Publications (8)27.22 Total impact
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Article: Is adjunctive corticosteroid beneficial in pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone?
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ABSTRACT: The role of adjunctive corticosteroids remains controversial in meningitis by penicillin-resistant pneumococci. We determined the effect of adjunctive corticosteroids in adults with pneumococcal meningitis in a region with a high rate of penicillin resistance. A multicenter, retrospective cohort study was conducted between 1998 and 2008 in Korea. The mortality and neurological sequelae were evaluated. Among 93 patients with pneumococcal meningitis, adequate adjunctive corticosteroids were given in 45.2%. The penicillin resistance rate was 60.0%, and 42.1% were nonsusceptible to ceftriaxone. The 30-day mortality rates in the group receiving adequate corticosteroid therapy, the group in which corticosteroid was not given, and that inadequately given were 24.3, 31.6, and 27.3%, respectively, and there was no difference between the groups. The rates of development of neurological sequelae were 34.3, 33.3, and 43.5%, respectively. Multivariate analysis showed that adequate corticosteroids did not reduce mortality (HR 0.773, 95% CI 0.293-2.040) and neurologic sequelae (HR 0.604, CI 0.262-1.393). Propensity-adjusted analysis showed that adjunctive corticosteroid was not associated with time to death (HR 0.949, CI 0.374-2.408), however, a decreasing tendency was shown in neurologic sequelae in the adequate corticosteroid group (HR 0.479, CI 0.207-1.110). In conclusion, adjunctive corticosteroids did not affect mortality in adults with pneumococcal meningitis in a region with high rates of resistance to penicillin and ceftriaxone; however, the patients receiving adequate corticosteroid therapy tended to develop neurologic sequelae less frequently.Journal of Neurology 01/2012; 259(7):1453-60. · 3.47 Impact Factor -
Article: Impact of discordant empirical therapy on outcome of community-acquired bacteremic acute pyelonephritis.
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ABSTRACT: As ciprofloxacin resistance rate of Escherichia coli causing urinary tract infections has been increasing, concern about inappropriate empirical therapy has been arisen. We performed a retrospective cohort study to determine the impact of discordant empirical antimicrobial therapy on outcome of community-acquired bacteremic acute pyelonephritis. Among a total of 164 cases included, ciprofloxacin was empirically used in 80.5%. The most frequent etiologic organism was E. coli (92.1%), of which 20.5% was resistant to ciprofloxacin. Discordant empirical therapy was documented in 29 cases, which included 25 cases caused by ciprofloxacin-resistant E. coli. Discordant therapy resulted in lower early clinical response rate (34.5% vs. 82.2%; P < 0.001) and longer hospital stay (13.3 days vs. 8.7 days; P = 0.002) compared to concordant therapy. However, overall mortality and clinical cure rate did not differ between two groups. Multivariate analyses showed that worse early clinical response was associated with discordant empirical therapy (OR, 11.08; 95% CI, 4.37-28.07) and presentation with septic shock (OR, 8.52; 95% CI, 1.75-41.49). Longer hospital stay was also associated with discordant empirical therapy (OR, 2.47; 95% CI, 1.04-5.84). Discordant empirical therapy, mostly with ciprofloxacin, leads to worse early clinical response and longer hospital stay than concordant therapy in community-acquired bacteremic acute pyelonephritis, although it does not affect on overall mortality or clinical cure rate.The Journal of infection 11/2010; 62(2):159-64. · 4.13 Impact Factor -
Article: Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia.
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ABSTRACT: The aim of this study was to identify risk factors for development of severe sepsis or septic shock and to evaluate the clinical impact of severe sepsis on outcome in patients with gram-negative bacteremia (GNB). From the database of a nationwide surveillance for bacteremia, patients with GNB were analyzed. Data of patients with severe sepsis or septic shock were compared with those of patient with sepsis. Of 2286 patients with GNB, 506 (22.1%) fulfilled the criteria of severe sepsis or septic shock. Factors associated with severe sepsis or septic shock in the multivariate analysis included renal disease, indwelling urinary catheter, hematologic malignancy, and neutropenia. The 30-day mortality of patients with severe sepsis or septic shock was significantly higher than that of patients with sepsis (39.5% [172/435] vs. 7.4% [86/1170]; P < 0.001). Multivariable analysis revealed that solid tumor, liver disease, pulmonary disease, pneumonia, and pathogens other than Escherichia coli, which were risk factors of development of severe sepsis or septic shock, were also found to be strong predictors of mortality. Severe sepsis or septic shock was a significant factor associated with mortality (OR, 3.34; 95% CI, 2.35-4.74), after adjustment for other variables predicting poor prognosis. Severe sepsis or septic shock was a common finding in patients with GNB, predicting a higher mortality rate. Renal disease and indwelling urinary catheter were the most important risk factors significantly associated with severe sepsis or septic shock among patients with GNB.The Journal of infection 11/2010; 62(1):26-33. · 4.13 Impact Factor -
Article: Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli.
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ABSTRACT: The purpose of this study was to identify risk factors for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli amongst community-onset bacteraemia and to evaluate treatment outcomes. From the database of a nationwide surveillance programme for bacteraemia, data from patients with community-onset E. coli bacteraemia were analysed. Patients with ESBL-producing E. coli bacteraemia were compared with those with non-ESBL-producing bacteraemia. The overall proportion of ESBL-producers was 9.5% (82/865) amongst community-onset E. coli bacteraemia cases. Healthcare-associated infection, underlying liver disease and primary bacteraemia were significant independent factors associated with ESBL-producing E. coli bacteraemia (P<0.05). There was a trend toward mortality being higher in the ESBL group compared with the non-ESBL group (15.0% vs. 7.6%; P=0.096). ESBL production was found to be an independent factor associated with mortality after adjusting for confounding variables (odds ratio=2.99, 95% confidence interval 1.01-8.84; P=0.048), along with severe sepsis, higher Pitt bacteraemia score, primary bacteraemia, pneumonia and underlying liver disease (P<0.05). ESBL-producing E. coli is a significant cause of bacteraemia, even in patients with community-onset infections, predicting higher mortality, particularly in patients with primary bacteraemia, underlying liver disease or healthcare-associated infection.International journal of antimicrobial agents 09/2010; 36(3):284-7. · 3.03 Impact Factor -
Article: Invasive infection caused by a community-associated methicillin-resistant Staphylococcus aureus strain not carrying Panton-Valentine leukocidin in South Korea.
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ABSTRACT: Panton-Valentine leukocidin (PVL)-negative, SCCmec type IVa strains are the most common strains of methicillin-resistant Staphylococcus aureus (MRSA) circulating in the community in South Korea. This report describes five elderly patients presenting in 2006 to 2007 with invasive community-associated MRSA infection caused by a PVL-negative, SCCmec type IVa strain with sequence type 72 and spa type t324.Journal of clinical microbiology 11/2009; 48(1):311-3. · 4.16 Impact Factor -
Article: Evidence for clonal dissemination of the serotype K1 Klebsiella pneumoniae strain causing invasive liver abscesses in Korea.
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ABSTRACT: Seventy-three liver abscess isolates of serotype K1 Klebsiella pneumoniae from a nationwide collection in Korea were genotypically characterized using pulsed-field gel electrophoresis and multilocus sequence typing. We found that serotype K1 K. pneumoniae strains that caused liver abscesses in Korea were genotypically related and that most were sequence type 23.Journal of clinical microbiology 11/2008; 46(12):4061-3. · 4.16 Impact Factor -
Article: Kinetics of inflammatory cytokines in patients with scrub typhus receiving doxycycline treatment.
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ABSTRACT: Animal models have suggested that various cytokines and chemokines play an important role in host defense against Orientia tsutsugamushi, however, human data are limited. We investigated the kinetics of inflammatory responses in patients with scrub typhus receiving doxycycline. Amongst patients being treated for scrub typhus, serially collected sera were tested for TNF-alpha, IFN-gamma, IL-2, IL-4, IL-5, and IL-10 by immunoassay. The mRNAs encoding TNF-alpha, IL-1 beta, IL-6, IL-8, IFN-gamma, IL-12, IL-2, IL-4, IL-5, and IL-10 were measured by semiquantitative reverse transcription-PCR. The concentrations of TNF-alpha, IFN-gamma, and IL-10 of patients prior to doxycycline treatment were significantly higher than those of healthy volunteers. They decreased markedly within 24h after starting doxycycline. The mRNAs for IL-1 beta, TNF-alpha, IL-6, IFN-gamma, and IL-10 were highly expressed. Expression of mRNAs for IL-1 beta, IFN-gamma, and IL-10 decreased at day 2-7 of doxycycline treatment. Inflammatory cytokines including TNF-alpha, IL-1 beta, and IL-6 are markedly upregulated in patients with scrub typhus. Doxycycline treatment rapidly reduces the production of these cytokines, corresponding to the early defervescence after the start of the treatment. The profiles of T cell-derived cytokines in patients with scrub typhus do not follow typical Th1 or Th2 patterns.The Journal of infection 02/2008; 56(1):44-50. · 4.13 Impact Factor -
Article: A case of transition of polycythemia vera to chronic neutrophilic leukemia.
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ABSTRACT: Chronic Neutrophilic Leukemia (CNL) is a rare myeloproliferative disorder characterized by a persistent increase of mature peripheral neutrophils, myeloid hyperplasia in bone marrow, hepatosplenomegaly, elevated neutrophil alkaline phosphatase (NAP) and absence of Philadelphia chromosome, with no evidence of infection or malignancy sufficient to mimic a leukemoid reaction. CNL has been associated with multiple myelomas in many reported cases, but transition of Polycythemia Vera (PV) to CNL is very rare. An 81-year-old female patient, who had undergone intermittent phlebotomy following the diagnosis of PV 8 years previously, was admitted to our hospital due to lower back pain. A physical examination showed a splenomegaly 2 cm below the costal margin, with tenderness of the thoracic and lumbar spine area. A peripheral blood examination showed a WBC count of 91,800/microL (neutrophil 88%) with a rare immature form, hemoglobin of 9.1 g/dL and a platelet count of 1,661,000/microL. Her NAP score was 58. The bone marrow examination showed 95% cellularity, with an M:E ratio of 10:1, increased megakaryocytes with normal morphology and the absence of myelofibrosis. Chromosomal studies showed no Philadelphia chromosome. A radiological examination showed compression fractures of the vertebrae and spinal cord compression. No underlying disease causing a leukemoid reaction was detected. With iron replacement, the hemoglobin level failed to increase over 12 g/dL. Therefore, it was concluded to be a transition of PV to CNL. After administration of hydroxyurea and vertebroplasty, the symptom improved and the WBC count was sustained below 40,000/microL.The Korean Journal of Internal Medicine 01/2005; 19(4):285-8.
Top co-authors
Top Journals
Institutions
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2008–2010
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Hallym University Medical Center
Seoul, Seoul, South Korea
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2009
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Yonsei University Hospital
Seoul, Seoul, South Korea
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2005
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Hallym University
- College of Medicine
Seoul, Seoul, South Korea
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