Kyong Ran Peck

Samsung Medical Center, Sŏul, Seoul, South Korea

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Publications (252)625.01 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although most Klebsiella pneumoniae liver abscesses have been reported to be monomicrobial, clinical outcomes have not been compared between antimicrobial therapy with and without anti-anaerobic coverage. A propensity score–matched cohort study was conducted using the 731 cases of K. pneumoniae liver abscess. Clinical outcomes were compared between a group discontinuing anti-anaerobic agents after K. pneumoniae identification and a group continuing. A total of 170 cases were matched at a 1:1 ratio using their propensity to discontinue anti-anaerobic agents. The McNemar's test showed no difference in mortality rates (1.8% for discontinuation versus 2.3% for continuation; P = 1.00) or relapse (1.8% versus 2.9%; P = 0.73) between groups. Early discontinuation of anti-anaerobic agents had no association with treatment failure by means of the generalized estimating equation model (odds ratio 0.48; P = 0.14) and the Kaplan–Meier method (P = 0.85) in matched groups. Early discontinuation of anti-anaerobic agents does not affect the clinical outcomes of patients with K. pneumoniae liver abscess.
    Diagnostic Microbiology and Infectious Disease. 10/2014;
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    ABSTRACT: Background: Cytomegalovirus (CMV) colitis is a common manifestation of CMV end-organ diseases, which has been usually described in immunocompromised hosts. Recently, it is recognized that we also occasionally experience it among immunocompetent patients. To get relevant data about clinical presentation, prognosis, and risk factors for development of CMV colitis in immunocompetent hosts, we analyzed all cases that occurred during a 19-year period in our center. Methods: A case-control study was performed to identify risk factors of CMV colitis in immunocompetent hosts. The electronic medical records were reviewed in individuals who admitted and were diagnosed with CMV colitis during the period of January 1995 through February 2014 at a tertiary care university hospital. Two non-CMV colitis patients with age and sex matching were selected to each case patient as controls. Results: A total of 51 patients with CMV colitis were included and compared with 102 control patients. Renal disease on hemodialysis, neurologic disease, rheumatologic disease, ICU care, and exposure to antibiotics, antacid, steroid, and RBC transfusion within 1 month prior to diagnosis of colitis were associated with CMV colitis in the univariate analysis. Among them, steroid use (OR 9.95, 95% CI 1.95-46.66) and RBC transfusion (OR 30.85, 95% CI 5.70-167.06) within 1 month were identified to be independent risk factors for development of CMV colitis in the multivariate analysis. 30-day mortality was 7.8% without any attributable mortality. Conclusion: Steroid use and RBC transfusion within 1 month prior to diagnosis of colitis were independent risk factors for development of CMV colitis in immunocompetent hosts.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: S. maltophilia is an important nosocomial pathogen, mainly in immunocompromised patients, and is associated with high mortality. However, data regarding clinical features and risk factors for mortality of S. maltophilia bacteremia in patients with hematologic malignancies are limited. Methods: We conducted a retrospective analysis of S. maltophilia bacteremia in patients with hematologic malignancies who were treated at Samsung Medical Center, in South Korea, from 2000 to 2012. Results: During a 13 year period, we identified 101 adult patients with S. maltophilia bacteremia. The median age of the patients was 57 years (IQR, 45–64 years), 87 cases (86.1%) were hospital-acquired, and 25 cases (24.8%) had polymicrobial bacteremia.The most common underlying hematologic malignancy was acute myeloid leukemia (61 [60.4%] of 101) and twenty patients (19.8%) underwent stem cell transplantation. 83.2% of the patients had profound neutropenia and the median duration of neutropenia before the onset of bacteremia onset was 16 days (IQR, 10-26 days). 81 patients (80.2%) received prior antibiotic therapy during the previous month with carbapenem and, in 73 patients (72.3%), breakthrough bacteremia developed during carbapenem treatment. Catheter related infection (59.4%) and pneumonia (30.7%) were the most frequent primary sources of bacteremia. The 14-day mortality rate was 40.6% (41 of 101) and 65 patients (64.4%) received appropriate definitive antimicrobial therapy. Multivariate analysis demonstrated that the independent risk factors for 14-day mortality were pneumonia (OR, 18.76; 95% CI, 3.29-107.06; P=0.001), septic shock (OR, 15.84; 95% CI, 2.25-111.55; P=0.006), while appropriate definitive antimicrobial therapy was found to be a protective factor for 14-day mortality (OR, 0.06; 95% CI, 0.01-0.40; P=0.004). Conclusion: Physicians should consider S. maltophilia as the causative organism in hematologic malignancy patients, particularly those with the presence of prolonged neutropenia and carbapenem exposure. Although mortality rates were high, appropriate antibiotic therapy may improve the outcome of S. maltophilia bacteremia in patients with hematologic malignancies.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • Myung-Jin Choi, Kyong Ran Peck, Kwan Soo Ko
    Journal of Antimicrobial Chemotherapy 10/2014; · 5.34 Impact Factor
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    ABSTRACT: Background: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and recently had emerged in community. Recent published data have shown an inconsistent association between methicillin-resistance and mortality in patients with S. aureus bacteremia (SAB). To understand the changing epidemiology of MRSA and the impact of methicillin-resistance on outcomes in adults with S. aureusbacteremia (SAB) and endocarditis, we performed a meta-analysis for database published after 2000. Methods: We searched studies with SAB or endocarditis using electronic databases such as Ovid-Medline, EMBASE-Medline, and Cochrane Library, as well as five local databases for published studies during the period of Jan 2000 to Sep 2011. Two reviewers independently selected cohort studies, which compared in-hospital mortality or SAB-related mortality in adults with MRSA infection to those with methicillin-susceptible S. aureus (MSSA). Results: A total of 2,841 studies have been searched and of them, sixty-two with 17,563 adults were finally selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with MSSA, was evident with odds ratio (OR) of 1.95 (95% CI, 1.72-2.20, I2 = 43%; P<0.01). In sixteen studies which reported SAB-related mortality, OR was 2.04 (95% CI, 1 63-2.55). Methicillin-resistance in 13 endocarditis studies increased the risk for mortality, with OR of 2.49 (95% CI, 1.41-4.42). The average length of stay in MRSA group was 10 days longer than that in MSSA (95% CI, 3.36-16.70) Of six that have reported medical costs, two studies were integrated in the analysis resulting in estimated medical costs to be $9,954.58 (95% CI, 8,951.99-10,957.17). Conclusion: Methicillin-resistance is still associated with increased mortality, hospital stay and medical cost, compared with susceptible one in SAB for published studies since the year of 2000.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Tuberculosis (TB) is a common disease worldwide. However, nasal TB is quite rare, and the diagnosis of nasal TB requires a high index of suspicion. The most common symptoms of this unusual presentation are nasal obstruction and nasal discharge. We present a case of nasal TB with involvement of the hard palate presenting with a chronically progressive nasal deformity and ulceration of the hard palate. A biopsy confirmed the diagnosis, and medication for TB was started and the lesions resolved. When a patient presents with chronic ulcerative lesions that do not respond to antibiotic treatment, TB should be included in the differential diagnosis. Biopsy of the lesion can aid in the confirmation of the diagnosis.
    Clinical and Experimental Otorhinolaryngology 09/2014; 7(3):229-31. · 0.88 Impact Factor
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    ABSTRACT: Bacillus species have been frequently reported in recent decades as true pathogens among cancer patients. The purpose of this study was to evaluate the clinical features and risk factors of Bacillus bacteremia among adult patients with cancer.
    Supportive Care Cancer 08/2014; · 2.65 Impact Factor
  • Myung-Jin Choi, Kyong Ran Peck, Kwan Soo Ko
    International Journal of Antimicrobial Agents 08/2014; · 4.42 Impact Factor
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    ABSTRACT: A total of 114 Acinetobacter sp. isolates were collected from patients in the emergency departments (EDs) of two Korean hospitals. Most isolates belonged to the A. baumannii complex (105 isolates, 92.1%). Imipenem resistance was found in 39 isolates (34.2%) of the Acinetobacter sp. isolates, and six colistin-resistant isolates were also identified. Species distribution and antimicrobial resistance rates were different between the two hospitals. In addition, two main clones were identified in the imipenem-resistant A. baumannii isolates from hospital B, but very diverse and novel genotypes were found in those from hospital A. Many of Acinetobacter sp. isolates, including the imipenem-resistant A. baumannii, are considered to be associated with the community. The evidence of high antimicrobial resistance and different features in these Acinetobacter sp. isolates between the two EDs suggests the need for continuous testing to monitor changes in epidemiology.
    Journal of medical microbiology. 07/2014;
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    ABSTRACT: Cytomegalovirus (CMV) gastrointestinal (GI) disease has been noticed frequently in cancer patients, causing abdominal pain, diarrhea, and GI bleeding. However, little is known about its actual incidence, clinical presentation, and the risk factors for its development among cancer patients. To answer these questions, we analyzed all cases that occurred during an 18-year period at our center. A case-control study was performed to identify risk factors for CMV GI disease. Electronic medical records were reviewed from individuals who were admitted and diagnosed with CMV GI disease during the period of January 1995 through March 2013 at a tertiary care center. Two CMV disease-free cancer patients were matched as controls. A total of 98 episodes of CMV GI disease were included in this study, and the overall incidence rate was 52.5 per 100,000 cancer patients, with an increasing trend throughout the study period. According to multivariate analysis, male sex, low body mass index, lymphopenia, hematological malignancy, and steroid use and red blood cell transfusion within 1 month prior to the CMV disease were identified to be independent risk factors. Among these factors, RBC transfusion showed the highest odds ratio (OR = 5.09). Male sex, low body mass index, lymphopenia, hematological malignancy, steroid use, and red blood cell transfusion within 1 month prior to the CMV disease diagnosis were independent risk factors for the development of CMV GI disease in adult patients with cancer.
    05/2014;
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    ABSTRACT: To better understand extensively drug resistant Streptococcus pneumoniae, we assessed clinical and microbiological characteristics of 5 extensively drug-resistant pneumococcal isolates. We concluded that long-term care facility residents who had undergone tracheostomy might be reservoirs of these pneumococci; 13- and 23-valent pneumococcal vaccines should be considered for high-risk persons; and antimicrobial drugs should be used judiciously.
    Emerging Infectious Diseases 05/2014; 20(5):869-71. · 6.79 Impact Factor
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    The Korean Journal of Internal Medicine 05/2014; 29(3):398-401.
  • International journal of antimicrobial agents 02/2014; · 3.03 Impact Factor
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    ABSTRACT: A constant reduction in the incidence of community-onset acute pyelonephritis (CO-APN) caused by Escherichia coli has been shown with a parallel increase incidence caused by other organisms. Therefore, we evaluated the risk factors and outcome of non-E. coli as uropathogens in patients with community-onset APN. As a part of a nationwide multicentre surveillance study conducted in Korea, a total of 416 patients with CO-APN were collected with their epidemiological, antibiotic treatment and outcome data. The risk factors and outcomes of non-E. coli as uropathogens were evaluated in a total of 416 patients with culture-confirmed CO-APN. Non-E. coli caused 127 cases (30.5%) of CO-APN. CO-APN caused by non-E. coli resulted in higher inappropriate empirical therapy (38.6% vs. 20.1%, p < 0.001), longer hospital stay (12.6 days vs. 6.7 days, p = 0.005) and higher 30-day mortality (9.4% vs. 3.8% p = 0.020) compared with CO-APN caused by E. coli. Multivariate analyses showed that male gender (OR, 3.48; CI, 2.13-5.67; p < 0.001), underlying haematological disease (OR, 5.32; CI, 1.17-24.254; p = 0.031), underlying benign prostate hyperplasia (OR, 2.61; CI, 1.02-6.74; p = 0.046), chronic indwelling urethral catheter (OR, 6.34; CI, 1.26-31.84; p = 0.025) and admission history in the previous 6 months (OR, 2.12; CI, 1.23-3.58; p = 0.005) were predictors for CO-APN caused by a non-E. coli isolate. Community-onset APN caused by non-E. coli represents a distinct subset of urinary tract infections with worse outcomes. The defined risk factors related with non-E. coli should be taken into consideration when empirical antibiotic therapy is prescribed in patients with community-onset APN.
    International Journal of Clinical Practice 01/2014; · 2.43 Impact Factor
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    ABSTRACT: We performed a case-control study to identify risk factors of carbapenem-resistant Gram-negative bacteria (CRGNB) as an increasing cause of hospital-acquired pneumonia (HAP). The study included critically ill adult patients with HAP whose microbial etiology was identified at eight tertiary centers in Korea between June 2008 and December 2009. Eighty two patients with 86 isolates of CRGNB (62 Acinetobacter baumannii, 14 Pseudomonas aeruginosa, and 10 Stenotrophomonas maltophilia) were included in the case group, and 122 patients with carbapenem-susceptible Gram-negative bacteria were included in the control group. Diabetes mellitus (adjusted odds ratio [aOR] 2.82, 95% confidence interval [95% CI] 1.25-6.38), radiologic score ≥5 (aOR 4.56, 95% CI 2.36-8.81), prior fluoroquinolone (aOR 2.39. 95% CI = 1.07-5.35), or carbapenem usage (aOR 2.82, 95% CI 1.75-17.83) were found to be independent risk factors. Fluoroquinolone and carbapenem should be cautiously used to avoid HAP caused by CRGNB.
    Diagnostic microbiology and infectious disease 01/2014; · 2.45 Impact Factor
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    ABSTRACT: Objectives Although pyogenic vertebral osteomyelitis (PVO) with no identified microorganism is treated empirically, the clinical outcome is not well understood. Methods We conducted a retrospective review of patients with PVO at a tertiary-care hospital from 2000 through 2012. The study compared clinical features and outcomes of microbiologically confirmed (M-PVO) with clinically diagnosed PVO (C-PVO). Results Of 151 patients with PVO, 75 (49.7%) had M-PVO. Compared to patients with M-PVO, patients with C-PVO had fewer underlying medical conditions. In addition, they presented less frequently with fever, high acute-phase reactants levels and paraspinal abscess. The rate of treatment failure tended to be lower in the C-PVO group (9.2% [7/76] vs. 17.3% [13/75]; p=0.157). The overall relapse rate was 6.6% and did not differ significantly between groups; notably this rate was higher in patients who received antibiotics for ≤6 weeks (18.8% [3/16]) and ≤8 weeks (12.1% [4/33]). The independent risk factors for treatment failure were higher CRP levels (odds ratio [OR], 1.087; 95% confidence interval [CI], 1.025-1.153; p=0.005) and fever ≥37.8°C (OR, 8.556; 95% CI, 2.273-32.207; p=0.002). Conclusions Patients with C-PVO had less systemic inflammatory response and a more favorable outcome compared to M-PVO. Prolonged antibiotic therapy, for at least 8 weeks, might be required for C-PVO as well as for M-PVO until better outcomes are assured.
    Seminars in Arthritis and Rheumatism. 01/2014;
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    ABSTRACT: Based on the new recommendations of the Clinical and Laboratory Standards Institute (CLSI), the revised cephalosporin breakpoints may result in many CTX-M-producing Escherichia coli being reported as susceptible to ceftazidime. We determined the activity of ceftazidime and other parenteral β-lactam agents in standard- and high-inoculum minimum inhibitory concentration (MIC) tests against CTX-M-producing E. coli isolates. Antimicrobial susceptibility was determined using a broth microdilution MIC method with inocula that differed 100-fold in density. An inoculum effect was defined as an eight-fold or greater increase in MIC on testing with the higher inoculum. When the revised CLSI ceftazidime breakpoint of 4 μg/mL was applied, 34 (34.3%) of the 99 CTX-M-producers tested were susceptible. More specifically, for 42 CTX-M-14-producing E. coli isolates, 32 (76.2%) were susceptible at 4 μg/mL. Cefotaxime, ceftazidime, cefepime and piperacillin/tazobactam were found to be associated with inoculum effects in 100% of the evaluable tests for extended-spectrum β-lactamase-producing E. coli isolates. The MIC50 (MIC required to inhibit 50% of isolates) of ceftazidime was 16 μg/mL in the standard-inoculum tests and > 512 μg/mL in the high-inoculum tests. In the high-inoculum tests including isolates encoding CTX-M-14, ceftazidime was dramatically affected, with susceptibility decreasing from 82.1% of isolates inhibited at 4 μg/mL in the standard-inoculum tests to 0% at high inoculum. Although further studies may demonstrate that ceftazidime has a role in the treatment of infections caused by these organisms, we suggest that until more data become available, clinicians should be cautious about treating serious CTX-M-producing E. coli infections with ceftazidime or cefepime.
    International journal of antimicrobial agents 01/2014; · 3.03 Impact Factor
  • Y M Wi, J M Kim, K R Peck
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    ABSTRACT: Low serum albumin levels occur in a variety of disease states and are related to in-hospital mortality and length of stay. The purpose of this study was to evaluate the association of commonly measured biochemical markers in critically ill patients such as serum albumin or C-reactive protein (CRP) with the need for intensive respiratory or vasopressor support (IRVS) in patients with 2009 influenza A (H1N1). A total of 104 patients from an H1N1 registry database of 2436 patients were enrolled. Clinical characteristics and laboratory findings within 24 h of admission were reviewed to evaluate whether serum biochemical markers can be used as predictors of illness severity in adult patients with H1N1 based on the need for IRVS. Twenty-four (23.1%) of the 104 patients enrolled in the study received IRVS during the study period. Independent predictors of the need IRVS were serum glucose level on admission (OR 1.02; 95% CI 1.00-1.04; p = 0.021) and serum albumin level on admission (OR 0.12; 95% CI 0.02-0.63; p = 0.013). The diagnostic sensitivity of albumin levels for predicting the need for IRVS in patients with confirmed H1N1 with a cut-off value of 2.7 g/dl was 79.17% (95% CI 57.8-92.9), the specificity was 85.71% (95% CI 75.9-92.6), the positive predictive value was 63.3% (95% CI 43.9-80.1) and the negative predictive value was 93.0% (95% CI 84.3-97.7). The area under the receiver operation characteristic curve was 0.860 (95% CI 0.773-0.923) for albumin, 0.808 (95% CI 0.713-0.882) for glucose and 0.734 (95% CI 0.633-0.821) for CRP. Serum albumin levels and glucose levels on admission were predictors of the need IRVS in adult patients with H1N1. Based on these findings, the level of albumin at presentation may serve as a novel and simple early biomarker to identify patients at high risk for a complicated clinical course of disease.
    International Journal of Clinical Practice 12/2013; · 2.43 Impact Factor
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    ABSTRACT: The causative pathogens of and prevalence of antibiotic resistance in community-acquired pneumonia (CAP) varies across countries. We evaluated the patterns of antibiotic prescriptions for adult CAP patients, and physician satisfaction with the form and content of the 2009 Korean CAP treatment guidelines. We designed an online survey for clinical physicians who treat CAP (infectious disease specialists, pulmonologists, and other physicians). We e-mailed the online survey to physicians and gathered results from December 2011 to January 2012, and then analyzed their responses. A total of 157 physicians responded to our survey: 61 (38.9%) infectious disease specialists, 33 (21.0%) pulmonologists, and 63 (40.1%) other physicians. Two-thirds (96/157, 61.2%) had positions in tertiary and secondary hospitals; the others (61, 38.8%) worked in primary clinics (hospitals and private clinics). One hundred and eight (68.8%) were aware of the Korean CAP clinical guidelines; of these, 98 (62.4%) applied the guidelines to their practice. Among physicians using them, 86.7% (85/98) reported the guidelines to be most useful for empirical selection of antibiotics, and 75.2% (118/157) said the guidelines were useful and satisfactory. Sixty-eight (43.3%) respondents indicated that they had not used aminoglycosides as an initial empirical CAP treatment, while 51 (32.5%) had combined aminoglycosides with other antibiotics to treat patients with CAP. Seventy-three (46.5%) physicians often combined macrolides with β-lactam antibiotics for empirical treatment of CAP, and 21 (13.4%) reported using macrolide monotherapy (which is not recommended in the 2009 Korean CAP treatment guidelines) for CAP patients. The most commonly used β-lactams were third-generation cephalosporins (72, 45.9%) and ampicillin/sulbactam or amoxicillin/clavulanate (28, 17.8%). Some physicians remain unaware of the 2009 Korean treatment guidelines for CAP and do not use them in clinical practice. In addition, aminoglycoside combination therapy is frequently and inappropriately used in practice. In some cases, CAP is treated with macrolide monotherapy. Thus, the Korean CAP clinical guidelines must be more aggressively and continuously publicized.
    Infection & chemotherapy. 12/2013; 45(4):394-405.
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    ABSTRACT: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. While gastrointestinal surgery is relatively common in Korea, few studies have evaluated SSI in the context of gastric surgery. Thus, we performed a prospective cohort study to determine the incidence and risk factors of SSI in Korean patients undergoing gastric surgery. A prospective cohort study of 2,091 patients who underwent gastric surgery was performed in 10 hospitals with more than 500 beds (nine tertiary hospitals and one secondary hospital). Patients were recruited from an SSI surveillance program between June 1, 2010, and August 31, 2011 and followed up for 1 month after the operation. The criteria used to define SSI and a patient's risk index category were established according to the Centers for Disease Control and Prevention and the National Nosocomial Infection Surveillance System. We collected demographic data and potential perioperative risk factors including type and duration of the operation and physical status score in patients who developed SSIs based on a previous study protocol. A total of 71 SSIs (3.3%) were identified, with hospital rates varying from 0.0 - 15.7%. The results of multivariate analyses indicated that prolonged operation time (P = 0.002), use of a razor for preoperative hair removal (P = 0.010), and absence of laminar flow in the operating room (P = 0.024) were independent risk factors for SSI after gastric surgery. Longer operation times, razor use, and absence of laminar flow in operating rooms were independently associated with significant increased SSI risk after gastric surgery.
    Infection & chemotherapy. 12/2013; 45(4):422-30.

Publication Stats

2k Citations
625.01 Total Impact Points

Institutions

  • 2007–2014
    • Samsung Medical Center
      • Department of Infectious Diseases
      Sŏul, Seoul, South Korea
    • Gyeongsang National University
      Shinshū, South Gyeongsang, South Korea
  • 1998–2014
    • Sungkyunkwan University
      • • Department of Internal Medicine
      • • Samsung Medical Center
      • • Department of Molecular and Cell Biology
      • • School of Medicine
      • • Department of Surgery
      Sŏul, Seoul, South Korea
  • 2009–2013
    • Dankook University
      Eidō, North Chungcheong, South Korea
  • 2007–2013
    • Yonsei University Hospital
      • Department of Internal Medicine
      Seoul, Seoul, South Korea
  • 2012
    • Mahidol University
      Krung Thep, Bangkok, Thailand
    • Chonnam National University Hospital
      Sŏul, Seoul, South Korea
  • 2009–2012
    • Konkuk University Medical Center
      • Department of Infectious Diseases
      Changnyeong, South Gyeongsang, South Korea
  • 2003–2012
    • Chungnam National University Hospital
      Sŏul, Seoul, South Korea
  • 2002–2012
    • Kyungpook National University Hospital
      Sŏul, Seoul, South Korea
  • 2011
    • Dankook University Hospital
      Anjŏ, Gyeonggi Province, South Korea
  • 2008–2010
    • Jeju National University
      Tse-tsiu, Jeju, South Korea
    • Hallym University
      Sŏul, Seoul, South Korea
  • 2004
    • Dong-A University
      • Department of Infectious Diseases
      Tsau-liang-hai, Busan, South Korea