Jae-Phil Choi

Post‐infectious irritable bowel syndrome in patients with Shigella infection

Background and Aims: Bacterial gastroenteritis has been known as a risk factor of irritable bowel syndrome (IBS). Several risk factors of post‐infectious IBS (PI‐IBS) have been documented. The aims of this study were to verify the role of bacterial gastroenteritis in the development of IBS and the risk factors for the development of PI‐IBS. The clinical course of PI‐IBS was also investigated.

Clinical Significance of Spontaneous Aeromonas Bacterial Peritonitis in Cirrhotic Patients: A Matched Case-Control Study

BACKGROUNDnAlthough Aeromonas species are known to cause bacteremia in patients with cirrhosis, less is known about spontaneous bacterial peritonitis (SBP) caused by Aeromonas species in these patients.nnnMETHODSnWe performed a retrospective, matched case-control study (1:2 ratio) consisting of patients presenting with SBP due to Aeromonas species from January 1997 through December 2006. Control subjects were patients with SBP caused by other organisms and were matched to the patients by age (+/- 1 year) and sex.nnnRESULTSnWe identified 43 patients with SBP due to Aeromonas species, 40 (93%) of whom had Aeromonas hydrophila infection and 3 (7%) of whom had Aeromonas sorbia infection. There were 81 control subjects, of whom 38 (47%) were infected with Escherichia coli, 25 (31%) were infected with Klebsiella species, 12 (15%) were infected with Streptococcus species, and 6 (7%) were infected with other bacteria. Baseline Child-Pugh class and model for end-stage liver disease score did not differ between groups. A significant increase in the incidence of infection during the warm season (July-September) was observed in the group with SBP due to Aeromonas species, compared with the group with SBP due to other bacteria (63% vs. 25%; P < .001). Diarrheal episodes were significantly more frequent in the group with SBP due to Aeromonas species (26% vs. 6%; P = .002). There were no statistically significant differences between groups with regard to appropriateness of initial antibiotic therapy,3-day mortality, and 30-day cumulative survival. In the group with Aeromonas infection, the in-hospital mortality rate was 23%; septic shock was the only independent prognostic factor of in-hospital mortality (odds ratio, 34.5;95% confidence interval, 1.9-640.6; P = .02).nnnCONCLUSIONnAeromonas species should be considered to be a causative organism of SBP in cirrhotic patients presenting with diarrheal episodes during the warm season. Compared with SBP caused by other organisms, SBP due to Aeromonas species was not associated with more-advanced cirrhosis.

The Outcomes of Using Colistin for Treating Multidrug Resistant Acinetobacter Species Bloodstream Infections

Despite the identification of Acinetobacter baumannii isolates that demonstrate susceptibility to only colistin, this antimicrobial agent was not available in Korea until 2006. The present study examined the outcomes of patients with multidrug resistant (MDR) Acinetobacter species bloodstream infection and who were treated with or without colistin as part of their regimen. The colistin group was given colistin as part of therapy once colistin became available in 2006. The non-colistin group was derived from the patients who were treated with other antimicrobial regimens before 2006. Mortality within 30 days of the onset of bacteremia occurred for 11 of 31 patients in the colistin group and for 15 of 39 patients in the non-colistin group (35.5% vs 38.5%, respectively, P = 0.80). Renal dysfunction developed in 50.0% of the 20 evaluable patients in the colistin group, but in 28.6% of the 35 evaluable patients in the non-colistin group (P = 0.11). On multivariate analysis, only an Acute Physiological and Chronic Health Evaluation II score ≥ 21 was associated with mortality at 30 days. This result suggests that administering colistin, although it is the sole microbiologically appropriate agent, does not influence the 30 day mortality of patients with a MDR Acinetobacter spp. bloodstream infection.

Extensive Viable Middle East Respiratory Syndrome (MERS) Coronavirus Contamination in Air and Surrounding Environment in MERS Isolation Wards

Middle East respiratory syndrome (MERS) coronavirus was found by reverse-transcription polymerase-chain-reaction from viral cultures of 4 of 7 air samples and 15 of 68 surface swabs from 3 MERS patients rooms, calling for epidemiologic investigation for contact and airborne transmission.

The clinical significance of concurrent Staphylococcus aureus bacteriuria in patients with S. aureus bacteremia.

OBJECTIVEnTo investigate the clinical significance of Staphylococcus aureus bacteriuria (SABU) in patients with S. aureus bacteremia (SAB).nnnMETHODSnWe reviewed clinical data for 203 patients with SAB from January 2006 to July 2007 in a tertiary care hospital. In all patients, blood and urine cultures were performed concurrently. Among these cases, we compared clinical data between patients with and without SABU. To rule out mere colonization of S. aureus through indwelling urinary catheters (IDUC), we excluded patients using IDUC and then repeated the analyses.nnnRESULTSnConcurrent SABU was observed in 31 of 203 patients (15.3%). In patients without an IDUC, 25 of 128 (19.5%) were positive for SABU. Concurrent SABU was associated with methicillin-susceptible, community-onset SAB, urinary tract obstruction/surgery, urinary tract infection, and vertebral osteomyelitis in patients with SAB. In patients without an IDUC, methicillin-susceptible SAB, urinary tract obstruction, urinary tract infection, and vertebral osteomyelitis were associated with concurrent SABU. Finally, concurrent SABU was not associated with the severity and fatality of SAB.nnnCONCLUSIONnWe found that SABU was not a result of colonization via IDUC, but instead is a frequent concomitant of SAB. In septic conditions, especially without IDUC, SABU may indicate SAB with foci of infection in the urinary tract or the vertebral column.

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

Background 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. Materials and Methods 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. Results 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. Conclusion 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.

Antiviral Treatment Guidelines for Middle East Respiratory Syndrome

Middle East respiratory syndrome (MERS) is an acute infectious disease of the respiratory system caused by the new betacoronavirus (MERS coronavirus, MERS-CoV), which shows high mortality rates. The typical symptoms of MERS are fever, cough, and shortness of breath, and it is often accompanied by pneumonia. The MERS-CoV was introduced to Republic of Korea in May 2015 by a patient returning from Saudi Arabia. The disease spread mostly through hospital infections, and by the time the epidemic ended in August, the total number of confirmed diagnoses was 186, among which 36 patients died. Reflecting the latest evidence for antiviral drugs in the treatment of MERS-CoV infection and the experiences of treating MERS patients in Republic of Korea, these guidelines focus on antiviral drugs to achieve effective treatment of MERS-CoV infections.

Surveillance of the Middle East respiratory syndrome (MERS) coronavirus (CoV) infection in healthcare workers after contact with confirmed MERS patients: incidence and risk factors of MERS-CoV seropositivity.

n Abstractn n Given the mode of transmission of Middle East respiratory syndrome (MERS), healthcare workers (HCWs) in contact with MERS patients are expected to be at risk of MERS infections. We evaluated the prevalence of MERS coronavirus (CoV) immunoglobulin (Ig) G in HCWs exposed to MERS patients and calculated the incidence of MERS-affected cases in HCWs. We enrolled HCWs from hospitals where confirmed MERS patients had visited. Serum was collected 4 to 6xa0weeks after the last contact with a confirmed MERS patient. We performed an enzyme-linked immunosorbent assay (ELISA) to screen for the presence of MERS-CoV IgG and an indirect immunofluorescence test (IIFT) to confirm MERS-CoV IgG. We used a questionnaire to collect information regarding the exposure. We calculated the incidence of MERS-affected cases by dividing the sum of PCR-confirmed and serology-confirmed cases by the number of exposed HCWs in participating hospitals. In total, 1169 HCWs in 31 hospitals had contact with 114 MERS patients, and among the HCWs, 15 were PCR-confirmed MERS cases in study hospitals. Serologic analysis was performed for 737 participants. ELISA was positive in five participants and borderline for seven. IIFT was positive for two (0.3%) of these 12 participants. Among the participants who did not use appropriate personal protective equipment (PPE), seropositivity was 0.7% (2/294) compared to 0% (0/443) in cases with appropriate PPE use. The incidence of MERS infection in HCWs was 1.5% (17/1169). The seroprevalence of MERS-CoV IgG among HCWs was higher among participants who did not use appropriate PPE.n n

Influx of multidrug resistant, Gram-negative bacteria (MDRGNB) in a public hospital among elderly patients from long-term care facilities: a single-center pilot study.

Residence at a long-term care facility (LTCF) and older age are both recognized as significant risk factors for harboring MDRGNB. However, well designed prospective observational studies are few on the prevalence and risk factors of MDRGNB influx to hospital due to elderly patients arriving from LTCFs. Between November 1 and December 31, 2009, at a 500-bed, public teaching hospital in Seoul, Republic of Korea, all clinical cultures within 48 h of hospitalization from elderly patients at least 50 years of age arriving from LTCFs were collected prospectively. During these periods, the prevalence of MDRGNB influx among elderly patients from LTCFs was higher than that among other hospitalized patients (14.5% vs. 2.5%, odds ratio [OR] 8.1, 95% confidence interval [CI] 3.5-18.8, P<0.001). Of a total of 55 elderly hospitalized subjects from 6 LTCFs, clinical cultures were performed in 37. MDRGNB were found in 8 patients (6 of whom were infected). There was no difference between patients with and without MDRGNB regarding previously reported clinical characteristics associated with harboring MDRGNB. However, the mortality within one month of hospitalization was higher in patients with MDRGNB than without MDRGNB, regardless of the appropriateness of the antibiotics they received (OR, 15.91; 95% CI, 1.01-251.36; P=0.049). In conclusion, the prevalence of MDRGNB influx among elderly patients from LTCFs is significant in Korean public hospital. They require specific remedies in order to reduce the risk of early mortality.

Neurological Complications during Treatment of Middle East Respiratory Syndrome

Background and Purpose Middle East respiratory syndrome (MERS) has a high mortality rate and pandemic potential. However, the neurological manifestations of MERS have rarely been reported since it first emerged in 2012. Methods We evaluated four patients with laboratory-confirmed MERS coronavirus (CoV) infections who showed neurological complications during MERS treatment. These 4 patients were from a cohort of 23 patients who were treated at a single designated hospital during the 2015 outbreak in the Republic of Korea. The clinical presentations, laboratory findings, and prognoses are described. Results Four of the 23 admitted MERS patients reported neurological symptoms during or after MERS-CoV treatment. The potential diagnoses in these four cases included Bickerstaffs encephalitis overlapping with Guillain-Barré syndrome, intensive-care-unit-acquired weakness, or other toxic or infectious neuropathies. Neurological complications did not appear concomitantly with respiratory symptoms, instead being delayed by 2–3 weeks. Conclusions Neuromuscular complications are not rare during MERS treatment, and they may have previously been underdiagnosed. Understanding the neurological manifestations is important in an infectious disease such as MERS, because these symptoms are rarely evaluated thoroughly during treatment, and they may interfere with the prognosis or require treatment modification.