Proposal of a Selective Prophylaxis Strategy Based on Risk Factors to Prevent Early and Late Pneumocystis jirovecii Pneumonia after Renal Transplantation

이호,한아람,최찬중,안상현,민상일,민승기,이하정,김연수,양재석,하종원 대한이식학회 2018 Korean Journal of Transplantation Vol.32 No.4

Background: Currently, trimethoprim-sulfamethoxazole is used for Pneumocystis jirovecii pneumonia (PJP) prophylaxis, but it is associated with frequent adverse effects. This study evaluated the efficacy and safety of the current protocol and proposes an individualized risk-based prophylaxis protocol. Methods: The PJP incidence and risk factors during the first 6 months (early PJP) and afterwards (late PJP) was assessed in renal transplant recipients with (prophylaxis group) and without (no-prophylaxis group) 6-month PJP prophylaxis. Results: In 578 patients, there were 39 cases of PJP during a median follow-up of 51 months. Renal adverse events were encountered frequently during trimethoprim-sulfamethoxazole prophylaxis, leading to premature discontinuation. Patients without the prophylaxis had a significantly higher incidence of early PJP (n=27, 6.6%) compared to patients with the prophylaxis (n=0). The incidence of late PJP was 2.2%, without between-group differences. The factors associated with early PJP were preoperative desensitization and acute rejection within 1 month, whereas late PJP was associated with age, deceased donor transplant, and acute rejection requiring antithymocyte globulin treatment. Conclusions: Based on the simulation results of several risk-based scenarios, the authors recommend universal prophylaxis up to 6 months post-transplant and extended selective prophylaxis in patients aged ≥57 years and those with a transplant from deceased donors.

재발성 요로감염에 대한 예방적 항생제 요법

박민구,조대연 대한요로생식기감염학회 2014 Urogenital Tract Infection Vol.9 No.1

Recurrent uncomplicated urinary tract infection (UTI) is a common problem in women, causing considerable morbidity and expense, and is a management burden for clinicians. In management of recurrent UTI, non-antimicrobial approaches to prevention of UTI, such as behavioral modifications should first be tried as a way of minimizing antimicrobial exposure, however, antimicrobial treatment of prophylaxis may be necessary in those who continue to have recurrences. Continuous antimicrobial prophylaxis, post-coital prophylaxis with low dose antimicrobials, and intermittent self-treatment with antimicrobials have all been shown to be effective in prevention of recurrent uncomplicated UTIs. The decision regarding which approach to use for prophylaxis depends on the frequency and pattern of recurrence and the patient’s preference to commit to a specific method. The risk of adverse events and the plan for pregnancy should be considered before starting any regimen of antimicrobial prophylaxis. The susceptibility of the organisms causing the previous UTIs and history of the patient’s drug allergies should be considered before selection of antimicrobials. Before initiation of any prophylaxis regimen, eradication of a previous UTI should be confirmed by a negative urine culture. Continuous antimicrobial prophylaxis is usually used for long periods, thus likely contributing to the widespread problem of antimicrobial resistance. Post-coital prophylaxis and self-treatment approach result in less antimicrobial use, but should be used in the appropriate settings.

Effects of coagulation factor concentrate prophylaxis in moderate and severe hemophilia A patients at a single hemophilia center in Korea

Moon, Byung Suk,Choi, Jun Seok,You, Chur Woo The Korean Pediatric Society 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.7

Purpose: The aim of this study was to investigate prophylactic treatment effects in Korean patients with severe hemophilia A. Methods: A prospective study of 32 severe hemophilia A patients was conducted with the approval of the Institutional Review Board at the Eulji University Hospital. Two patients received primary prophylaxis; whereas, the other 30 patients were divided into 2 groups-secondary prophylaxis (n=15) and on-demand (n=15)-on the basis of their consent for secondary prophylaxis. A 20-25 IU/kg dose of factor VIII concentrate was administered to the primary and secondary prophylaxis group patients every 3 days for 1 year. The prophylactic effect was evaluated by observing changes in the Pettersson scores, annual number of total and joint bleeds, and factor VIII consumption for 1 year. Results: No moderate or severe bleeding was observed, and the Pettersson scores remained unchanged during the prophylaxis period in the patients who received primary prophylactic treatment. After the treatment was changed from on-demand to secondary prophylaxis, the annual number of total and joint bleeds in the secondary prophylaxis group decreased by $64.4%{\pm}13.0%$ and $70.0%{\pm}15.2%$, respectively. The average increase in Pettersson scores within 1 year was $0.5{\pm}0.8$ and $1.3{\pm}1.1$ in the secondary prophylaxis and on-demand groups, respectively. Prophylactic effects were also observed in patients >17 years who had nearly the same initial Pettersson scores. Conclusion: Intermediate-dose prophylactic treatment may delay hemarthropathy progression and prevent its occurrence in Korean severe hemophilia A patients.

Effects of coagulation factor concentrate prophylaxis in moderate and severe hemophilia A patients at a single hemophilia center in Korea

문병숙,최준석,유철우 대한소아청소년과학회 2013 Clinical and Experimental Pediatrics (CEP) Vol.56 No.7

Purpose: The aim of this study was to investigate prophylactic treatment effects in Korean patients with severe hemophilia A. Methods: A prospective study of 32 severe hemophilia A patients was conducted with the approval of the Institutional Review Board at the Eulji University Hospital. Two patients received primary prophylaxis;whereas, the other 30 patients were divided into 2 groups—secondary prophylaxis (n=15) and on-demand (n=15)—on the basis of their consent for secondary prophylaxis. A 20–25 IU/kg dose of factor VIII concentrate was administered to the primary and secondary prophylaxis group patients every 3 days for 1 year. The prophylactic effect was evaluated by observing changes in the Pettersson scores,annual number of total and joint bleeds, and factor VIII consumption for 1 year. Results: No moderate or severe bleeding was observed, and the Pettersson scores remained unchanged during the prophylaxis period in the patients who received primary prophylactic treatment. After the treatment was changed from on-demand to secondary prophylaxis, the annual number of total and joint bleeds in the secondary prophylaxis group decreased by 64.4%±13.0% and 70.0%±15.2%,respectively. The average increase in Pettersson scores within 1 year was 0.5±0.8 and 1.3±1.1 in the secondary prophylaxis and on-demand groups, respectively. Prophylactic effects were also observed in patients >17 years who had nearly the same initial Pettersson scores. Conclusion: Intermediate-dose prophylactic treatment may delay hemarthropathy progression and prevent its occurrence in Korean severe hemophilia A patients.

Varicella zoster virus infection after allogeneic hematopoietic cell transplantation in children using a relatively short duration of acyclovir prophylaxis : A retrospective study

Han, Seung Beom,Kim, Seong koo,Lee, Jae Wook,Lee, Dong-Gun,Chung, Nack-Gyun,Jeong, Dae Chul,Cho, Bin,Kang, Jin-Han Williams & Wilkins Co 2017 Medicine Vol.96 No.14

<P><B>Abstract</B></P><P>Although acyclovir prophylaxis against varicella zoster virus (VZV) infection for ≥1 year is recommended after allogeneic hematopoietic cell transplantation (HCT), the emergence of acyclovir-resistant viruses and adverse drug effects cannot be ignored. We investigated the cumulative incidence of VZV infection after allogeneic HCT in children receiving a shorter duration of acyclovir prophylaxis than recommended and evaluated the appropriateness of the short duration of acyclovir prophylaxis.</P><P>Medical records of 217 children who received allogeneic HCT were retrospectively reviewed until a median of 25 months (range = 1–59 months) after HCT. Acyclovir prophylaxis was given for a median of 9 weeks (range = 3–24 weeks) after HCT.</P><P>VZV infection was diagnosed in 33 (15.2%) children at a median time of 5 months (range = 2–41 months) after HCT. The 1-year and 2-year cumulative incidences of VZV infection after allogeneic HCT were 11.2% and 15.5%, respectively. These incidences were between the previously reported 1-year incidence of 25% to 30% in patients not receiving prophylaxis and 1-year incidence of 4% to 5% in patients receiving ≥1 year duration of prophylaxis. Male sex and older age were significantly associated with VZV infection after allogeneic HCT. Only 1 chickenpox patient experienced severe complications because of VZV infection, and there were no deaths attributable to VZV infection.</P><P>In conclusion, a shorter duration of acyclovir prophylaxis may be appropriate for children receiving allogeneic HCT, based on the rare occurrence of severe complications because of VZV infection and the expected discomfort because of daily oral medication for a long time.</P>

내시경을 이용한 경접형동 접근 수술 중에 시행한 비강내 세균 배양 검사 및 그에 대한 항생제 감수성 결과 분석과 3세대 세팔로스포린의 예방적 항생제로서의 임상적 효과에 대한 분석

이민기(Min-Gi Lee),박재성(Jae-Sung Park),김도현(Do Hyun Kim),김성원(Sung Won Kim),전신수(Sin Soo Jeun),홍용길(Yong-Kil Hong) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.2

Background : We analyzed the distribution of identified micro-organisms from the nasal cavity during EETS and their antibiotic susceptibility testing (AST) results. In addition, we evaluated the clinical outcomes of antibiotic prophylaxis with third-generation cephalosporins for endoscopic transsphenoidal surgery. Methods : From November 2014 to October 2017, a total of 225 EETS cases with available nasal cavity culture results were reviewed to identify the clinical data relevant to CNS infection. Ceftriaxone was used for antibiotic prophylaxis, and the patients were divided into subgroups according to the AST results. Results : Gram-positive cocci were the most commonly identified micro-organisms. The patient population was divided into the following three groups: prophylaxis-appropriate, prophylaxis-inappropriate, and Undetermined group, each amounting to 132 (59.5%), 34 (15.3%), and 56 (25.2%) cases, respectively. CNS infection was observed in 2 (0.9%) cases. But, statistical analyses did not show significant differences in the occurrence of CNS infection among the studied groups. Conclusions : Antibiotic prophylaxis with third-generation cephalosporins showed that most (85%) patients received appropriate prophylaxis, and the clinical outcomes regarding the CNS infection were also comparable to other previous reports. Future larger-scale studies are mandatory to establish the relationship between prophylaxis-appropriateness and the occurrence of CNS infection.

Infections in Lung Transplant Recipients during and after Prophylaxis

Bae Moonsuk,이상오,조경욱,최세훈,Lee Jina,채은진,도경현,Choi Dae-Kee,최인철,홍상범,심태선,김형렬,김동관,박승일 대한감염학회 2020 Infection and Chemotherapy Vol.52 No.4

Background: The timeline of infections after lung transplantation has been changed with the introduction of new immunosuppressants and prophylaxis strategies. The study aimed to investigate the epidemiological characteristics of infectious diseases after lung transplantation in the current era. Materials and Methods: All patients who underwent lung or heart–lung transplantation at our institution between October 29, 2008 and April 3, 2019 were enrolled. We retrospectively reviewed the patients' medical records till April 2, 2020. Results: In total, 100 consecutive lung transplant recipients were enrolled. The median follow-up period was 28 months after lung transplantation. A total of 127 post–lung transplantation bacterial infections occurred. Catheter-related bloodstream infection (25/84, 29.8%) was the most common within 6 months and pneumonia (23/43, 53.5%) was the most common after 6 months. Most episodes (35/40, 87.5%) of respiratory viral infections occurred after 6 months, mainly as upper respiratory infections. The remaining episodes (5/40, 12.5%) mostly manifested as lower respiratory tract infections. Seventy cytomegalovirus infections observed in 43 patients were divided into 23 episodes occurring before and 47 episodes occurring after discontinuing prophylaxis. Of 10 episodes of cytomegalovirus disease, four occurred during prophylaxis and six occurred after prophylaxis. Of 23 episodes of post–lung transplantation fungal infection, 7 were aspergillosis and all occurred after the discontinuation of prophylaxis. Conclusion: Lung transplant recipients experienced a high burden of infection even after 6 months, especially after the end of the prophylaxis period. Therefore, these patients should be continued to be monitored long-term for infectious disease.

Outcomes of Palivizumab Prophylaxis for Respiratory Syncytial Virus Infection in Preterm Children with Bronchopulmonary Dysplasia at a Single Hospital in Korea from 2005 to 2009

장승구,박문성,유재은 대한의학회 2010 Journal of Korean medical science Vol.25 No.2

This study was performed to evaluate the utilization and outcomes of palivizumab in high risk children born prematurely with chronic lung disease (CLD). A retrospective review of 128 patients was conducted from September 2004 to March 2009 at the Ajou University Hospital. All patients were diagnosed with CLD, were born at ≤35 weeks of gestation, were <2 yr old at the onset of respiratory syncytial virus (RSV) season, and had received medical therapy within six months prior to the RSV season. Fifty-three patients did not receive palivizumab prophylaxis and 75patients received at least one dose of palivizumab. There were no statistically significant differences between the patients with and without palivizumab prophylaxis with regard to demographic characteristics and risk factors for RSV infection. There were no systemic adverse responses. Compliance with the course of prophylaxis was 92.2%. Hospitalization associated with RSV occurred in 12 cases (22.6%) in the group without prophylaxis and in three cases (4.0%) with prophylaxis. Palivizumab prophylaxis significantly reduced the frequency of RSV-related hospitalization in preterm children with CLD. This is the first retrospective review of palivizumab prophylaxis in Korea. Palivizumab is effective and well tolerated in high risk prematurely born children.

Efficacy of Itraconazole Prophylaxis for Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors: A Prospective Double-Blind Randomized Study

Yae-Jean Kim,Ki Woong Sung,황혜숙,정신한,김주연,조은주,임수진,최영배,주희원,이수현,유건희,구홍회 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2

Purpose: The risk of invasive fungal infection is greater for allogeneic hematopoietic stem cell transplantation (HSCT) than for autologous transplantation. Therefore,many transplantation centers use antifungal prophylaxis for allogeneic HSCT, however, there exists no standard guidelines or consensus regarding autologous HSCT. Materials and Methods: A prospective double-blind randomized study was conducted in autologous HSCT recipients who were divided into prophylaxis and empirical treatment groups, and we investigated the efficacy of itraconazole prophylaxis in pediatric autologous HSCT. Results: Total 87 autologous HSCT episodes in 55 children with high-risk solid tumors were studied. No invasive fungal infections occurred in either group. However, patients in the prophylaxis group had a significantly shorter duration of fever (p < 0.05) and received antibacterial treatment of shorter duration (p < 0.05) with fewer numbers of antibiotics (p < 0.05 for the use of second line antibiotics) than those in the empirical group. No significant additional adverse events were found with itraconazole prophylaxis. Conclusion: Although beneficial effects such as a shorter duration of fever and reduced need for antibiotic use were observed in the prophylaxis group, the results were not sufficient to draw a definite recommendation about the routine use of antifungal prophylaxis in pediatric autologous HSCT recipients with high-risk solid tumors (Trial registration: NCT00336531).

Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries; a systematic review and meta-analysis

Tantry Thrivikrama P,BG Muralishankar,Karanth Harish,Shetty Pramal K,Shenoy Sunil P,Kadam Dinesh,Tantry Gururraj,Shetty Rithesh 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.5

Background: Prophylaxis for cerebral desaturation events (CDEs) during anesthesia in the beach chair position (BCP) for shoulder surgeries has not been evaluated. We systematically analyzed the effectiveness of various prophylactic measures used in this clinical setting. Methods: We performed a meta-analysis (PROSPERO; no. CRD42020167285) of trials reporting CDEs and regional cerebral oxygen saturation (rSO2) and jugular venous oxygen saturation (SjvO2) values in anesthetized patients undergoing shoulder surgery in BCP. Considering the type of prophylactic measures used (pharmacological or non-pharmacological), a subgroup analysis was planned. Outcomes included (1) rSO2 and SjvO2 data with and without prophylactic measures for CDEs, recorded for different time intervals, and (2) the number of patients experiencing CDEs and hypotension. Results: Twelve studies (786 patients) were included in the analysis. We observed lower absolute rSO2 values for early and all-time periods for vasoactive agent prophylaxis. The lowest achieved rSO2 values were also lower for vasoactive agent prophylaxis. Risk of CDEs was higher with vasoactive agent prophylaxis. Subgroup analysis identified targeted mild hypercarbia as effective in preserving cerebral oxygenation. Similarly, targeted mild hypercarbia prevented the fall in rSO2 with position change. Meta-regressions revealed statistically significant highest estimates for vasoactive agent prophylaxis in contrast to targeted mild hypercarbia. Likelihood of not developing CDEs was higher for targeted mild hypercarbia. In contrast to rSO2, most prophylactic methods reduced hypotensive episodes. Conclusions: Targeted mild hypercarbia can reduce BCP-related CDEs. Evidence does not favor prophylactic use of vasoactive agents for the prevention of cerebral desaturations irrespective of whether their use interferes with cerebral oximetry readings.