Coinfection of Severe Fever With Thrombocytopenia Syndrome Virus and Coxiella burnetii in Developmental Stage of Hard Ticks in Subtropical Region of Korea

Background@#Severe fever with thrombocytopenia syndrome virus (SFTSV) is transmitted through tick bites. Ticks are potential vectors for the bacterium Coxiella burnetii that causes Query fever. Here, we analyzed SFTSV and C. burnetii co-infection rates in ticks in rural areas of Jeju Island, South Korea. @*Methods@#Free ticks were collected from the natural environment of the island between 2016 and 2019, and SFTSV RNA was extracted. Additionally, ribosomal RNA gene sequencing was used to identify Coxiella species. @*Results@#Haemaphysalis longicornis was the most common tick species followed by H. flava. Tick number gradually increased from April, peaked in August, and was lowest in March. Of all the collected ticks, 82.6% (2,851/3,458) were nymphs, 17.9% (639/3,458) adults, and 0.1% (4/3,458) larvae. SFTSV-infected ticks comprised 12.6% of all ticks; their numbers were the lowest in November–December, increased from January, and were mostly identified in the adult stage during June–August. C. burnetii infections were detected in 4.4% of the SFTSVinfected H. longicornis ticks. C. burnetii co-infection was mainly observed in the nymph stage of H. longicornis, with the highest infection rate in January, followed by December and November. @*Conclusion@#Our findings suggest that Jeju Island has a high SFTSV and potential C. burnetii infection in ticks. This study provides important insights regarding SFTS and Q fever risk to humans in South Korea.

Use of Antibiotics Within the Last 14 Days of Life in Korean Patients:A Nationwide Study

Background@#Antimicrobial prescriptions for serious chronic or acute illness nearing its end stages raise concerns about the potential for futile use, adverse events, increased multidrugresistant organisms, and significant patient and social cost burdens. This study investigated the nationwide situation of how antibiotics are prescribed to patients during the last 14 days of life to guide future actions. @*Methods@#This nationwide multicenter retrospective cohort study was conducted at 13 hospitals in South Korea from November 1 to December 31, 2018. All decedents were included in the study. Antibiotic use during the last two weeks of their lives was investigated. @*Results@#A total of 1,201 (88.9%) patients received a median of two antimicrobial agents during the last two weeks of their lives. Carbapenems were prescribed to approximately half of the patients (44.4%) in the highest amount (301.2 days of therapy per 1,000 patient-days).Among the patients receiving antimicrobial agents, 63.6% were inappropriate and only 327 patients (27.2%) were referred by infectious disease specialists. The use of carbapenem (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.13–2.03; P = 0.006), underlying cancer (OR, 1.56; 95% CI, 1.20–2.01, P = 0.047), underlying cerebrovascular disease (OR, 1.88; 95% CI, 1.23–2.89, P = 0.004), and no microbiological testing (OR, 1.79; 95% CI, 1.15–2.73; P = 0.010) were independent predictors for inappropriate antibiotic prescribing. @*Conclusion@#A considerable number of antimicrobial agents are administered to patients with chronic or acute illnesses nearing their end-of-life, a high proportion of which are prescribed inappropriately. Consultation with an infectious disease specialist, in addition to an antimicrobial stewardship program, may be necessary to induce the optimal use of antibiotics.

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

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.

Expert Consensus on Measures to Promote Physical and Psychological Health among COVID-19-Related Healthcare Workers in Korea using Delphi Technique

Background@#The coronavirus disease 2019 (COVID-19) pandemic has caused health problems and distress among healthcare workers (HCWs), so supportive measures to promote their health and relieve distress are needed. @*Materials and Methods@#We conducted two rounds of Delphi surveys with 20 COVID-19-related frontline healthcare professionals and public officials. The surveys evaluated means of supporting HCWs’ health by improving health care systems and working environments in terms of effectiveness and urgency. The validity of the measures was assessed by calculating the content validity ratio. @*Results@#The top-priority measures to support HCWs were “secure isolation units capable of treating severe cases” in the facility infrastructure category, “secure nursing staff dedicated for patients in the intensive care units” in the personnel infrastructure category, “improve communication between central office and frontline field” in the cooperation system category, “support personal protective equipment and infection control supplies” in the aid supplies category, and “realization of hazard pay” in the physical/mental health and compensation category. @*Conclusion@#There was consensus among the experts on the validity and priorities of policies in the facility, personnel, cooperation, supplies, and compensation categories regarding measures to promote COVID-19 related HCWs’ health.

Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults

The guidelines are intended to provide practical information for the correct use of antibiotics for intra-abdominal infections in Korea. With the aim of realizing evidence-based treatment, these guidelines for the use of antibiotics were written to help clinicians find answers to key clinical questions that arise in the course of patient care, using the latest research results based on systematic literature review. The guidelines were prepared in consideration of the data on the causative pathogens of intra-abdominal infections in Korea, the antibiotic susceptibility of the causative pathogens, and the antibiotics available in Korea.

Aseptic Meningitis Following Second Dose of an mRNA Coronavirus Disease 2019 Vaccine in a Healthy Male:Case Report and Literature Review

no abstract available.

Reply: Aseptic Meningitis and mRNA Coronavirus Disease 2019 Vaccine

no abstract available.

Reply: Diagnose Aseptic Meningitis Caused by SARS-CoV-2 Vaccination Only After Ruling Out All Possible Differentials

no abstract available.

Clinical Characteristics and Risk Factors for Severe Disease of Coronavirus Disease 2019 in a Low Case Fatality Rate Region in Korea

Background@#Jeju island had the seventh highest incidence rate of coronavirus disease 2019 (COVID-19) but showed the lowest case fatality rate among 17 provinces of Korea, which may be associated with comorbidities and geographic differences. This study aimed to analyze the epidemiological and clinical characteristics of patients with COVID-19 and evaluate the risk factors for severe COVID-19 in Jeju island, Korea. @*Materials and Methods@#All patients with COVID-19 admitted between February 20, 2020, and June 19, 2021, at a single center were retrospectively enrolled in this study. The severity of illness was defined using five categories (asymptomatic, mild, moderate, severe, and critical) according to the National Institute of Health criteria. Then, patients with severe and critical illness were grouped into a severe group, whereas patients with asymptomatic, mild, and moderate illness were grouped into a non-severe group. Multivariate logistic regression analysis was performed using risk factors that were found to be significantly associated with the severe group. @*Results@#This study included 348 patients with a median age was 57 years, and 37.5% were aged 60 or older. Among them, 43.4% were male and 10.9% were asymptomatic, whereas 41.4%, 33.9%, 12.9%, and 1.1% had mild, moderate, severe, and critical illness. The all-cause mortality of patients with COVID-19 was 0.28% (1/348). Among confirmed patients with COVID-19, exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was mainly within Jeju island (75.9%). The mean body mass index was 24.09 ± 4.04 kg/m 2 , the median comorbidity index score was low in each group (0 in asymptomatic; 1 in mild; 1 in moderate; 1 in severe; and 2 in critical group, P <0.548). In the multivariable analysis, male sex [odds ratio (OR), 6.37; 95% confidence interval (CI), 2.69 – 15.13; P <0.001], ≥65 years of age (OR, 2.68; 95% CI, 1.18 – 6.10; P <0.019), chronic pulmonary disease (OR, 6.10; 95% CI, 1.40 – 26.61; P = 0.016), and length of fever duration (OR, 1.33; 95% CI, 1.19 – 1.49; P <0.001) were independently associated with severe COVID-19. @*Conclusion@#The most relevant risk factors of COVID-19 severity were male sex, older age, underlying chronic lung diseases, and duration of fever during hospitalization. The risk factors for severe COVID-19 were not significantly different from those reported in other studies. However, a lower proportion of the older population among confirmed SARS-CoV-2 cases might contribute to the lower fatality rate than the national rate.

Evaluation of the early fluconazole treatment of candidemia protocol with automated short message service alerts: a before-and-after study

Background/Aims@#We introduced the Early Fluconazole Treatment in Candidemia (EFTC) protocol in August 2015 to improve the outcomes of patients with candidemia. This study evaluated the effectiveness of the EFTC protocol. @*Methods@#We conducted a retrospective before-and-after study among patients in the intensive care units and Hemato-Oncology and General Surgery wards of our hospital between January 2013 and December 2018. The EFTC protocol entailed sending an automatic notification by short message service, feedback to the responsible healthcare worker, and regular standardized education of medical staff. On receiving a notification, physicians prescribed empirical fluconazole immediately. The effectiveness of the EFTC protocol was evaluated by multivariate analysis of risk factors for 30-day mortality. @*Results@#Of 103 patients with candidemia, 50 were admitted before (pre-EFTC group) and 53 were admitted after (post-EFTC group) the introduction of the EFTC protocol. Patients’ mean age ± SD was 67.1 ± 18.6 years, and 55 (53.4%) were male. The mean ± SD time from Candida isolation to antifungal drug administration in the pre-EFTC and post-EFTC groups was 89.1 ± 73.6 and −9.8 ± 63.9 minutes, respectively (p = 0.01). The 30-day mortality in the pre-EFTC and post-EFTC groups was 54.5% (95% confidence interval [CI], 42.3 to 66.7), and 37.6% (95% CI, 26.1 to 49.1), respectively (p = 0.05). In the multivariate analysis, implementation of the EFTC protocol was independently associated with a reduction in 30-day mortality (odds ratio, 0.27; 95% CI, 0.12 to 0.63; p = 0.01). @*Conclusions@#The early f luconazole treatment, monitoring, and education were effective in reducing mortality in patients with candidemia.

Evaluation of the early fluconazole treatment of candidemia protocol with automated short message service alerts: a before-and-after study

Background/Aims@#We introduced the Early Fluconazole Treatment in Candidemia (EFTC) protocol in August 2015 to improve the outcomes of patients with candidemia. This study evaluated the effectiveness of the EFTC protocol. @*Methods@#We conducted a retrospective before-and-after study among patients in the intensive care units and Hemato-Oncology and General Surgery wards of our hospital between January 2013 and December 2018. The EFTC protocol entailed sending an automatic notification by short message service, feedback to the responsible healthcare worker, and regular standardized education of medical staff. On receiving a notification, physicians prescribed empirical fluconazole immediately. The effectiveness of the EFTC protocol was evaluated by multivariate analysis of risk factors for 30-day mortality. @*Results@#Of 103 patients with candidemia, 50 were admitted before (pre-EFTC group) and 53 were admitted after (post-EFTC group) the introduction of the EFTC protocol. Patients’ mean age ± SD was 67.1 ± 18.6 years, and 55 (53.4%) were male. The mean ± SD time from Candida isolation to antifungal drug administration in the pre-EFTC and post-EFTC groups was 89.1 ± 73.6 and −9.8 ± 63.9 minutes, respectively (p = 0.01). The 30-day mortality in the pre-EFTC and post-EFTC groups was 54.5% (95% confidence interval [CI], 42.3 to 66.7), and 37.6% (95% CI, 26.1 to 49.1), respectively (p = 0.05). In the multivariate analysis, implementation of the EFTC protocol was independently associated with a reduction in 30-day mortality (odds ratio, 0.27; 95% CI, 0.12 to 0.63; p = 0.01). @*Conclusions@#The early f luconazole treatment, monitoring, and education were effective in reducing mortality in patients with candidemia.

Antimicrobial Susceptibility Trends of Streptococcus pneumoniae by Age Groups Over Recent 10 Years in a Single Hospital in South Korea

Purpose@#Streptococcus pneumoniae (S. pneumoniae) causes respiratory tract infections. Its non-vaccine serotypes and multidrug-resistant pneumococcal diseases have increased during the post-pneumococcal vaccination era. Therefore, it is important to understand the regional and age-related antimicrobial susceptibility of S. pneumoniae to select appropriate empirical antimicrobials. @*Materials and Methods@#We retrospectively studied trends in the antimicrobial resistance of S. pneumoniae to commonly prescribed antibiotics in patient groups of various ages at a single teaching hospital in Jeju Island from 2009 to 2018. @*Results@#In total, 1460 S. pneumoniae isolates were obtained during the study period. The overall antimicrobial resistance rates of S. pneumoniae to penicillin, erythromycin, ceftriaxone, levofloxacin, and vancomycin were 16.2%, 84.7%, 25.9%, 3.3%, and 0.0%, respectively, and the MDR rate was 6.7%. Erythromycin and ceftriaxone resistance rates increased by years; however, they were significantly reduced in adult groups. Levofloxacin resistance and MDR rates were also higher in adult groups. Overall, the MDR rate significantly increased during the recent 10 years, as well as in patients with a history of hospitalization within 90 days [odds ratio (OR)=3.58, 95% confidence interval (CI)=1.91–6.71] and sinusitis (OR=4.98, 95% CI=2.07–11.96). @*Conclusion@#Erythromycin and ceftriaxone resistance rates and the MDR rate of S. pneumoniae significantly increased during the recent 10 years; the trends in individual antimicrobial resistance rates significantly differed between the age groups. This study indicates the need for caution when using ceftriaxone as an empirical antimicrobial against pneumococcal infections.

A Fatal Pulmonary Event during Plasma Exchange in a Patient with Severe Fever with Thrombocytopenia Syndrome / 대한내과학회지

Severe fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus (SFTSV), a novel Phlebovirus, is endemic to South Korea, central and northeastern China, and western Japan. SFTS poses a threat to public health because of its high mortality and secondary transmission. Ticks and domestic animals are hosts for SFTSV in endemic areas. There is no specific treatment for SFTS, and avoiding tick bites is the best way to prevent infection. Early therapeutic plasma exchange (TPE) is a rescue therapy in patients with rapidly progressive SFTS. Here, we present a patient with SFTS who was improving on TPE but died suddenly due to acute lung injury after TPE.

A Rare Case of Chronic Otitis Media Caused by Mycobacterium massiliense in a Healthy Adult / 대한내과학회지

Mycobacterium massiliense (M. massiliense) is a novel nontuberculous mycobacteria (NTM) and an opportunistic pathogen that lives in the water, soil, food, and air. It is a subspecies of the rapidly growing mycobacteria Mycobacterium abscessus. This atypical pathogen has been reported mainly in patients with lung disease or those undergoing cosmetic or surgical procedures. A 62-year-old woman presented with productive otorrhea for 10 months, no history of surgery, and chronic otitis media. M. massiliense was identified from a tissue specimen using real-time polymerase chain reaction for NTM (Biosewoom, Seoul, Korea), and NTM was identified by acid-fast bacilli culture. Successful treatment consisted of clarithromycin for 4 months. No other case of chronic otitis media related to M. massiliense has been reported. This is the first confirmed case of chronic otitis media caused by M. massiliense in a healthy adult in South Korea.

Phylogenetic Analysis for the Origin of Typhoid Fever Outbreak on Jeju Island, Korea, in 2017

In June 2017, on Jeju Island, six patients were diagnosed with typhoid fever. All six patients were admitted to our hospital with fever, all of them had been working at the same hotel.The gyrA and gyrB genes of four out of six Salmonella typhi cases were amplified by polymerase chain reaction. The phylogenetic tree of the genes showed that the S. Typhi isolates from Jeju Island in 2017 had the same genotype and were similar to isolates from the United Kingdom.The origin of the isolates of the outbreak was the same, and the disease strain may have been imported from outside of Korea.

Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi

Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.

Acute Cholangitis Caused by Boryong Strain of Orientia tsutsugamushi

Scrub typhus present with a variety clinical manifestations caused by Orientia tsutsugamushi, it is sometimes accompanied by severe complications. The clinical course of this complication is not well clear. Herein, we first report a case with acute cholangitis and acalculous cholecystitis caused by the Boryong genotype of O. tsutsugamushi. A 82-year-old woman presented with fever and acute abdominal pain on the right upper quadrant. Initially, the patient showed an abnormality of liver enzymes of cholestatic pattern. An acute cholangitis and cholecystitis were suspected on the enhanced computed tomography (CT), and emergent endoscopic retrograde cholangiopancreatography (ERCP) performed. However, neither ERCP nor CT detected common bile duct stones or sludge. The patient's illness progressed despite bile drainage and antibiotic therapy. On the fifth day in hospital, an immunofluorescence IgG assay for O. tsutsugamushi was positive, and the patient newly developed a skin rash and an eschar lesion on the right abdomen. The polymerase chain reaction amplification of Orientia genes from blood and bile was positive, genotype of both samples was identified the Boryong type. The presentation of scrub typhus as an acute cholangitis is not reported till now. In endemic areas, scrub typhus would be considered a rare etiology of acute cholangitis.

First Report of Tenosynovitis Caused by Mycobacterium virginiense in Korea

No abstract available.

Changes in Serotype of Streptococcus pneumoniae After the Introduction of the 13-Valent Pneumococcal Vaccine in a Homogenous Population on Jeju Island

We compared the serotypes of Streptococcus pneumoniae between the pre-pneumococcal conjugate vaccine (PCV)13 era and post-PCV13 era among homogenous inhabitants of an isolated South Korean island. A total of 325 S. pneumoniae strains were isolated. In the pre-PCV13 era, 19A/F, 15A/F, 19B, and 23A serotypes were identified. In the post-PCV13 era, 15 serotypes were identified. The 19F and 23A serotypes showed the highest prevalence in the pre- and post-PCV13 era, respectively. After PCV13 introduction, the PCV 13 serotype coverage rate was decreased (80.0% and 30.5% in the pre- and post-PCV13 eras, respectively), while the proportion of non-PCV 13 serotypes increased.

Seroprevalence of Severe Fever with Thrombocytopenia Syndrome in the Agricultural Population of Jeju Island, Korea, 2015–2017

BACKGROUND@#Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease that is caused by the SFTS virus (SFTSV), and exhibits an overall mortality rate of approximately 20.0% in Korea. Most cases of this disease have been reported in Korea, East China, and Japan, and it mostly affects outdoor workers and farmers. This study aimed to investigate the seroprevalence of SFTSV among healthy farmers on Jeju Island, Korea.@*MATERIALS AND METHODS@#In this prospective cross-sectional study, we analyzed 421 blood samples obtained from 254 farmers (mean age, 59.9 years; 68.9% male) to determine the seroprevalence of SFTSV in 16 rural areas of the Jeju Special Self-Governing Province over a period of 3 years (January 2015–December 2017). We used an enzyme-linked immunosorbent assay to detect immunoglobulin (Ig) G antibodies against SFTSV in the collected samples.@*RESULTS@#The seroprevalence of the SFTSV IgG among farmers on Jeju Island was observed to be 2.4%. One subject showed seropositivity over the entire 3-year study period. The areas with the highest SFTSV IgG seropositivity rates were Seonheul-ri in Jocheon-eup, followed by Namwon-eup. Fruit farmers were at a higher risk of exposure to SFTSV than other farmers.@*CONCLUSION@#The seroprevalence of SFTSV in the healthy agricultural population of Jeju Island was not high. However, personal hygiene management should be implemented for the agricultural population in the endemic areas. Surveillance of mild or asymptomatic infections is required in the endemic regions.