associated more with the recurrent episodes of infection. E. coli isolates from subjects with recurrent UTIs showed higher rates of antimicrobial resistance and extended-spectrum β-lactamase (ESBL) production. The E. coli clone— sequence type 131 was detected in similar proportions in isolates, recovered from subjects in both groups— recurrent episodes and single episode of UTI. @*Conclusion@#The control of antimicrobial-resistant ESBL-producing E. coli strains may be difficult using antimicrobial therapy and subsequently delay the clearance of the etiologic agent. This could play a major role in the development of recurrent UTIs.
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Purpose@#This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. @*Methods@#Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. @*Results@#Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). @*Conclusion@#Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.
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Objective@#This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors. @*Methods@#A total of 96 participants with ASD (mean age=14.30 years; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants’ parents completed the Child Behavior Checklist (CBCL). Pearson’s correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson’s correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants’ age and IQ. @*Results@#The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors. @*Conclusion@#Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.
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Objective@#Adults with autism spectrum disorders (ASD) experience significant difficulties with executive functioning (EF) and related adaptive skills, yet the lack of interventions in South Korea targeting these areas has resulted in a heightened need to develop an evidence- based program. Therefore, we developed a novel intervention aiming to enhance everyday EF and daily adaptive skills in adults with high-functioning ASD and conducted a pilot study to evaluate the validity and feasibility of the program. @*Methods@#A behavioral intervention of 10-weekly sessions was developed based on literature searches and focus group interviews. Seven adults with high-functioning ASD (mean age=20.29) participated in a single-group pilot trial. We used self and parent-report questionnaires as well as skills measured by assessment instruments to analyze differences before and after the intervention. @*Results@#Significant improvements were shown in everyday EF, including time management, organization, self-restraint, and regulation of emotions. Additionally, results demonstrated an enhancement in adaptive functioning, especially in the subdomains of daily living skills. Analyses of parental outcomes only revealed a significant decrease in the scores of emotion regulation. @*Conclusion@#The current study provides good evidence for the validity and feasibility of an intervention to improve everyday EF and adaptive skills in adults with ASD.
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Objective@#Isotretinoin is among the most notorious human teratogens, documented originally as causing up to 30% of malformations. This systematic review and meta-analysis aimed to evaluate the rates of major malformation (MM) among isotretinoin-exposed pregnant women over the years through a systematic review and meta-analysis. @*Methods@#Eligible studies were searched and identified using various databases. Single-arm meta-analysis and meta-analysis of odd ratios among controlled studies were performed using Review Manager version 5.3. @*Results@#Ten eligible studies that combined 2,783 isotretinoin-exposed women were included in our study. The rate of MM weighted for the sample size was 15%. Three studies that included an unexposed comparison group were eligible for the meta-analysis. The pooled odds ratio of MM for isotretinoin-exposed women was 3.76. After 2006, the pooled odds ratio of MM for isotretinoin exposure was significantly lower at 1.04. @*Conclusion@#The current rate of MM in isotretinoin-exposed women was substantially lower after 2006.
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Purpose@#This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. @*Methods@#Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. @*Results@#Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). @*Conclusion@#Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.
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Ovarian pregnancies comprise approximately 3% of ectopic pregnancies. Moreover, ovarian pregnancies in the second trimester are extremely rare. We herein present a case of ruptured ovarian pregnancy in the second trimester. A 26-year-old Asian woman presented to our hospital complaining of an abrupt mental change. She was pregnant; however, she had not been receiving antenatal care. Her initial vital signs were unstable, and pelvic ultrasound revealed pelvic fluid collection. We analyzed the hemoperitoneum and performed exploratory laparotomy. When her abdomen was opened, we observed that her right ovary was ruptured. Placental cord insertion originated from the ovary, and a fetus was found in the pelvic cavity. The ovarian pregnancy was detected in a delayed state. Pregnant women require appropriate antenatal care, and pelvic ultrasound should be performed in the second trimester to ensure that the fetus is in the intrauterine cavity.
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Active surveillance culture (ASC) can help detect hidden reservoirs, but the routine use of ASC for extended spectrum β-lactamase-producing Enterobacteriaceae is controversial in an endemic situation. We aimed to determine the prevalence and risk factors of extended spectrum β-lactamase-producing Klebsiella pneumoniae (EBSL-Kpn) colonization among intensive care unit (ICU)-admitted patients. Prospective screening of ESBL-Kpn colonization was performed for ICU-admitted patients within 48 hours for two months. A perirectal swab sample was inoculated on MacConkey agar supplemented with 2 µg/mL ceftazidime. ESBL genotype was determined by PCR-sequencing, and clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). The risk factors of ESBL-Kpn colonization were evaluated. The ESBL-Kpn colonization rate among the 281 patients at ICU admission was 6.4% (18/281), and bla(CTX-M-15) was detected in all isolates. ESBL producers also showed resistance to fluoroquinolone (38.9%, 7/18). All isolates had the same ESBL genotype (bla(CTX-M-15)) and a highly clustered PFGE pattern, suggesting cross-transmission without a documented outbreak. In univariate analysis, the risk factor for ESBL-Kpn colonization over the control was the length of hospital stay (odds ratio=1.062; P=0.019). Routine use of ASC could help control endemic ESBL–Kpn for ICU patients.
Subject(s)
Humans , Agar , Ceftazidime , Colon , Critical Care , Electrophoresis, Gel, Pulsed-Field , Enterobacteriaceae , Genotype , Intensive Care Units , Klebsiella pneumoniae , Klebsiella , Length of Stay , Mass Screening , Prevalence , Prospective Studies , Risk FactorsABSTRACT
No abstract available.