Kyong Ran Peck

Samsung Medical Center, Sŏul, Seoul, South Korea

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Publications (236)609.61 Total impact

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    ABSTRACT: Tigecycline is an important agent in clinical practice because of its broad-spectrum activity. However, it has no activity against Pseudomonas or Proteus species. We conducted a case-control study to analyze risk factors for acquisition of Pseudomonas or Proteus species during tigecycline therapy. Placement of suction drainage at infected wound sites, ICU stay, and neurologic disease were identified as independent risk factors for acquisition of Pseudomonas and Proteus spp. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 06/2015; DOI:10.1128/AAC.04865-14 · 4.45 Impact Factor
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    ABSTRACT: A 61-year-old man with chronic hepatitis B and dyslipidemia visited the emergency department with a fever and severe headache. He was diagnosed with bacterial meningitis after a lumbar puncture, and blood culture revealed Parvimonas micra bacteremia. Although he had a history of extraction of a molar two weeks before symptom onset, there was no evidence of abscess formation on physical examination or imaging studies. He was successfully treated with oral metronidazole for 12 days after 9 days of treatment with IV ceftriaxone and vancomcycin. This is the first report of primary bacterial meningitis caused by this organism, which indicates that this organism is capable of being a bacterial meningitis pathogen. Copyright © 2015. Published by Elsevier Ltd.
    Anaerobe 05/2015; DOI:10.1016/j.anaerobe.2015.05.004 · 2.36 Impact Factor
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    PLoS ONE 05/2015; 10(5):e0123554. DOI:10.1371/journal.pone.0123554 · 3.53 Impact Factor
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    ABSTRACT: Although heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) has been increasingly reported, the true prevalence of hVISA is unclear, especially in Asia. In this study, the genotype-specific prevalence of hVISA among meticillin-resistant S. aureus (MRSA) clinical isolates collected from Asian countries was determined. Among MRSA collections from South Korea, Taiwan, Hong Kong, Thailand, the Philippines, Vietnam, India and Sri Lanka in the ANSORP surveillance study during 2004 and 2006, isolates with a vancomycin minimum inhibitory concentration of ≥0.25mg/L were randomly selected. After screening by macro Etest, hVISA was confirmed using the modified population analysis profile method. MRSA isolates were typed by spa tying and multilocus sequence typing (MLST). Among 462 MRSA isolates, 16 (3.5%) were confirmed as hVISA. The proportion of hVISA was highest in South Korea and Vietnam (both 7.0%), followed by Thailand (3.2%) and Taiwan (1.9%). spa type t601 belonging to clonal complex (CC) 5 showed the highest proportion of hVISA (33.3%), and hVISA accounted for 6.9% among isolates of t002 belonging to CC5. Among CC239 isolates, only those of t037 were hVISA (1.6%). Among isolates of community-associated MRSA genotypes, hVISA was found only in those of t437 (4.8%) belonging to CC59, and no hVISA was found among those of CC30 or CC72. The prevalence of hVISA in the Asian region differed by country and was dependent upon the genotype of MRSA strains. It suggests that differences in hVISA prevalence between countries can be affected by the genotype distribution of MRSA strains. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
    International journal of antimicrobial agents 04/2015; DOI:10.1016/j.ijantimicag.2015.03.009 · 4.26 Impact Factor
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    ABSTRACT: Despite the remarkable emergence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli sequence type 131 (ST131), the clinical features and outcomes of infections caused by ST131 remain poorly described. From 2011 to 2012, we collected ESBL-producing E. coli isolates from patients with bloodstream infections in 13 hospitals in Korea and compared clinical characteristics and outcomes between ST131 and non-ST131 clones. Of the 110 ESBL-producing isolates, the most common ST was ST131 (30.9%). Multivariate analysis showed that recent operation was the only variable associated with the ST131 clone; other comorbid conditions and clinical features were similar between ST131 and non-ST131 clones. CTX-M-14 and CTX-M-15 were the predominant types of ESBLs, and CTX-M-15 was significantly associated with ST131. The rate of nonsusceptibility to ciprofloxacin was higher in ST131 than in non-ST131 clones (94.1% vs. 75.0%). No significant differences in 30-day mortality rates were found between ST131 and non-ST131 clones. Multivariate analysis revealed that older age (odds ratio [OR]=5.39, 95% confidence interval [CI] 1.22-23.89; p=0.027), nosocomial infection (OR=4.81, 95% CI 1.15-20.15; p=0.032), and higher Pitt bacteremia score (OR=7.26, 95% CI 1.41-37.42; p=0.018) were independent risk factors for 30-day mortality. The ESBL-producing E. coli ST131 clone has emerged and disseminated in Korea. Our findings reveal similarities in clinical and demographic characteristics between ST131 and non-ST131 clones. Although a more resistant profile has been detected in ST131, patients with the ST131 clone did not exhibit a higher mortality rate.
    Microbial drug resistance (Larchmont, N.Y.) 03/2015; DOI:10.1089/mdr.2014.0261 · 2.52 Impact Factor
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    ABSTRACT: The first cases of infective endocarditis due to a new species of Bergeyella, Bergeyella cardium sp. nov., are reported. Two strains, 13-07(T) (= JCM 30115(T) = NCCP 15908(T)) and 13-16, were independently isolated from 2 patients in different hospitals in Korea. Initially, the isolates were identified as Brevundimonas spp.; however, their 16S rRNA gene sequences shared a similarity of 94.9% with Bergeyella zoohelcum, implying that they are a new species belonging to of the genus Bergeyella. The organisms might be susceptible to many commonly used antibiotics, including penicillin. The first case was successfully treated with ceftriaxone, and the second, with piperacillin/tazobactam plus amikacin. Copyright © 2014 Elsevier Inc. All rights reserved.
    Diagnostic Microbiology and Infectious Disease 12/2014; 81(3). DOI:10.1016/j.diagmicrobio.2014.12.001 · 2.57 Impact Factor
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    ABSTRACT: Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard chemotherapy in diffuse large B-cell lymphoma (DLBCL) patients. Although febrile neutropenia (FN) is the major toxicity of this regimen, non-neutropenic fever (NNF) becomes an emerging issue. We analyzed clinical features and outcomes of febrile complications from 397 patients with newly diagnosed DLBCL who were registered in the prospective cohort study. They had completed R-CHOP between September 2008 and January 2013. Thirty-nine patients (9.8%) had NNF whereas 160 patients (40.3%) had FN. Among them, 24 patients (6.0%) had both during their treatment. Compared to frequent occurrence of initial FN after the first cycle (> 50% of total events), more than 80% of NNF cases occurred after the third cycle. Interstitial pneumonitis comprised the highest proportion of NNF cases (54.8%), although the causative organism was not identified in the majority of cases. Thus, pathogen was identified in a limited number of patients (n=9), and Pneumocystis jiroveci pneumonia (PJP) was the most common. Considering that interstitial pneumonitis without documented pathogen could be clinically diagnosed with PJP, the overall rate of PJP including probable cases was 4.5% (18 cases from 397 patients). The NNF-related mortality rate was 10.3% (four deaths from 39 patients with NNF) while the FN-related mortality rate was only 1.3%. NNF was observed with incidence of 10% during R-CHOP treatment, and showed different clinical manifestations with respect to the time of initial episode and causes.
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    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; 81(1). DOI:10.1016/j.diagmicrobio.2014.10.002 · 2.57 Impact Factor
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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; 70(2). DOI:10.1093/jac/dku406 · 5.44 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: 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 10/2014; 44(2). DOI:10.1016/j.semarthrit.2014.04.008 · 3.63 Impact Factor
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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. DOI:10.3342/ceo.2014.7.3.229 · 0.84 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; 23(2). DOI:10.1007/s00520-014-2382-1 · 2.50 Impact Factor
  • Myung-Jin Choi, Kyong Ran Peck, Kwan Soo Ko
    International Journal of Antimicrobial Agents 08/2014; DOI:10.1016/j.ijantimicag.2014.07.015 · 4.26 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; DOI:10.1099/jmm.0.075325-0 · 2.27 Impact Factor
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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 05/2014; 43(5). DOI:10.1016/j.ijantimicag.2014.01.030 · 4.26 Impact Factor
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    The Korean Journal of Internal Medicine 05/2014; 29(3):398-401. DOI:10.3904/kjim.2014.29.3.398
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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. DOI:10.3201/eid2005.131371 · 7.33 Impact Factor

Publication Stats

3k Citations
609.61 Total Impact Points

Institutions

  • 2004–2015
    • Samsung Medical Center
      • Department of Infectious Diseases
      Sŏul, Seoul, South Korea
  • 2001–2014
    • Sungkyunkwan University
      • • Department of Internal Medicine
      • • Samsung Medical Center
      Sŏul, Seoul, South Korea
  • 2012
    • University of Seoul
      Sŏul, Seoul, South Korea
  • 2009
    • Dankook University
      Eidō, North Chungcheong, South Korea
    • Konkuk University Medical Center
      • Department of Infectious Diseases
      Changnyeong, South Gyeongsang, South Korea
  • 2008
    • Hallym University
      Sŏul, Seoul, South Korea
    • Jeju National University
      Tse-tsiu, Jeju, South Korea
  • 2003–2008
    • Chungnam National University Hospital
      Sŏul, Seoul, South Korea
    • Kyorin University
      Edo, Tōkyō, Japan
  • 2007
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2002–2004
    • Kyung Hee University
      Sŏul, Seoul, South Korea
    • Kyungpook National University Hospital
      Sŏul, Seoul, South Korea