•The impact of vancomycin resistance in enterococcal bacteremia is controversial.•Monomicrobial Enterococcus faecium bacteremia was collected through multicenter surveillance.•Vancomycin resistance ...was independently associated with all-cause mortality.•Pitt score and inappropriate definitive antibiotics were associated with mortality.•Further efforts must be made to mitigate the spread of vancomycin-resistant enterococci and to improve therapy.
It is unclear whether the poor outcome of patients with severe vancomycin-resistant enterococci (VRE) infection is attributable to vancomycin resistance or to Enterococcus faecium (Efm), which predominates among VRE.
Retrospective study of a prospectively identified cohort from nationwide surveillance. A cohort of consecutive, nonduplicate episodes of monomicrobial bloodstream infections (BSIs) caused by Efm in 2016 was selected. The primary outcome was all-cause, 30-day, in-hospital mortality. Inverse probability weighting was applied using the propensity score for vancomycin-resistant Efm (VREfm) BSI.
A total of 241 Efm BSI episodes were included, of which 59 (24.5%) were VREfm. Patients with VREfm BSI were younger but had similar comorbidities to those with vancomycin-sensitive Efm (VSEfm) BSI. Multivariable logistic regression revealed that younger age, previous piperacillin-tazobactam use, and steroid use were significant risk factors for VREfm BSI, but 30-day in-hospital mortality did not differ significantly between groups (35.6% and 23.6% for VREfm and VSEfm, respectively; odds ratio, 1.79; 95% confidence interval, 0.95-3.37; P = 0.101). However, Cox regression with inverse probability weighting revealed that vancomycin resistance was independently associated with an increased risk of mortality (adjusted hazard ratio, 2.18; 95% confidence interval, 1.03-4.62; P = 0.041).
In patients with Efm BSI, vancomycin resistance was independently associated with mortality.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The widespread administration of carbapenems to patients with ESBL-producing Enterobacteriaceae bacteraemia (ESBL-B) has accelerated the emergence of carbapenem-resistant Enterobacteriaceae. This ...study aimed to systematically review recently published data to evaluate the clinical effectiveness of carbapenems, compared with other antibiotics, in the treatment of ESBL-B.
We searched the Ovid-Medline, Ovid-Embase, Cochrane Library and five Korean local databases until January 2016. We selected studies that reported overall mortality in patients with ESBL-B who had been treated with carbapenems and alternatives. Overall mortality was assessed as the primary outcome and sepsis-related mortality and adverse events were analysed as secondary outcomes.
Thirty-five publications fulfilled the inclusion criteria. Regarding empirical therapy, there were no significant differences between the groups that received carbapenems and those that received non-carbapenems in relation to overall mortality. Regarding definitive therapy, overall mortality was lower for patients administered carbapenems compared with those administered non-carbapenems risk ratio (RR) 0.78, 95% CI 0.61-0.98, non-β-lactam/β-lactamase inhibitor combinations (non-BL/BLI) (RR 0.71, 95% CI 0.56-0.90) and cephalosporins (RR 0.56, 95% CI 0.42-0.74). There were no differences between the carbapenems and the other antibiotics, namely BL/BLIs, quinolones and aminoglycosides.
This meta-analysis showed that BL/BLIs may be promising alternative antibiotics for definitive therapy in patients with ESBL-B. However, the lack of robust data derived from randomized controlled trials limits the conclusions and inferences from the pooled data.
Countries authorized the emergency use of oral antiviral agents in patients with mild-to-moderate COVID-19. We assessed the cost-effectiveness of introducing these novel oral antiviral agents to ...reduce the number of severe patients infected with SARS-CoV-2 and the burden of the medical systems.
From the existing COVID-19 Epidemiology Model, we projected the number of people who require hospital/ICU admissions in Korea in 2022. Treatment scenarios included (i) all adults, (ii) elderly, and (iii) adult patients with underlying diseases administered molnupiravir or nirmatrelvir/ritonavir vis-a-vis standard care. Under the current health systems capacity, we calculate the incremental cost per severe patient averted and per net admission for each scenario relative to standard care.
An estimated, 236,510 COVID-19 patients would require hospital/ICU in Korea in 2022 with standard care. Nirmatrelvir/ritonavir (87% efficacy) is expected to reduce the number of severe patients requiring hospital/ICU admissions by 80%, 24%, and 17% (25%, 8%, and 4% by molnupiravir with 30% efficacy) when targeting all adults, adults with underlying diseases, and elderly patients, respectively. Administration of Nirmatrelvir/ritonavir may be cost-effective as $1,454, $8,878, and $8,964 (while molnupiravir may be less likely cost-effective as $7,915, $28,492, $29,575) per severe patient averted if targeted respectively to the target group mentioned above, compared to standard care.
In Korea, oral nirmatrelvir/ritonavir treatment of symptomatic COVID-19 patients can be highly cost-effective if targeted to elderly patients while substantially reducing hospital admission demand below the health systems capacity limit if all adult patients are targeted compared to standard care.
Abstract During the 2015 Korean MERS outbreak, we experienced atypical presentations of MERS-CoV infections in three immunocompromised hosts that warranted exceptional management. Case 1 showed ...delayed symptom development after a four-day asymptomatic period, Case 2 experienced a 20-day incubation period, and Case 3 exhibited persistent viral shedding without clinical deterioration. Recognizing these exceptions is extremely important in the management of MERS-CoV-exposed or -infected patients and for control of potential MERS outbreaks.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
•There are limited data on teicoplanin as a treatment for Enterococcus faecium bacteremia.•Teicoplanin and vancomycin were compared in a multicenter surveillance.•There was no significant difference ...in 30-day in-hospital mortality.•Our findings suggest teicoplanin as a useful alternative to vancomycin.
Vancomycin and teicoplanin are glycopeptides with activity against Enterococcus faecium. However, studies on the clinical efficacy of teicoplanin are limited. This study aimed to compare the therapeutic efficacy of teicoplanin and vancomycin in E. faecium bacteremia.
We identified patients with bloodstream infections prospectively from July 2015 to December 2016 in 14 hospitals as part of a multicenter nationwide surveillance. Patients with E. faecium monomicrobial bacteremia were selected. Teicoplanin and vancomycin groups included patients treated with either agent for ≥48 hours. The primary outcome was 30-day all-cause in-hospital mortality. The Cox proportional hazards model with inverse probability weighting was used to account for the imbalance in baseline characteristics between the two groups.
Among 97 patients with E. faecium bacteremia, 33 (34%) were treated with teicoplanin and 64 (66%) with vancomycin. There were no significant differences in 30-day in-hospital mortality (18.2% vs 26.6%, P = 0.358) and 7-day mortality (6.1% vs 15.6%, P = 0.212). Furthermore, multivariable analysis confirmed that the use of teicoplanin was not significantly associated with mortality (adjusted odds ratio, 0.72; 95% confidence interval, 0.28-1.86; P = 0.494).
We found no significant differences in the clinical outcomes. These findings suggest teicoplanin as a useful alternative to vancomycin.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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.
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.
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.
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.
After the eradication of smallpox, there have been no specific public health measures for any Orthopoxviruses (OPXVs). Therefore, it is necessary to countermeasure OPXV infections after Mpox ...(formerly monkeypox) occurrences, such as the latest global outbreak in 2022–2023. This study aimed to provide crucial insights for the development of effective public health policy making against mpox in populations residing in regions where the virus is not prevalent.
This study used enzyme-linked immunosorbent assays (ELISA) to examine smallpox and mpox antibodies in Koreans with three different age groups. We analyzed 56 sera obtained from a tertiary care hospital in South Korea between September 2022 and April 2023. Plasma levels of antibodies against the viral proteins of smallpox (variola cytokine response-modifying protein B) and MPXV (A29) were measured using enzyme-linked immunosorbent assays.
Plasma samples from participants in their early 40 s and older exhibited higher reactivity to viral antigens than those from younger participants. Furthermore, there was a strong positive correlation in antibody positivity for the two different viruses across the sera.
The presence of low antibody levels in participants ˂40 years may hinder their ability to defend against OPXV. Therefore, it is imperative to implement effective public health measures to mitigate the transmission of OPXV within the community. These findings serve as fundamental information for devising strategies to combat mpox efficiently, particularly in regions where the virus is not prevalent.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Although multilocus sequence typing (MLST) has been used to study molecular epidemiology and to explore the population structure of
Enterococcus faecium
, vancomycin-resistant
E. faecium
(VREF) ...strains lacking the
pstS
gene that were non-typable using conventional MLST methods were reported recently. We found nationwide emergence of VREF isolates lacking
pstS
in Korea and hereby report the molecular characteristics of these isolates. Forty-six VREF isolates lacking the
pstS
gene were identified among 300 VREF rectal isolates collected from hospitalized patients between 2014 and 2015. MLST was performed and clonal relatedness was determined by pulsed-field gel electrophoresis (PFGE). Four VREF ST1421 isolates were whole-genome sequenced. Among the VREF rectal isolates lacking
pstS
, 98% were classified as ST1421, which has identical allelic profiles to ST17 for all housekeeping genes except
pstS
. PFGE pattern analyses revealed 32 pulsotypes. All isolates harbored Tn
1546
components with various transposase and insertion sequences. The whole-genome sequencing of four VREF ST1421 isolates showed that the
pstS
gene region was deleted at various locations with considerable inversion. The
pstS
gene was also depleted in 12.1% of 33 VREF clinical isolates in 2006–2007 and in 11.8% of 59 clinical isolates in 2012–2013. VREF ST1421 strains lacking the
pstS
gene have emerged in Korea. The emergence and spread of
pstS
-deleted VREF strains pose a serious challenge for epidemiological investigation. Alternative molecular typing methods to MLST will be increasingly necessary.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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