Wan Beom Park

Seoul National University Bundang Hospital, Sŏul, Seoul, South Korea

Are you Wan Beom Park?

Claim your profile

Publications (87)239.56 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Vancomycin is frequently inappropriately prescribed, especially as empirical treatment. The aim of this study was to evaluate (1) the amount of inappropriate continued use of empirical vancomycin as a proportion of total vancomycin use, and (2) the risk factors associated with inappropriate continued use of empirical vancomycin. We reviewed the medical records of adult patients who had been prescribed at least one dose of parenteral vancomycin between January and June 2012 in a single tertiary hospital. When empirically prescribed vancomycin was continued after 96 hours without documentation of beta-lactam-resistant gram-positive microorganisms in clinical specimens with significance, the continuation was considered inappropriate, and the amount used thereafter was considered inappropriately used. We identified risk factors associated with the inappropriate continued use of empirical vancomycin by multiple logistic regression. During the study period, the amount of parenteral vancomycin prescribed was 34.2 defined daily doses (DDDs)/1,000 patient-days (1,084 prescriptions in 971 patients). The amount of inappropriately continued empirical vancomycin was 8.5 DDDs/1,000 patient-days which comprised 24.9% (8.5/34.2 DDDs/1,000 patient-days) of the total parenteral vancomycin used. By multivariate analyses, inappropriate continued use of empirical vancomycin was independently associated with the absence of any documented etiologic organism (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.06∼2.41), and suspected CNS infection (aHR 2.33, 95% CI 1.20∼4.50). A higher Charlson's comorbidity index score was inversely associated with inappropriate continued use of empirical vancomycin (aHR 0.90, 95% CI 0.85∼0.97). Inappropriate continued use of empirical vancomycin comprised 24.9% of the total amount of vancomycin prescribed, this means room for improvement. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 11/2014; · 4.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The therapeutic response is monitored serologically after syphilis treatment. However, some patients remain serologically active despite treatment. We tried to identify the clinical characteristics associated with remaining serofast. Methods: We conducted a retrospective cohort study of patients treated for syphilis in Seoul National University Bundang Hospital. Factors related to the serological response after 1 year of treatment was analyzed. 4 folds decrease in nontreponemal antibody titer was regareded as serological cure and others as serofast. Results: A total of 154 HIV negative patients with primary, secondary, tertiary and latent syphilis were included in the final analysis. Among them, 107 patients remained serofast and the other 47 patients showed serological cure. Older patients and patients with later disease stage were more likely to remain serofast. Having initial nontreponemal antibody titer of 1:2 and 1:4 was also associated with the serofast. Conclusion: The disease stage, age and initial nontreponemal antibody titer were important factors related to the serological response. Table1. Factors associated with remaining serofast, 1 year after treatment of the syphilis Serofast (n=107) Serological cure (n=47) OR(95% CI) Age Group 10-29 1(25.0%) 3(75.0%) 1 30-49 17(50.0%) 17(50.0%) 3.00(0.28-31.80) 50-69 50(71.4%) 20(28.6%) 7.50(0.74-76.46) >= 70 39(84.8%) 7(15.2%) 16.71(1.51-184.60) Sex Male 45(63.4%) 26(36.6%) 1 Female 62(74.7%) 21(25.3%) 1.71(0.85-3.41) History of syphilis No 86(68.8%) 39(31.2%) 1 Yes 21(72.4%) 8(27.6%) 1.19(0.49-2.92) Stage Primary 0(0%) 4(100%) N/A Secondary 1(12.5%) 7(87.5%) 1 Early latent 7(87.5%) 7(87.5%) 3.11(0.28-34.42) Late latent 102(79.7%) 26(20.3%) 27.46(3.23-233.19) Tertiary 0(0%) 1(100%) N/A Initial RPR titer 1:1 40(81.6%) 9(18.4%) 26.67(2.85-249.76) 1:2 24(92.3%) 2(7.7%) 72.00(5.56-932.99) 1:4 18(94.7%) 1(5.3%) 108.00(5.81-2005.95) 1:8 13(76.5%) 2(23.5%) 19.50(1.78-213.95) 1:16 11(68.8%) 5(31.3%) 13.20(1.24-140.68) 1:32 1(14.3%) 6(85.7%) 1 >=1:64 0(0%) 11(100%) N/A Abbreviations: CI, confidence interval; OR, odds ratio; RPR, rapid plasma regain; N/A, not applicable
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Cefazolin is a common antibiotic for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Type A or C β-lactamase-producing MSSA frequently shows the cefazolin inoculum effect (CIE). However, the clinical implication of the CIE for MSSA bacteremia is obscure. Methods: MSSA bacteremic patients treated with cefazolin were included in a retrospective cohort study. The blaZ gene of the isolates was sequenced to identify the type of β-lactamase. The patients whose isolates showed a ≥4-fold increase in cefazolin, the minimal inhibitory concentration (MIC) at the high inoculum (∼5×10(7) CFU/ml), were assigned to the CIE-positive group and the remainder to the CIE-negative group. Treatment failure was assessed at 12 weeks after cefazolin was initiated. Results: A total of 113 MSSA bacteremic patients were included. Among the 113 isolates, 57.5% showed the CIE and 77.9% carried the blaZ gene; type A β-lactamase was 15.0% and type C was 40.7%. Persistent bacteremia was more common in the CIE-positive group (9% vs. 0%, p=0.04). Treatment failure rates were higher in the CIE-positive group with high bacterial burden infection, but the difference was not significant (48% vs. 25%, p=0.13). There was no significant difference of failure between groups with high-inoculum MIC ≥16 and ≤1 μg/ml (13% vs. 5%, p=0.31). In the multivariable analysis, underlying cardiovascular diseases, pneumonia, osteoarticular infections, and endocarditis were significant risk factors for treatment failure and the CIE was not significantly associated with treatment failure. Conclusion: The CIE might be associated with persistent bacteremia if cefazolin is used for MSSA bacteremia with a high burden of infections. However, the sites of infections are more important factors for the clinical outcome than the CIE.
    Microbial drug resistance (Larchmont, N.Y.) 07/2014; · 1.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Direct fluorescent antibody (DFA) staining of induced sputum is frequently used to diagnose Pneumocystis pneumonia (PCP) in patients infected with human immunodeficiency virus, although induction can provoke nausea and bronchospasm. Since the diagnostic value of expectorated sputum examined with DFA stain has not been well evaluated, we reviewed the medical records of HIV-infected patients who were clinically diagnosed as having PCP between 1999 and 2011. Over this 13-year period, we found 76 patients whose records included the results of DFA staining of expectorated sputum and noted that 42 (55.3%) were positive. Polymerase chain reaction to detect Pneumocystis in the sputum of 65 of the patients resulted in the finding of 43 (66.2%) who were positive. Our findings suggest that DFA staining of expectorated sputum could be a useful initial diagnostic method in HIV-infected patients with PCP.
    Medical mycology: official publication of the International Society for Human and Animal Mycology 03/2014; · 2.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Low bone mass is prevalent in HIV-positive patients. However, compared to Western countries, less is known about HIV-associated osteopenia in Asian populations. Methods: We performed a cross-sectional survey in Seoul National University Hospital from December 2011 to May 2012. We measured bone mineral density using central dual energy X-ray absorptiometry, with consent, in male HIV-positive patients, aged 40 years and older. Diagnosis of low bone mass was made using International Society for Clinical Densitometry Z-score criteria in the 40-49 years age group and World Health Organization T-score criteria in the >50-year age group. The data were compared with those of a community-based cohort in Korea. Results: Eighty-four HIV-positive male patients were included in this study. Median age was 49 (interquartile range [IQR], 45-56) years, and median body mass index (BMI) was 22.6 (IQR, 20.9-24.4). Viral suppression was achieved in 75 (89.3%) patients and median duration of antiretroviral therapy was 71 (IQR, 36-120) months. The overall prevalence of low bone mass was 16.7% in the 40-49 years age group and 54.8% in the>50 years age group. Our cohort had significantly lower bone mass at the femur neck and total hip than HIV-negative Koreans in the 40-49 years age group. Low bone mass was significantly associated with low BMI, and a high level of serum carboxy-terminal collagen crosslinks, but was not associated with antiretroviral regimen or duration of antiretroviral therapy. Conclusions: Low bone mass is prevalent in Korean HIV-positive males undergoing antiretroviral therapy, and may be associated with increased bone resorption.
    Journal of the International AIDS Society 01/2014; 17(1):18773. · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There have been few clinical studies on the association between the 24-h area under the concentration-time curve (AUC24) to minimum inhibitory concentration (MIC) ratio and vancomycin treatment outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infections. Patients with MRSA bacteraemia between July 2009 and January 2012 were analysed retrospectively. All adult patients treated with vancomycin for ≥72h without dialysis were included. The MIC was determined by Etest and broth microdilution (BMD). Initial steady-state AUC24 was estimated using a Bayesian model, and the AUC24/MIC cut-off value for differentiating treatment success and failure was calculated by classification and regression tree (CART) analysis. In total, 76 patients were enrolled; vancomycin treatment failure occurred in 20 patients (26.3%). Catheter-related infection was the most frequent (35.5%), followed by surgical site infection (26.3%), whilst 25 (32.9%) had complicated infections. In univariate analysis, decreased MRSA vancomycin susceptibility (MIC≥1.5mg/L) and vancomycin trough levels (15-20mg/L) were not associated with treatment outcomes. In the CART analysis, low initial vancomycin AUC24/MIC (<430 by Etest; <398.5 by BMD) was associated with a higher treatment failure rate (50.0% vs. 25.0%, P=0.039 by Etest; 45.0% vs. 23.2%; P=0.065 by BMD). In multivariate analysis, low initial vancomycin AUC24/MIC was a significant risk factor for treatment failure [adjusted odds ratio (aOR)=4.39, 95% confidence interval (CI), 1.26-15.35 by Etest; aOR=3.73, 95% CI 1.10-12.61 by BMD]. In MRSA bacteraemia, a low initial vancomycin AUC24/MIC is an independent risk factor for vancomycin treatment failure.
    International journal of antimicrobial agents 11/2013; · 3.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: This study was designed to explore the impact of staphylococcal cassette chromosome mec (SCCmec) type on mortality attributed to methicillin-resistant Staphylococcus aureusbacteremia (MRSAB). Methods: A retrospective cohort study was conducted at a tertiary-care hospital. All adults with MRSAB over a 4-year period were enrolled. SCCmec type was determined for all the isolates. Cases of SCCmectype II and III were grouped together and were compared to the cases of type IV. MRSAB-attributed mortality is defined as a death with at least one of the followings; documented MRSAB at the time of death, presence of persistent focus of MRSAB and sign of sepsis, and death within 14 days of MRSAB without other plausible explanations. Results: Among 179 cases, 45 (25%) were MRSAB-attributed death, and the numbers of SCCmec type II/III and IV were 130 (73%) and 49 (27%). MRSAB-attributed mortality was higher in SCCmec type II/III (30%, 39/130) than in type IV (12%, 6/49) (P=0.010). In multivariate analyses, higher Charlson’s comorbidity index score, higher Pitt bacteremia score, and central line associated infection were independently associated with MRSAB-attributed mortality. SCCmec type II/III compared to type IV was also correlated to MRSAB-attributed mortality with borderline statistical significance (multivariate odds ratio, 3.04; 95% confidence interval, 0.96-9.59, P=0.058) (Table). Conclusion: In MRSAB, SCCmectype II/III compared to type IV tended to correlate to MRSAB-attributed mortality. Survivor (n=134) Non-survivor (n=45) Univariate OR (95% CI) Multivariate OR (95% CI) Charlson’s comorbidity index 4.7 (±2.7) 6.1 (±2.7) 1.20 (1.06-1.35)a 1.25 (1.06-1.47)a Pitt bacteremia score 1.5 (±1.8) 4.7 (±4.0) 1.51 (1.29-1.76)a 1.55 (1.29-1.86)a Primary bacteremia 15 (11.2) 12 (26.7) 2.89 (1.23-6.76)b 1.35 (0.41-4.41) Central line associated infection 50 (37.3) 9 (20.0) 0.42 (0.19-0.94)b 0.31 (0.10-0.95)b Bone & joint infection 12 (9.0) 0 (0) NAb NA Pneumonia 9 (6.7) 7 (15.6) 2.56 (0.89-7.33)c 0.71 (0.17-2.96) Intra-abdominal infection 5 (3.7) 5 (11.1) 3.23 (0.89-11.71)c 1.43 (0.17-11.97) SCCmec type II/III (versus type IV) 91 (67.9) 39 (86.7) 3.07 (1.21-7.81)b 3.04 (0.96-9.59)c Vancomycin MIC ≥ 1.5 (E-test) 72 (53.7) 19 (42.2) 0.63 (0.32-1.25) OR, odds ratio; CI, confidence interval; NA, not available, MIC, minimum inhibitory concentration aP < 0.01; bP < 0.05; cP < 0.10
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Asymptomatic bacteriuria (ABU) is common and often leads to inappropriate antimicrobial use. This study was designed to investigate the appropriateness of antibiotic use for ABU and to explore the knowledge and practice of the physicians involved in the process of prescribing antibiotics for ABU. Methods: We reviewed medical records of all inpatients with >105 colony-forming units/mL bacteria on urine culture at a 900-bed university affiliated hospital from January to December 2011. ABU and appropriate therapy were defined according to the 2005 IDSA guidelines. Multivariate analysis using logistic regression was applied to evaluate factors associated with inappropriate treatment of ABU. To assess physician practices and perceptions related to ABU, we conducted a survey for residents primarily caring for inpatients. Results: We identified 222 cases of ABU among a total of 1167 positive urine cultures. Of these 222 cases, 73 (32.9%) were inappropriately treated. Female sex, pyuria, hematuria, nitrite positivity on urinalysis were associated with unnecessary antimicrobial use for ABU. On the survey, 95 of 128 physicians (74%) responded. Only 33% of responders were able to distinguish ABU from urinary tract infection (UTI) and 46% showed discordant practice with knowledge. Specialties and years in practice were not associated with the discordance. Reasons for inappropriately prescribing antibiotics for ABU were as follows; eradication of a possible infection source before surgery (39%), as a routine practice (23%), and prevention of symptomatic UTIs (9%). Urine cultures in asymptomatic patients, which might contribute to inappropriate treatment, were mostly ordered during work up for hidden infections (78%) or urinary abnormalities (57%). Routine urine cultures during systemic antibiotic treatment for other concomitant infections (23%) or for surveillance in the intensive care unit (8%) were other reasons. Conclusion: About one third of ABUs were inappropriately treated in our hospital. Lack of knowledge and inconsistency between perception and practice regarding ABU highlight the importance of educational interventions.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Infectious complications after transrectal ultrasono-guided prostatic biopsy (TRUS-PB) are major post-biopsy morbidities. We have prescribed fluoroquinolones for prophylaxis. However since the resistance rate of community acquired E.coli to fluoroquinolones exceeds 20%, infections due to fluoroquinolone-resistant organisms are increasingly observed. We tried to reduce TRUS-PB related infections with prophylactic 3rdgeneration cephalosporins rather than fluoroquinolones. Methods: Before September 2012, the prophylactic antibiotic regimen for TRUS-PB was Ciprofloxacin 500mg bid PO for 5 days starting on the day before biopsy. It was changed to 1 dose of Ceftriaxone 1g IV 1 hour before biopsy plus Cefixime 100mg bid PO for 5 days starting on the day before. We retrospectively reviewed electronic medical records of patients who underwent TRUS-PB 14 months before and 7 months after change of protocols for infectious complications. Infection rates and causative organisms with their antimicrobial susceptibility were compared. Results: TRUS-PB related infection rates were 3.19% (26/816) before and 1.03% (4/389) after implementing the new protocol (P = 0.012). The predominant organism was E. coli: 92.3% (24/26) before and 100% (4/4) after protocol change. Ciprofloxacin resistance was 100% (24/24) and 75% (3/4), respectively. ESBLs were identified in 37.5% (9/24) before and 75% (3/4) after protocol change. Conclusion: A prophylactic regimen containing 3rd generation cephalosporins would be better than a fluoroquinolone in a community where fluoroquinolone resistance of E. coli exceeds 20%.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: The increased possibility of bioterrorism has led to reinitiation of smallpox vaccination. In Korea, more than 30 years have passed since the last smallpox vaccinations, and even people who were previously vaccinated are not regarded as adequately protected against smallpox. We evaluated the efficacy and safety of CJ-50300, a newly developed cell culture-derived smallpox vaccine, in healthy adults previously vaccinated against smallpox. We conducted an open label, single arm, phase III clinical trial to evaluate the efficacy and safety of CJ-50300. Healthy volunteers, previously vaccinated against smallpox, born between 1950 and 1978 were enrolled. CJ-50300 was administered with a bifurcated needle over the deltoid muscle according to the recommended method. The rate of the cutaneous take reaction, humoral immunogenicity, and safety of the vaccine was assessed. Of 145 individuals enrolled for vaccination, 139 completed the study. The overall rates of cutaneous take reactions and humoral immunogenicity were 95.0% (132/139) and 88.5% (123/139), respectively. Although 95.9% (139/145) reported adverse events related to vaccination, no serious adverse reactions were observed. CJ-50300 can be used safely and effectively in healthy adults previously vaccinated against smallpox.
    Vaccine 09/2013; · 3.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study was performed to detect risk factors for Pseudomonas aeruginosa bacteremia in patients with liver cirrhosis. A retrospective case--control study was designed to identify risk factors for P. aeruginosa bacteremia in cirrhotic patients. The cases were cirrhotic patients with P. aeruginosa bacteremia and the controls were cirrhotic patients with Enterobacteriaceae bacteremia. Sixty-one cases and the same number of controls were enrolled. In a multivariate analysis, younger age (adjusted odds ratio (aOR) per one year: 0.96, 95% confidence interval: 0.93 - 0.99), nosocomial acquisition (aOR 3.87, 95% confidence interval: 1.50 - 9.94), preexisting biliary disease (aOR 4.79, 95% confidence interval: 1.92 - 10.47), and recent exposure to immunosuppressive agent (aOR 3.10, 95% confidence interval: 1.23 - 7.82) were associated with P. aeruginosa bacteremia. In the case group the frequency of appropriate initial antibiotic regimens was considerably lower than in the control group: 29.5% vs. 65.6% (P <0.01). However, thirty day mortality did not differ significantly between cases and controls (19.7% vs. 24.6%). Nosocomial acquisition, preexisting biliary disease, and recent use of immunosuppressive agents are strong predictive factors for P. aeruginosa bacteremia in cirrhotic patients.
    BMC Infectious Diseases 07/2013; 13(1):332. · 3.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Korea is a low prevalence country for human immunodeficiency virus (HIV) infection and has an intermediate tuberculosis (TB) burden. We previously reported that the incidence of TB in HIV-infected patients was 9.6 cases per 100 person-years (P-Y) between 1988 and 1997. The aims of the present study were to measure any change in incidence from the previous study, and to identify risk factors for TB in HIV-infected patients. We reviewed all medical records of HIV-infected patients who were followed-up in one tertiary hospital between 1998 and 2010. Over the total observation period of 5858.33 P-Y, TB developed in 70 patients (1.19 cases per 100 P-Y; 95% confidence interval [CI], 0.91-1.47 cases per 100 P-Y). Based on Poisson regression, one risk factor associated with TB was an initial CD4+ cell count below 200 cells/µL (relative risk, 2.34; 95% CI, 1.47-3.73). Mean CD4+ cell counts of pulmonary, extrapulmonary, and both pulmonary and extrapulmonary TB were 179.8 cells/µL, 138.3 cells/µL, and 114.2 cells/µL, respectively (P = 0.55). In conclusion, the incidence of TB in HIV-infected patients has decreased since the previous study. An initial CD4+ cell count below 200 cells/µL is an independent risk factor for development of TB in HIV-infected patients.
    Journal of Korean medical science 03/2013; 28(3):374-7. · 0.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Diagnostic error can be caused by several types of cognitive bias, which may be reversed by enhancing analytic reasoning. Aims: To evaluate whether enhancing analytic reasoning can increase diagnostic accuracy in objective structured clinical examination (OSCE) in medical students. Methods: All fourth-year medical students, randomly assigned to the analytic reasoning or control groups, undertook the OSCE with four cases using standardized patients. The analytic reasoning group was requested to list differential diagnoses and findings compatible or not compatible with each diagnosis prior to providing a diagnosis, while the control group provided a diagnosis without these processes. Mean diagnostic accuracy scores (perfect score, 4.0) from four cases of OSCE were compared between the two groups. Results: One hundred forty-five students were randomly assigned to the analytic reasoning group (n = 65) or the control group (n = 80). The baseline characteristics, including grade point average and the scores from each patient encounter, were comparable between groups. Mean diagnostic accuracy scores were significantly higher in the analytic reasoning group than in the control group (3.40 ± 0.66 versus 3.05 ± 0.98; p = 0.011). Conclusion: Enhancement of analytic reasoning may improve diagnostic accuracy in novice doctors.
    Medical Teacher 01/2013; · 1.82 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case-control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk factors for persistent bacteremia and to reevaluate the necessity of follow-up blood culture in KpB. Persistent KpB is defined as the finding of K. pneumoniae in more than two separate blood-culture samples for longer than a two-day period in a single episode. The case- and control-groups were patients with persistent and non-persistent KpB, respectively, and they were matched 1-to-3 according to age and gender. Among 1068 KpB episodes analyzed after excluding polymicrobial infection and repeated KpB, follow-up blood cultures were performed in 862 cases (80.7%), 62 of which (7.2%) were persistent. Independent risk factors for persistence were intra-abdominal infection, higher Charlson's comorbidity weighted index score, prior solid organ transplantation, and unfavorable treatment response, which was defined as positivity for at least two parameters among fever, leukocytosis, and no decrease of C-reactive protein on the second day after initial culture. A proposed scoring system using four variables, namely, intra-abdominal infection, nosocomial KpB, fever and lack of C-reactive protein decrease, the last two being assessed on the second day after the initial blood culture, showed that only 4.9% of the patients with no risk factors or with only intra-abdominal infection had persistent KpB. Though persistent KpB is uncommon, follow-up blood culture was performed in as many as 80% of the cases in this study. A more careful clinical assessment is warranted to reduce the cost and patient inconvenience involved in follow-up blood culture.
    BMC Infectious Diseases 01/2013; 13(1):365. · 3.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated risk factors for neutropenic fever and febrile prolonged neutropenia during vincristine-including chemotherapy to treat HIV-related lymphoma to investigate whether protease inhibitor (PI) treatment is associated with infectious complications due to drug interactions with chemotherapeutic agents. We included all HIV patients who received chemotherapy including vincristine for lymphoma at a single referral center in 1999-2010. Neutropenic fever was defined as absolute neutrophil count < 500 cells/µL with body temperature over 38℃; and prolonged neutropenia was defined if it persisted over 7 days. CODOX-M/IVAC and Stanford regimens were considered high-risk regimens for prolonged neutropenia. We analyzed 48 cycles of chemotherapy in 17 HIV patients with lymphoma. There were 22 neutropenic fever and 12 febrile prolonged neutropenia events. In multivariate analysis, neutropenic fever was associated with old age and low CD4 cell count, but not with PI use or ritonavir-boosted PI use. Low CD4 cell count and high-risk regimens were associated with febrile prolonged neutropenia. Neutropenic fever and febrile prolonged neutropenia is associated with old age, low CD4 cell count, and high-risk regimens, but not PI use, in HIV patients undergoing chemotherapy including vincristine for lymphoma.
    Journal of Korean medical science 12/2012; 27(12):1468-71. · 0.84 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although tigecycline is considered one of the few therapeutic options for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteraemia, its role in the treatment of CRAB bacteraemia remains unclear. We describe the clinical outcomes of 9 patients who received tigecycline for CRAB bacteraemia. Although all CRAB blood isolates were susceptible to tigecycline, 5 (56%) deaths were related to CRAB bacteraemia and 1 case of breakthrough CRAB bacteraemia was observed during tigecycline therapy. Clinical outcomes of tigecycline therapy may be poor in patients with tigecycline-susceptible CRAB bacteraemia, although multiple factors including delayed treatment could contribute to the poor outcomes.
    Scandinavian Journal of Infectious Diseases 10/2012; · 1.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nontuberculous mycobacteria (NTM) are classified into 2 categories: slow-growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM), based on interval to colony formation by subculture on solid media. However, little is known about the growth rate of NTM in liquid broth media. We evaluated the differences in time to growth detection (TGD) of RGM and SGM in liquid broth media according to acid-fast stain. Among the 696 NTM isolates, 201 were RGM and 495 were SGM. In acid-fast bacilli (AFB)-negative specimens, the mean TGD was 133 h for RGM and 269 h for SGM (P < 0.001). In AFB-positive specimens, the mean TGD was 112 ± 37 h for RGM and 155 ± 125 h for SGM (P = 0.063). In the AFB-negative group, a cut-off value of 6 days was most effective for distinguishing SGM from RGM; however, in the AFB-positive group, an appropriate cut-off value was hard to define with TGD only.
    Diagnostic microbiology and infectious disease 10/2012; · 2.45 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. Blood levels of voriconazole, a first line therapy for invasive aspergillosis, may correlate with adverse events and treatment response. However, no randomized controlled studies have been conducted to evaluate the clinical utility of routine therapeutic drug monitoring (TDM) of voriconazole. This study aimed to determine whether routine TDM of voriconazole reduces drug adverse events or improves treatment response in invasive fungal infections. Methods. This was a randomized, assessor-blinded, controlled, single center trial. One hundred ten adult patients were randomly assigned to TDM or non-TDM groups. In the TDM group, voriconazole dosage was adjusted (target range, 1.0-5.5 mg/L) according to the serum trough level measured on the fourth day after initiation of voriconazole. The non-TDM group received a fixed, standard dosage. Voriconazole-related adverse events were monitored, and treatment response was assessed three months after the initiation of therapy. Results. Baseline characteristics including the CYP2C19 genotype were comparable between the two groups. While the incidence of adverse events was not different between the TDM group and the non-TDM group (both 42%; P = .97), the proportion of voriconazole discontinuation due to adverse events was significantly lower in the TDM group than in the non-TDM group (4% vs 17%; P = .02). A complete or partial response was observed in 81% (30 of 37) of patients in the TDM group compared to 57% (20 of 34) in the non-TDM group (P = .04). Conclusions. Routine TDM of voriconazole may reduce drug discontinuation due to adverse events and improve the treatment response in invasive fungal infections. Clinical Trial Registration. NCT00890708.
    Clinical Infectious Diseases 07/2012; 55(8):1080-7. · 9.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is little information about the effectiveness of ciprofloxacin in regions where ciprofloxacin-resistant Escherichia coli is prevalent. This study was conducted to evaluate whether ciprofloxacin is effective as the initial empirical antibiotic for treatment of uncomplicated acute pyelonephritis (APN) due to ciprofloxacin-resistant E. coli. A total of 255 women with clinical diagnoses of uncomplicated APN due to E. coli were enrolled in the emergency department between March 2005 and December 2008. All enrolled patients were initially treated with ciprofloxacin. Patients were followed up 4 to 7 days after the start of therapy and 14 to 21 days after its completion. At the first follow-up visit, ciprofloxacin was changed to the appropriate antibiotic when necessary, depending on the antibiotic susceptibility results. Not only improvement of symptoms and signs but also microbiologic eradication was assessed at each visit. Fifteen percent (39/255) of the E. coli isolates were resistant to ciprofloxacin. There was no statistically significant difference between the clinical cure rates of the ciprofloxacin-susceptible group and the ciprofloxacin-resistant group at the first follow-up (87.0% versus 76.9%, P = 0.135) or the second follow-up (98.6% versus 94.9%, P = 0.177). However, there was a lower microbiologic cure rate in the ciprofloxacin-resistant group than in the ciprofloxacin-susceptible group (92.4% versus 41.7%, P = 0.000) at the first follow-up visit. No complications occurred in the ciprofloxacin-resistant group during the follow-up period. Our findings indicate that ciprofloxacin is an appropriate choice for empirical therapy of uncomplicated APN and has no serious adverse outcomes, if it is tailored appropriately, even for women infected with ciprofloxacin-resistant E. coli.
    Antimicrobial Agents and Chemotherapy 03/2012; 56(6):3043-6. · 4.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We retrospectively reviewed medical records to identify the factors that affect the results of culture in patients with pyogenic vertebral osteomyelitis. In multivariate analysis, the presence of paravertebral abscess was associated with positive results of microbiologic culture. Prior antibiotic exposure, especially of longer duration, was strongly associated with negative results.
    Antimicrobial Agents and Chemotherapy 01/2012; 56(4):2122-4. · 4.57 Impact Factor

Publication Stats

1k Citations
239.56 Total Impact Points

Institutions

  • 2009–2013
    • Seoul National University Bundang Hospital
      • Department of Laboratory Medicine
      Sŏul, Seoul, South Korea
  • 2004–2013
    • Seoul National University Hospital
      • Department of Internal Medicine
      Seoul, Seoul, South Korea
    • Seoul National University
      • Department of Internal Medicine
      Seoul, Seoul, South Korea
  • 2007
    • Dongguk University
      • Department of Internal Medicine
      Seoul, Seoul, South Korea