Risk factors and clinical impact of COVID-19- associated pulmonary aspergillosis: multicenter retrospective cohort study

( Raeseok Lee ),( Sung-yeon Cho ),( Dong-gun Lee ),( Hyojin Ahn ),( Hyeah Choi ),( Su-mi Choi ),( Jae-ki Choi ),( Jung-hyun Choi ),( Shin Young Kim ),( Youn Jeong Kim ),( Hyo-jin Lee ) 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.4

Background/Aims: The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, and no data have been reported in Korea. This study aimed to investigate the epidemiology and importance of CAPA diagnostic efforts and to identify the predictors of CAPA and the impacts on clinical outcomes. Methods: Between January 2020 and May 2021, data of severely to critically ill COVID-19 patients were extracted from seven hospitals of the Catholic Medical Center through a clinical data warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day dose, mean daily dose, and duration of use. Results: A total of 2,427 patients were screened, and 218 patients were included. CAPA was diagnosed in 4.6% (10/218) of all hospitalized and 11.2% (10/89) of intensive care unit patients. Total cumulative dose (over 1,000 mg as methylprednisolone) and daily high-dose corticosteroid use (over 60 mg/day) were independent predictors but not early 7-day high-dose corticosteroid use (over 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 to 8.571) nor prolonged use (OR, 2.794; 95% CI, 0.635 to 13.928). In-hospital overall mortality was 11.9% (26 of 218). CAPA itself did not affect the outcome; rather, daily high-dose steroid use significantly increased the 30-day mortality (hazard ratio, 5.645; 95% CI, 1.225 to 26.091). Conclusions: CAPA was not uncommon, especially in critically ill patients. Daily high-dose corticosteroid use was the predictor of CAPA and associated with high mortality rates. High-dose corticosteroids use after early inflammatory phase should be avoided, and active surveillance methods for CAPA are essential for those high-risk patients.

The First Case of Pulmonary Mucormycosis Caused by Lichtheimia ornata

Lee Jungjun,Lee Dong-Gun,Lee Raeseok,Yoon Jae-Ho,Beck Kyongmin Sarah,Yoo In Young,Park Yeon-Joon 대한진단검사의학회 2024 Annals of Laboratory Medicine Vol.44 No.4

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

Soo Jin Lee,Raeseok Lee,Sung-Yeon Cho,Dukhee Nho,Hye Lim Ahn,Dong-Gun Lee 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.3

Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.

Development of the analytical method of ethanol with GC/FID using capillary column for the purity test of dexamethasone phosphate disodium in korean pharmacopoeia

Hwa-mi Lee,Daun Jeong,Raeseok Jung,KwangMoon Lee,Kyung-Won Seo,Won Shin 한국분석과학회 2017 학술대회논문집 Vol.2017 No.11

유압 트랜스미션의 본드선도 모델링 및 시뮬레이션

우성우(Seongwoo Woo),박래석(Raeseok Park),이종길(Jongkil Lee) Korean Society for Precision Engineering 1996 한국정밀공학회지 Vol.13 No.12

Bloodstream Infections in Patients with Hematologic Diseases: Causative Organisms and Factors Associated with Resistance

Choi Hyeah,Ahn Hyojin,Lee Raeseok,Cho Sung-Yeon,Lee Dong-Gun 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.2

Background Patients with hematologic diseases are at high risk of bloodstream infections (BSIs). This study aimed to analyze clinical features and distributions of microorganisms in patients with hematologic diseases presenting at a tertiary care university-affiliated hospital in Korea. Materials and Methods We retrospectively reviewed all BSI episodes recorded in patient medical records at two hematologic wards of the Catholic Hematology Hospital from January to December 2020. Our aim was to analyze demographic and clinical characteristics relevant to BSIs. We also described the antimicrobial resistance patterns of the major pathogens identified in this study, and evaluated risk factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae isolates and for vancomycin resistance in enterococcal isolates. Results A total of 380 BSI episodes were identified in 334 patients over the course of 1 year (monomicrobial BSI episodes, 86.1%; polymicrobial BSI episodes, 13.9%). Gram-negative bacteria accounted for 242 isolates (54.8%). The most frequently isolated Gram-negative bacteria isolates were Escherichia coli (107 [24.2%]) followed by Klebsiella spp. (72 [16.3%]), Pseudomonas spp. (21 [4.8%]), and Enterobacter spp. (12 [2.7%]). The most commonly identified Gram-positive bacteria were Enterococcus spp. (72 [16.3%]) followed by viridans streptococci (54 [12.2%]), coagulase-negative staphylococci (CoNS) (24 [5.4%]), and Corynebacterium spp. (22 [5.0%]). ESBL-producing Enterobacteriaceae accounted for 25.1% of the total distribution. Among 54 Enterococcus faecium isolates, 100.0% were resistant to ampicillin and 55.6% showed resistance to vancomycin, while 100.0% (n = 12) of Enterococcus faecalis isolates were susceptible to ampicillin and vancomycin, respectively. Use of ciprofloxacin prophylaxis (odds ratio: 5.20; 95% confidence interval: 1.11 - 24.34; P = 0.04) was an independent risk factor for ESBL production in Enterobacteriaceae BSIs. Conclusion Compared with the results of a previous study conducted at the same institution, our findings demonstrated that Gram-negative bacteria remained dominant pathogens in BSIs occurring in patients with hematologic diseases. Our findings also demonstrated a comparatively decreased prevalence of ESBL-producing Enterobacteriaceae in the evaluated BSIs. However, the prevalence of enterococcal BSIs had not decreased, and the proportion of vancomycin-resistant Enterococcus isolates from E. faecium BSIs had increased. In addition, we found that ciprofloxacin prophylaxis was statistically significantly associated with ESBL production in Enterobacteriaceae BSIs. We conclude that, in order to avoid critical complications and to reduce the burden of antimicrobial-resistant organisms in patients with hematologic diseases, it is necessary to conduct periodic examinations evaluating changes in BSI epidemiology within a single medical center. Background Patients with hematologic diseases are at high risk of bloodstream infections (BSIs). This study aimed to analyze clinical features and distributions of microorganisms in patients with hematologic diseases presenting at a tertiary care university-affiliated hospital in Korea. Materials and Methods We retrospectively reviewed all BSI episodes recorded in patient medical records at two hematologic wards of the Catholic Hematology Hospital from January to December 2020. Our aim was to analyze demographic and clinical characteristics relevant to BSIs. We also described the antimicrobial resistance patterns of the major pathogens identified in this study, and evaluated risk factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae isolates and for vancomycin resistance in enterococcal isolates. Results A total of 380 BSI episodes were identified in 334 patients over the course of 1 year (monomicrobial BSI episodes, 86.1%; polymicrobial BSI episodes, 13.9%). Gram-negative bacteria accounted for 242 isolates (54.8%). The most frequently isolated Gram-negative bacteria isolates were Escherichia coli (107 [24.2%]) followed by Klebsiella spp. (72 [16.3%]), Pseudomonas spp. (21 [4.8%]), and Enterobacter spp. (12 [2.7%]). The most commonly identified Gram-positive bacteria were Enterococcus spp. (72 [16.3%]) followed by viridans streptococci (54 [12.2%]), coagulase-negative staphylococci (CoNS) (24 [5.4%]), and Corynebacterium spp. (22 [5.0%]). ESBL-producing Enterobacteriaceae accounted for 25.1% of the total distribution. Among 54 Enterococcus faecium isolates, 100.0% were resistant to ampicillin and 55.6% showed resistance to vancomycin, while 100.0% (n = 12) of Enterococcus faecalis isolates were susceptible to ampicillin and vancomycin, respectively. Use of ciprofloxacin prophylaxis (odds ratio: 5.20; 95% confidence interval: 1.11 - 24.34; P = 0.04) was an independent risk factor for ESBL production in Enterobacteriaceae BSIs. Conclusion Compared with the results of a previous study conducted at the same institution, our findings demonstrated that Gram-negative bacteria remained dominant pathogens in BSIs occurring in patients with hematologic diseases. Our findings also demonstrated a comparatively decreased prevalence of ESBL-producing Enterobacteriaceae in the evaluated BSIs. However, the prevalence of enterococcal BSIs had not decreased, and the proportion of vancomycin-resistant Enterococcus isolates from E. faecium BSIs had increased. In addition, we found that ciprofloxacin prophylaxis was statistically significantly associated with ESBL production in Enterobacteriaceae BSIs. We conclude that, in order to avoid critical complications and to reduce the burden of antimicrobial-resistant organisms in patients with hematologic diseases, it is necessary to conduct periodic examinations evaluating changes in BSI epidemiology within a single medical center.

Case 4: A 70-Year-Old Man With Painful Swelling of Left Forearm Unresponsive to Antibiotics

Kim Mi-Hee,Choi Sangsuk,Park Hyunwoo,Lee Raeseok,Kim Soo-Young,Wie Seong-Heon 대한의학회 2022 Journal of Korean medical science Vol.37 No.43

Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions

Park Se Yoon,Kim Yong Chan,Lee Raeseok,Kim Bongyoung,Moon Song Mi,Kim Hong Bin 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.4

Identifying inappropriately prescribed antibiotics for infectious diseases by monitoring the quality of antibiotics use is essential for effective implementation of antibiotic stewardship. Qualitative assessment of the use of antibiotics has been conducted in some countries, including Korea, since the 2000s. The qualitative assessment generally involves an assessment of each component of the antibiotics prescription process, based on specific criteria. However, there is no standardized assessment method or cycle, and infectious diseases or antibiotics included in the assessments vary from country-to-country. According to the results reported in the United States, Europe, Australia, and Korea so far, approximately 20 - 55% of all antibiotics prescriptions are inappropriate. In this review, we describe the current progress in the quality assessment of the use of antibiotics on a global scale. Further, we highlight the future directions to improve antibiotic stewardship activities and the quality assessment of the use of antibiotics in Korea.

전자적 의약품 부작용 데이터 표준분석과 국내 적용

서정원 ( Jeong-won Seo ),이재옥 ( Jaeok Lee ),채규한 ( Gyuhan Chae ),도원임 ( Won-im Do ),이상훈 ( Sang-hun Lee ),정래석 ( Raeseok Jung ),신원 ( Won Shin ) 한국보건정보통계학회(구 한국보건통계학회) 2017 보건정보통계학회지 Vol.42 No.3

The aim of this study is to provide a method to apply the electronic data standard for electronic transmission of individual case safety reports (ICSRs) in Korea. In Korea, it is necessary to implement the ICH E2B guideline and the ICH MedDRA guideline within 5 years after approval to join ICH members in November 2016. With the spread of the internet network and the IT infrastructure worldwide, Data standardization has been developed not only by major countries such as the US, Europe, and Japan, but also by around the world. In addition, it is necessary to strengthen voluntary or mandatory reporting from consumers, pharmaceutical companies, and healthcare professionals by following the standardized electronic information exchange system for international sharing. This can be an opportunity to overcome limitations on the quality and quantity of information available at the time of authorization. Based on the data system applying the electronic standards, it is possible to search and prevent Korean inherent side effects by using the collected and analyzed information. The exchange of information of standardized data will enable regulatory authorities to communicate with data from different structure as well as many other countries with a single common document. We first reviewed the necessity of development of data standard for drug safety reporting. The ICH E2B guideline adopted as an international standard has been analyzed and the need for introduction into Korea has been examined. In major ICH regions like US, EU and Japan, regional implementation guides for E2B (R3) guideline were prepared and implemented in accordance with the guide. The guides and the status of these countries were compared and analyzed. Regional implementation guide for introducing ICH E2B, an international standard, in Korea was made which was reflecting domestic regulations such as pharmaceutical safety management regulations.