Discrepancy of C-Reactive Protein, Procalcitonin and Interleukin-6 at Hospitalization: Infection in Patients with Normal C-Reactive Protein, Procalcitonin and High Interleukin-6 Values

C-reactive protein (CRP) or procalcitonin (PCT) alone has limitations in the early detection of infection or inflammation due to shortcomings in specificity and varied cut-off values. Recently, interleukin (IL)-6 has been assessed, but it is not known to what extent the three values are homogeneous in reality. This retrospective study was conducted with two large datasets (discrepancy set with results within 24 h of admission [7149 patients] and follow-up set until 2 weeks of hospital stay [5261 tests]) consisting of simultaneous examinations of CRP, PCT, and IL-6 between January 2015 and August 2021. The specific discrepant group (n = 102, 1.4%) with normal CRP (<10 mg/L) and PCT (<0.1 ng/mL) and high IL-6 (≥100 pg/mL) values was extracted from the discrepancy set. Dimensionality reduction and visualization were performed using Python. The three markers were not clearly clustered after t-distributed stochastic neighbor embedding. Pearson's correlation coefficients between two markers were substantially low (0.23-0.55). Among the high normalized IL-6 levels (≥0.5) (n = 349), 17.8% and 38.7% of CRP and PCT levels were very low (≤0.01). 9.2% and 13.4% of normal CRP (n = 1522) had high PCT (≥0.5 ng/mL) and IL-6 (≥100 pg/mL) values, respectively. Infection and bacteremia among 102 patients occurred in 36 (35.3%) and 9 (8.8%) patients, respectively. In patients with bacteremia, IL-6 was the first to increase, followed by PCT and CRP. Our study revealed that CRP, PCT, and IL-6 levels were considerably discrepant, which could be misinterpreted if only CRP tests are performed.ope

Novel Mutations Conferring Amoxicillin Resistance in Helicobacter pylori in South Korea

Helicobacter pylori is the primary causative agent of gastritis, gastric ulcers, duodenal ulcers, gastric cancer, and peripheral B-cell lymphoma. H. pylori eradication often fails due to elevated antibiotic resistance. However, no previous studies have thoroughly examined amoxicillin resistance. Here, the objective was to identify clinical strains of H. pylori with amoxicillin resistance and to analyze single-nucleotide polymorphisms (SNPs) associated with amoxicillin resistance. From March 2015 to June 2019, genotypic and phenotypic amoxicillin resistance was analyzed using an E-test and whole-genome sequencing (WGS). Analysis of 368 clinical strains confirmed amoxicillin resistance in 31 strains (resistance rate of 8.7%). The genomes were extracted from nine resistant (<0.125 mg/L) strains, and WGS was performed for genetic analysis. WGS analysis identified SNPs present in pbp1a, pbp2, nhaC, hofH, hofC, and hefC in all nine isolates. Some of these genes may be related to amoxicillin resistance. A total of six SNPs (A69V, V374L, S414R, T503I, A592D, and R435Q) were identified in PBP2 of H-8, the most resistant strain. We predict that these six SNPs are associated with high amoxicillin resistance. Amoxicillin resistance should be considered in the clinical setting for the treatment failure of H. pylori eradication.ope

Clinical characteristics of nontuberculous mycobacterial disease in people living with HIV/AIDS in South Korea: A multi-center, retrospective study

With the introduction of combination antiretroviral therapy (cART), the prevalence of human immunodeficiency virus (HIV)-associated nontuberculous mycobacteria (NTM) disease has declined. However, NTM diseases still occur in people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA). We analysed the clinical and microbiological features of NTM diseases in PLWHA in South Korea. PLWHA who were diagnosed with NTM diseases between January 2000 and March 2021 were retrospectively enrolled from five different hospitals in South Korea. Data on baseline demographics, HIV status, CD4+ T cell counts, viral load, past and current cART regimens, isolated NTM species, results of antimicrobial susceptibility tests, treatment regimens, and outcomes were collected by reviewing medical records. A total of 34 cases of NTM in PLWHA were included. Pulmonary and extrapulmonary NTM diseases accounted for 58.8% (n = 20) and 41.2% (n = 14), respectively. The lymph node was the most common site of extrapulmonary NTM disease (64.3%). The age at the time of NTM disease diagnosis was younger in the extrapulmonary NTM group than in the pulmonary NTM group (37.0 vs. 49.0 years). Mean CD4+ T cell counts at the time of NTM disease diagnosis was 186.6 cells/μL (range: 1-1394). Nine patients (26.5%) had fully suppressed viral loads at the time of NTM disease diagnosis. Mycobacterium avium complex (MAC) was the most common species found, followed by M. intracellulare and M. kansasii. MAC isolates were all susceptible to clarithromycin, but the rates of non-susceptibility to moxifloxacin, linezolid, ethambutol, and rifampin were 75%, 37.5%, 12.5%, and 12.5%, respectively. The average duration of treatment was 17 months and the mortality rate was 8.8%. NTM diseases may occur in PLWHA, even with completely suppressed viral loads. The identified clinical features of NTM diseases are essential for its clinical management in South Korea.ope

Clinical and microbiological characteristics of and risk factors for bloodstream infections among patients with extracorporeal membrane oxygenation: a single-center retrospective cohort study

Extracorporeal membrane oxygenation (ECMO) provides hemodynamic and oxygenation support to critically ill patients. Due to multiple catheter cannulations, patients on ECMO are vulnerable to bloodstream infections (BSIs). We aimed to investigate the incidence, clinical characteristics, risk factors, and microorganisms associated with BSIs during ECMO. This single-center retrospective cohort study was conducted between January 2015 and May 2021. Patients aged 18 years or older with an ECMO duration of &gt; 48 h for cardiogenic or respiratory support were included in the study. Patients who developed bacteremia or candidemia from 12 h after ECMO cannulation to 7 days after de-cannulation were included. The clinical factors between non-BSI and BSI were compared, along with an analysis of the risk factors associated with BSI during ECMO. A total of 480 patients underwent ECMO for cardiogenic shock (n = 267, 55.6%) or respiratory failure (n = 213, 44.4%) during the study period. The incidence was 20.0 episodes per 1000 ECMO-days. Approximately 20.2% (97/480) and 5.4% (26/480) of the patients developed bacteremia and candidemia, respectively. The median numbers of days of BSI development were 8.00 days for bacteremia and 11.0 days for candidemia. The most common pathogens were methicillin-resistant coagulase-negative staphylococci (n = 24), followed by vancomycin-resistant Enterococcus (n = 21). Multivariable logistic analysis demonstrated that hemodialysis (odds ratio [OR] 2.647, p &lt; 0.001), veno-arterial-venous mode (OR 1.911, p = 0.030), and total ECMO duration (OR 1.030, p = 0.007) were significant risk factors for bacteremia. The total ECMO duration was the only risk factor associated with candidemia (OR 1.035, p = 0.010). The mortality rate was significantly higher in the bacteremia (57.7%) and candidemia (69.2%) groups than that in the non-BSI group (43.6%). BSI is a common complication of patients receiving ECMO support and is associated with poor clinical outcomes. Determining the type of frequently isolated organisms and the median onset time of BSI would help in the selection of appropriate prophylactic antibiotics or antifungal agents.ope

Increasing Fusobacterium infections with Fusobacterium varium, an emerging pathogen

Infections caused by Fusobacterium species are rare; however serious infections with complications or mortality may occur occasionally. We conducted a retrospective study to investigate the clinical features of patients with Fusobacterium infections and the differences between infections caused by the species F. necrophorum, F. nucleatum, and F. varium. Additionally, we attempted to identify risk factors for Fusobacterium-associated mortality. This study included all patients at a large tertiary care teaching hospital in South Korea with Fusobacterium infections from January 2006 to April 2021. Demographic, clinical, laboratory, and outcome data were analyzed. Multiple logistic regression analysis was performed to assess the risk factors for in-hospital mortality associated with F. nucleatum and F. varium infections. We identified 272 patients with Fusobacterium infections during the study period. The number of Fusobacterium cases has increased recently, with F. varium infections markedly increasing since 2016 and causing a significant proportion of infections. Patients with F. varium infections were older and had a higher proportion of nosocomial infections than the other groups. The F. nucleatum and F. varium groups showed higher in-hospital mortality than the F. necrophorum group. Through logistic regression analysis, APACHE II score and serum albumin level were considered risk factors for in-hospital mortality. APACHE II score was positively correlated with age, red cell distribution width, and serum blood urea nitrogen, and negatively correlated with serum albumin level. Infections caused by Fusobacterium species are increasing. F. varium causes a significant proportion of severe infections.ope

Duration of culturable SARS-CoV-2 within different specimens among mild and severe COVID-19 patients: A longitudinal study

ope

Impact of Valve Culture Positivity on Prognosis in Patients with Infective Endocarditis Who Underwent Valve Surgery

Introduction: Infective endocarditis (IE) is a severe and fatal infection with high in-hospital and overall mortality rates of approximately up to 30%. Valve culture positivity was associated with in-hospital mortality and postoperative complications; however, few studies have analyzed the relationship between valve cultures and overall mortality over a long observation period. This study aimed to compare the association of valve culture positivity with overall mortality in patients with IE who underwent valve surgery. Methods: A total of 416 IE patients admitted to a tertiary hospital in South Korea from November 2005 to August 2017 were retrospectively reviewed. A total of 202 IE patients who underwent valve surgery and valve culture were enrolled. The primary endpoint was long-term overall mortality. Kaplan-Meier curve and Cox proportional hazards model were used for survival analysis. Results: The median follow-up duration was 63 (interquartile range, 38-104) months. Valve cultures were positive in 22 (10.9%) patients. The overall mortality rate was 15.8% (32/202) and was significantly higher in valve culture-positive patients (36.4%, p = 0.011). Positive valve culture [hazard ratio (HR) 3.921, p = 0.002], Charlson Comorbidity Index (HR 1.181, p = 0.004), Coagulase-negative staphylococci (HR 4.233, p = 0.001), new-onset central nervous system complications (HR 3.689, p < 0.001), and new-onset heart failure (HR 4.331, p = 0.001) were significant risk factors for overall mortality. Conclusions: Valve culture positivity is a significant risk factor for long-term overall mortality in IE patients who underwent valve surgery. The importance of valve culture positivity needs to be re-evaluated, as the valve culture positivity rate increases with increasing early surgical intervention.ope

A Study on Renewal of National Curriculum in First Grade Program

이 연구는 국가수준에서 제정한 우리들은 1학년 교육과정 조직요소가 지역수준에서 개발․보급한 학생용 교과서와 교사용 지도서에서 어떻게 재구성되는지, 그리고 국가수준 교육과정과 지역수준의 교과서 및 교사용 지도서가 학교의 수업에서 어떻게 재구성되는지를 검토하고자 하였다. 이를 위하여 부산시 우리들은 1학년 교과서와 교사용 지도서, 그리고 수업에서 나타나는 교육과정 조직요소의 재구성 과정을 양적인 방법과 질적인 방법을 활용하여 분석하였다. 연구 결과, 지역수준에서 개발한 교과서와 교사용 지도서에 비하여, 수업이 국가수준 교육과정의 조직요소에 더 충실하였던 점을 확인할 수 있었으며, 국가수준 교육과정의 조직요소 이외에 추가된 조직요소의 유형에 있어 교실관리를 위한 지시나 활동과 아동의 흥미를 고려한 활동이 빈번하게 나타남을 확인할 수 있었다. This study has two primary purposes. One is to analyze how organizing elements shown in "First Grade Program" text book and teacher's guide developed by Pusan Educational Administration(PEA), were renewed from the national curriculum. The other is to scrutinize how organizing elements in national curriculum and in two books of PEA, were modified in class. In other to achieve these purposes, Content analysis, non-participant observation on the class, and interview were adopted. The results of the study are summarized as follows. 1) In comprising organizing elements, both "First Grade Program" text book and teacher's guide tried to include all the elements in national curriculum and so had high fidelities to it from content sections to detailed content elements. While two books of PEA didn't reflect well the idea of the national curriculum which intend to set the section of basic learning skills in the lowest rank. 2) During the class, all content sections and detailed contents' elements proposed by the national curriculum, were treated without any omissions

Analysis on Organization and Implementation of General Education Curriculum in Korean Universities

본 연구는 대학 간 생존경쟁이 치열해지고 취업을 외면할 수 없는 상황에서, 교양교육을 강화하는 최근 한국 대학의 교육과정 동향을 분석하고자 한 연구이다. 이를 위하여 2001년 대교협 평가에서 최우수 및 우수 판정을 받은 대학들을 대상으로 대학 교양교육과정 편성과 운영 체제를 기술 및 분석하였다. 연구의 과정은 첫째, 대학 교양교육과정의 이념 및 목적, 교양교육과정 편성의 구조, 그리고 이수방식 등에 관하여 이론적으로 검토하고 이를 분석의 틀로 활용하였다. 둘째, 교양교육에 대한 외부 평가 결과에서 비교적 우수하다고 판정받은 7개 대학의 교양교육과정 담당기구, 교양교육의 목표, 교양교육과정 편성의 구조, 그리고 교양교육과정 이수방식을 분석하고, 이를 근거로 하여 대학 교양교육과정 개선을 위한 방안을 제언하였다. The purpose of this study was to provide valuable information for improving general education curriculum by analyzing current practices in general education courses and curriculum implementation systems of Higher Education Institutions in Korea. First, the study analyzed the role of organizations in the universities to find out whether the universities have offices whose main role is to implement general education curriculum. According to the data, Seoul National University, Sungkyunkwan University, Yonsei University, and Hanyang University implemented an office that is responsible general education curriculum only, while Ehwa University, Kangwon National University, Chonnam National University did not have such offices in their universities. Second, the study analyzed the mission statement of general education curriculum in each university. The data revealed that most of the universities, except for Seoul National University and Sungkyunkwan University, include quite amount of specific instructional objectives focusing on certain skills and knowledge for fostering experts in certain academic areas in their mission statements. Third, this study analyzed the structure of general education curriculum. The data revealed that each university uses titles that represent characteristics of subordinate curriculum areas. The curriculum showed hierarchical structure in which the courses listed as subordinate courses tend to belong to the same academic discipline areas. Forth, the study compared the proportion of general education courses in the whole curriculum. Chonnam National University showed the lowest proportion (18.5%) while Sungkyunkwan University showed the highest proportion (33.3%) in their general education courses. Fifth, the study analyzed the ways of implementing general education courses. In general, the universities tend to simultaneously implement both "free electives" and "distribution requirement" systems while Hanyang university implemented "core curriculum" only