Ji Hyeon Baek

Incidence and risk factors of infection in a single cohort of 110 adults with systemic lupus erythematosus

Infection is a major cause of mortality in patients with systemic lupus erythematosus (SLE). This study describes infectious complications in SLE patients and analyzes the risk factors for infection at the time of SLE diagnosis and during the course of SLE in a case-control study. Of 110 patients enrolled, 42 (38%) had at least 1 episode of infectious disease. The incidence of infectious disease was 4.4/100 patient-years (py) with a total follow-up duration of 954 y. In multivariate analysis, independent predictors of infection at the time of SLE diagnosis were an SLE disease activity index (SLEDAI) > 12 (p = 0.01), C3 levels < 90 mg/dl (p = 0.01) and positive anti-ds DNA antibodies (p < 0.01). Frequent flare-ups (p = 0.04) and follow-up duration ≥8 y (p = 0.023) were also significant risk factors for infectious diseases. It is mandatory to closely observe SLE patients with risk factors for developing infectious diseases.

A Comparison of the Clinical and Epidemiological Characteristics of Adult Patients with Laboratory-Confirmed Influenza A or B during the 2011–2012 Influenza Season in Korea: A Multi-Center Study

Background During the 2011/2012 winter influenza season in the Republic of Korea, influenza A (H3N2) was the predominant virus in the first peak period of influenza activity during the second half of January 2012. On the other hand, influenza B was the predominant virus in the second peak period of influenza activity during the second half of March 2012. The objectives of this study were to compare the clinical and epidemiological characteristics of patients with laboratory-confirmed influenza A or influenza B. Methodology/Principal Findings We analyzed data from 2,129 adult patients with influenza-like illnesses who visited the emergency rooms of seven university hospitals in Korea from October 2011 to May 2012. Of 850 patients with laboratory-confirmed influenza, 656 (77.2%) had influenza A (H3N2), and 194 (22.8%) influenza B. Age, and the frequencies of cardiovascular disorders, diabetes, hypertension were significantly higher in patients with influenza A (H3N2) (P<0.05). The frequencies of leukopenia or thrombocytopenia in patients with influenza B at initial presentation were statistically higher than those in patients with influenza A (H3N2) (P<0.05). The rate of hospitalization, and length of hospital stay were statistically higher in patients with influenza A (H3N2) (P<0.05), and of the 79 hospitalized patients, the frequency of diabetes, hypertension, cases having at least one of the comorbid conditions, and the proportion of elderly were significantly higher in patients with influenza A (H3N2) (P<0.05). Conclusions The proportion of males to females and elderly population were significantly higher for influenza A (H3N2) patients group compared with influenza B group. Hypertension, diabetes, chronic lung diseases, cardiovascular disorders, and neuromuscular diseases were independently associated with hospitalization due to influenza. Physicians should assess and treat the underlying comorbid conditions as well as influenza viral infections for the appropriate management of patients with influenza.

Effects of p-coumaric acid on erythema and pigmentation of human skin exposed to ultraviolet radiation.

Background.  It has been recently recognized that p‐coumaric acid (PCA) is a strong inhibitor of cellular melanogenesis.

Risk factors of all-cause in-hospital mortality among Korean elderly bacteremic urinary tract infection (UTI) patients

Urinary tract infection (UTI) is the most frequent cause of bacteremia/sepsis in elderly people and increasing antimicrobial resistance in uropathogens has been observed. To describe the characteristics of bacteremic UTI in elderly patients and to identify the independent risk factors of all-cause in-hospital mortality, a retrospective cohort study of bacteremic UTI patients of age over 65 was performed at a single 2000-bed tertiary hospital. Bacteremic UTI was defined as the isolation of the same organism from both urine and blood within 48 h. Eighty-six elderly bacteremic UTI patients were enrolled. Community-acquired infection was the case for most patients (79.1%), and Escherichia coli accounted for 88.6% (70/79) among Gram-negative organisms. Non-E. coli Gram-negative organisms were more frequent in hospital-acquired cases and male patients while chronic urinary catheter insertion was related with Gram-positive urosepsis. The antibiotic susceptibility among Gram-negative organisms was not different depending on the source of bacteremic UTI, while non-E. coli Gram-negative organisms were less frequently susceptible for cefotaxime, cefoperazone/sulbactam, and aztreonam. All-cause in-hospital mortality was 11.6%, and functional dependency (adjusted hazard ratio=HR=10.9, 95% confidence interval=95%CI=2.2-54.6) and low serum albumin (adjusted HR=27.0, 95%CI=2.0-361.2) were independently related with increased all-cause in-hospital mortality.

Clinical Review of Endogenous Endophthalmitis in Korea: A 14-Year Review of Culture Positive Cases of Two Large Hospitals.

Purpose To identify the clinical features and outcomes of endogenous endophthalmitis in Korea. Materials and Methods We reviewed 18 patients with endogenous endophthalmitis at 2 Korean hospitals, treated over a 14 year period between January 1993 and December 2006. Results The comorbidities observed in these cases were diabetes mellitus and liver cirrhosis. The most common pathogens, which were found in 7 patients each (38.9%), were Klebsiella pneumonia and Pseudomonas aeruginosa. All patients were treated with systemic antibiotics and fortified topical antibiotics. A surgical approach including vitrectomy was performed in 9 cases (50.0%). The prognosis was generally poor, and visual acuity improved slightly in 6 patients (33.3%). Conclusion In this study, diabetes mellitus and Klebsiella pneumonia showed a close relationship with endogenous endophthalmitis, respectively. Endogenous endophthalmitis is a serious risk to sight and careful attention to establishing the diagnosis and management may decrease the ocular morbidity.

Hospital‐based influenza surveillance in Korea: Hospital‐based influenza morbidity and mortality study group

Influenza epidemics occur annually with variations in size and severity. Hospital‐based Influenza Morbidity & Mortality was established to monitor influenza epidemics and their severity, which is composed of two surveillance systems: emergency room‐based and inpatient‐based surveillance. Regarding emergency room‐based surveillance, influenza‐like illness index (influenza‐like illness cases per 1,000 emergency room‐visiting subjects), number of laboratory‐confirmed cases and the distribution of influenza types were estimated weekly. Inpatient‐based surveillance included monitoring for hospitalization, complications, and mortality. The emergency room influenza‐like illness index correlated well with the number of laboratory‐confirmed influenza cases, and showed a bimodal peak at Week 4 (179.2/1,000 emergency room visits) and Weeks 13‐14 (169.6/1,000 emergency room visits) of 2012. Influenza A was the predominant strain during the first epidemic peak, while influenza B was isolated exclusively during the second peak. In 2011–2012 season, the mean admission rate of emergency room‐visiting patients with influenza‐like illness was 16.3% without any increase over the epidemic period. Among the hospitalized patients with influenza, 33.6% (41 out of 122 patients) were accompanied by complications, and pneumonia (28.7%, 35 out of 122 patients) was the most common. Most fatal cases were caused by influenza A (96.2%) after the first epidemic peak. In conclusion, Hospital‐based Influenza Morbidity & Mortality was effective for monitoring the trends in circulating influenza activity concurrently with its severity. In the 2011–2012 season, the influenza epidemic persisted for a ≥5‐month period, with a bimodal peak of influenza A and B in sequence. Overall, influenza A was more severe than influenza B. J. Med. Virol. 85:910–917, 2013.

Effectiveness of the influenza vaccine at preventing hospitalization due to acute lower respiratory infection and exacerbation of chronic cardiopulmonary disease in Korea during 2010–2011

BACKGROUND Influenza epidemics are accompanied by a considerable increase in hospitalization due to acute lower respiratory infection and exacerbation of underlying medical conditions. We estimated the effectiveness of the influenza vaccine at preventing hospitalization due to acute lower respiratory infection and new onset or acute exacerbation of chronic cardiopulmonary disease. METHOD During the peak influenza period in 2010-2011, we performed a multicenter, case-control, retrospective cohort study of patients who were hospitalized due to newly developed pneumonia, bronchitis, and bronchiolitis, or new onset or acute exacerbation of asthma, COPD, ischemic heart disease, and CHF. Controls were selected from outpatients who visited study hospitals but who were not hospitalized during the same study period. Controls were matched 1:1 to cases based on age, gender, and date of hospital visit. Univariate and multivariate logistic regression analyses were used to determine the effectiveness of the influenza vaccine at decreasing hospitalization. RESULTS Between December 2010 and February 2011, 556 hospitalized subjects were identified. Age, gender, and body mass index (BMI) were similar between case and control groups. The influenza vaccination rate of the hospitalized and non-hospitalized patients was 42.4% and 52.2%, respectively (p<0.001). The overall vaccine effectiveness for preventing hospitalization was 32.5% (odds ratio 0.675, 95% confidence interval [CI] 0.486-0.937; p=0.019). Multivariate logistic analysis showed that influenza vaccination significantly reduced the risk of hospitalization, especially due to new onset or acute exacerbation of ischemic heart disease and CHF in patients aged 65 years and older (OR 0.274, 95% CI 0.114-0.658, p=0.004). The estimated vaccine effectiveness in these patients was 72.6%. CONCLUSION Influenza vaccination reduced the rate of hospitalization among patients with underlying chronic heart disease, particularly those patients 65 years old and greater.

Predictive factors for indeterminate result on the QuantiFERON test in an intermediate tuberculosis-burden country

OBJECTIVES The QuantiFERON-TB Gold In-Tube (QFT-G IT) test is based on the cellular immune response, and this assay can result in indeterminate results for the diagnosis of tuberculosis. The occurrence of indeterminate results may decrease the clinical usefulness of this test. Therefore, we investigated possible predictive factors that can influence the occurrence of indeterminate results from the QFT-G IT test. METHODS We conducted a case-control study with 162 case patients who had indeterminate results from a QFT-G IT test at a tertiary hospital in South Korea, from September 2006 to September 2009. RESULTS Of the 1276 patients, 162 (12.7%) cases that underwent QFT-G IT testing were reported as indeterminate results. Severe lymphopenia (odds ratio [OR] = 8.839; p < 0.001), chronic renal disease (OR = 2.838; p = 0.007), autoimmune disease (OR = 2.527; p = 0.017) and chronic lung disease (OR = 3.169; p = 0.007) were independent predictive factors for indeterminate results from a QFT-G IT test. CONCLUSION The patients with lower lymphocyte counts or immunosuppressive conditions showed a higher probability of indeterminate results from the QFT-G IT test. Careful attention to the pre-analytical conditions may be able to minimize this proportion.

Incidence and risk factors of linezolid-induced lactic acidosis

BACKGROUND The use of linezolid has increased with the emergence of multidrug-resistant bacteria. Serum lactic acidosis has been reported as a serious side effect of linezolid use, therefore we evaluated the incidence and characteristics of linezolid-related lactic acidosis. METHODS Patients admitted to an 860-bed university hospital were enrolled. The patients were divided into two groups, those who used linezolid and those who used teicoplanin (control group). The study was conducted by review of the medical charts. RESULTS Seventy-two patients were included in the linezolid group. The control group comprised 72 patients matched to those in the linezolid group for age and indication for antibiotic use. Lactic acidosis occurred in five cases (6.8%) in the linezolid group. None of the patients who used teicoplanin developed lactic acidosis, which was a comparable result. The median change in anion gap in the linezolid group was -0.8 mmol/l (interquartile range (IQR) -3.55 to 1.28 mmol/l), which was significantly higher than in the teicoplanin group, 0.05 mmol/l (IQR -1.75 to 2.3 mmol/l) (p=0.026). The number of increased anion gap events in patients who used linezolid for more than 6 weeks was higher than in the group who used linezolid for less than 6 weeks (p=0.0014). However, no statistically significant difference was observed according to age, estimated glomerular filtration rate, or diabetes. CONCLUSIONS Linezolid showed an association with treatment-related lactic acidosis. A longer duration of linezolid use (>6 weeks) was one of the risk factors for metabolic acidosis. We suggest checking serum lactate concentrations regularly, especially in those on long-term use.

Severe influenza treatment guideline

Background and purpose Severe influenza is defined as influenza with a severe symptom or syndrome such as respiratory distress or deceased consciousness or accompanying a severe complication such as encephalopathy or renal failure. In contrast to mild influenza, for which patients recover mostly by ambulatory care, severe influenza requires hospital admission in most cases or intensive treatment in the intensive care unit in some cases. In particular, the elderly, infants, and chronic patients are known to be at high risk for severe influenza because they may have accompanying complications such as exacerbation of an underlying disease, development of pneumonia, and another organ dysfunction or they may die. Therefore, there is an increasing need for an effective treatment method applicable to severe influenza. Severe influenza treatment methods, which have been recently discussed, include high-dose, long-term antiviral therapy, combination antiviral therapy, administration of antibiotics, application of extracorporeal membrane oxygenation (ECMO), administration of a corticosteroid, administration of intravenous immunoglobulin (IVIG), application of plasmapheresis, and administration of a statin. However, no comprehensive, specific expert guideline for these methods is available yet. The Transgovernmental Enterprise for Pandemic Influenza in Korea published in 2012 a guideline for the use of an antiviral agent for seasonal influenza. But the guideline deals with only the use of an antiviral agent, not the various treatment methods which can be applied to severe influenza [1]. Therefore, this guideline was developed by analyzing and evaluating domestic and international literature and guidelines with respect to the various treatment methods so that severe influenza could be effectively treated.