Jin Won Chung

A Case of Isolated Invasive Aspergillus Colitis Presenting with Hematochezia in a Nonneutropenic Patient with Colon Cancer

Gastrointestinal invasive aspergillosis is often reported as part of a disseminated infection, and rarely as an isolated organ infection. Isolated invasive Aspergillus colitis is very rare, being observed only in patients with hematological malignancy and neutropenia. We encountered an unusual case of isolated invasive Aspergillus colitis presenting with hematochezia in a nonneutropenic patient with colon cancer. Fungal hyphae with surrounding inflammatory cells and mucosal necrosis were observed during the histological examination of a biopsy sample obtained at endoscopy. This case indicates that isolated invasive Aspergillus colitis may develop in a variable context of immunosuppression.

Prevalence and impact of extended-spectrum β-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia

Background/Aims We examined the prevalence of extended-spectrum β-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. Methods Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. Results Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality. Conclusions The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.

Adult invasive pneumococcal disease in the Republic of Korea: Risk medical conditions and mortality stratified by age group

OBJECTIVESnThis study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK).nnnMETHODSnClinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015.nnnRESULTSnA total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18-49 years, 23.7% in those aged 50-64 years, 33.0% in those aged 65-74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50-64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped.nnnCONCLUSIONSnThis study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.

Hospital-based surveillance of infection-related mortality in South Korea

Public Health Reports / November–December 2009 / Volume 124 883 This article by Choi et al. describes the findings from 19 tertiary-care teaching hospitals in South Korea. At first, the finding that infectious diseases are attributed to 29% of all in-hospital deaths seems unexpected. Then we realize that the numbers, while surprising, are not unusual. In the United States, hospital-acquired infections are a countrywide problem. It has been estimated that each year nearly two million patients get an infection while being treated in our nation’s hospitals, and almost 100,000 of them die in the U.S. The Centers for Disease Control and Prevention estimates the cost of hospital-acquired infections to be as high as

Epidemiology and Clinical outcomes of Invasive Pulmonary Aspergillosis: A Nationwide Multicenter Study in Korea

27.5 billion each year.1 The findings in this study and elsewhere bring to light the fact that even the “most developed” countries, such as South Korea, the United Kingdom,2 and the United States, still face a constant and, in some cases, increasing threat from infection-related mortality in hospital settings. It is also interesting to note that pneumonia and septicemia remain the most common causes of death. The sentinel hospital-based surveillance system is an important step toward developing and maintaining a useful monitoring system to control routine and extraordinary infectious diseases. Other studies in the literature set up a standardized methodology for the mining and investigation of infection control surveillance.3 This article, however, is the first to evaluate the proportions of infectious diseases among all in-hospital mortality cases as either the direct or underlying cause of death and investigate the description of infectious causes of in-hospital death in South Korea.