Background: The coronavirus disease-2019 (COVID-19) pandemic has contributed to the change in the epidemiology of many infectious diseases. This study aimed to establish the pre-pandemic epidemiology of pediatric invasive bacterial infection (IBI). Methods: A retrospective multicenter-based surveillance for pediatric IBIs has been maintained from 1996 to 2020 in Korea. IBIs caused by eight bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pyogenes, Listeria monocytogenes, and Salmonella species) in immunocompetent children > 3 months of age were collected at 29 centers. The annual trend in the proportion of IBIs by each pathogen was analyzed. Results: A total of 2,195 episodes were identified during the 25-year period between 1996 and 2020. S. pneumoniae (42.4%), S. aureus (22.1%), and Salmonella species (21.0%) were common in children 3 to 59 months of age. In children ≥ 5 years of age, S. aureus (58.1%), followed by Salmonella species (14.8%) and S. pneumoniae (12.2%) were common. Excluding the year 2020, there was a trend toward a decrease in the relative proportions of S. pneumoniae (rs = −0.430, P = 0.036), H. influenzae (rs = −0.922, P < 0.001), while trend toward an increase in the relative proportion of S. aureus (rs = 0.850, P < 0.001), S. agalactiae (rs = 0.615, P = 0.001), and S. pyogenes (rs = 0.554, P = 0.005). Conclusion In the proportion of IBIs over a 24-year period between 1996 and 2019, we observed a decreasing trend for S. pneumoniae and H. influenzae and an increasing trend for S. aureus, S. agalactiae, and S. pyogenes in children > 3 months of age. These findings can be used as the baseline data to navigate the trend in the epidemiology of pediatric IBI in the post COVID-19 era.

The authors regret that one co-author (Kyung-Hyo Kim) was missing in the article.

BACKGROUND: Invasive bacterial infections in apparently immunocompetent children were retrospectively analyzed to figure causative bacterial organisms in Korea. METHODS: A total of 947 cases from 25 university hospitals were identified from 2006 to 2010 as a continuance of a previous 10-year period study from 1996 to 2005. RESULTS: Escherichia coli (41.3%), Streptococcus agalactiae (27.7%), and Staphylococcus aureus (27.1%) were the most common pathogens in infants < 3 months of age. S. agalactiae was the most prevalent cause of meningitis and pneumonia and E. coli was the major cause of bacteremia without localizing signs in this group. In children 3 to 59 months of age, Streptococcus pneumoniae (54.2%), S. aureus (20.5%), and Salmonella spp. (14.4%) were the most common pathogens. S. pneumoniae was the leading cause of pneumonia (86.0%), meningitis (65.0%), and bacteremia without localizing signs (49.0%) in this group. In children ≥ 5 years of age, S. aureus (62.8%) was the predominant pathogen, followed by Salmonella species (12.4%) and S. pneumoniae (11.5%). Salmonella species (43.0%) was the most common cause of bacteremia without localizing signs in this group. The relative proportion of S. aureus increased significantly over the 15-year period (1996–2010) in children ≥ 3 months of age (P < 0.001), while that of Haemophilus influenzae decreased significantly in both < 3 months of age group (P = 0.036) and ≥ 3 months of age groups (P < 0.001). CONCLUSION: S. agalactiae, E. coli, S. pneumoniae, and S. aureus are common etiologic agents of invasive bacterial infections in Korean children.
Bacteremia ; Bacterial Infections ; Child ; Epidemiology ; Escherichia coli ; Haemophilus influenzae ; Hospitals, University ; Humans ; Infant ; Korea ; Meningitis ; Pneumonia ; Retrospective Studies ; Salmonella ; Staphylococcus aureus ; Streptococcus agalactiae ; Streptococcus pneumoniae

This study was performed to measure early changes in the serotype distribution of pneumococci isolated from children with invasive disease during the 3-year period following the introduction of 10- and 13-valent pneumococcal conjugate vaccines (PCVs) in Korea. From January 2011 to December 2013 at 25 hospitals located throughout Korea, pneumococci were isolated among children who had invasive pneumococcal disease (IPD). Serotypes were determined using the Quellung reaction, and the change in serotype distribution was analyzed. Seventy-five cases of IPD were included. Eighty percent of patients were aged 3-59 months, and 32% had a comorbidity that increased the risk of pneumococcal infection. The most common serotypes were 19A (32.0%), 10A (8.0%), and 15C (6.7%). The PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F, and 6A) accounted for 14.7% of the total isolates and the PCV13 minus PCV7 types (1, 3, 5, 7F and 19A) accounted for 32.0% of the total isolates. Serotype 19A was the only serotype in the PCV13 minus PCV7 group. The proportion of serotype 19A showed decreasing tendency from 37.5% in 2011 to 22.2% in 2013 (P = 0.309), while the proportion of non-PCV13 types showed increasing tendency from 45.8% in 2011 to 72.2% in 2013 (P = 0.108). Shortly after the introduction of extended-valent PCVs in Korea, serotype 19A continued to be the most common serotype causing IPD in children. Subsequently, the proportion of 19A decreased, and non-vaccine serotypes emerged as an important cause of IPD. The impact of extended-valent vaccines must be continuously monitored.
Adolescent ; Bacteremia/complications/diagnosis ; Child ; Child, Preschool ; Female ; Hospitals ; Humans ; Infant ; Male ; Pneumococcal Infections/microbiology/*prevention & control ; Pneumococcal Vaccines/*immunology ; Republic of Korea ; Serotyping ; Streptococcus pneumoniae/*classification/isolation & purification ; Vaccines, Conjugate/*immunology

PURPOSE: In cardiopulmonary resuscitation (CPR) there are different opinions on the compression rate that should be applied. The aim of this study was to compare the total number of adequate compressions delivered during a five-minute period among four groups of lay persons (> or =139 min-1, 129-138, 114-128, and <114). METHODS: This study represents a secondary data analysis from our previous research about the influence of age on fatigue during CPR. Participants were asked to perform chest compressions (without rescue breaths) at a rate of >100 times/minute and a depth of >5 cm for five minutes. A total of 86 participants were then divided into four groups based on their mean compression rate. Age, sex, and body mass index were analyzed as factors affecting the compression rates. RESULTS: The group delivering a compression rate above 139 compressions min-1 performed better than those delivering below 114 compressions min-1 (p=0.03). There was no significant difference in the mean compression depth (p=0.13), percentage of incomplete chest recoil (p=0.277), or the percentage of incorrect hand positioning (p=0.091). All participants (except five) performed chest compressions at a rate above 100 compressions min-1. CONCLUSION: Our results suggest that a chest compression rate above 139 compressions min-1 does not deteriorate the quality of compressions compared to a lower chest compression rate (below 114 min-1) during a five-minute period. Most untrained lay people performed chest compressions well, within a range of 100~150 min-1.
Body Mass Index ; Cardiopulmonary Resuscitation ; Fatigue ; Hand ; Heart Massage ; Humans ; Statistics as Topic ; Thorax

This study assessed the ability of the Sequential Organ Failure Assessment (SOFA) and Acute Physiology, Chronic Health Evaluation (APACHE) II scoring systems, as well as the Simplified Acute Physiology Score (SAPS) II method to predict group mortality in intensive care unit (ICU) patients who were poisoned with organophosphate. The medical records of 149 organophosphate poisoned patients admitted to the ICU from September 2006 to December 2012 were retrospectively examined. The SOFA, APACHE II, and SAPS II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hr of ICU admission. The probability of death was calculated for each patient based on the SOFA score, APACHE II score, and SAPS II equations. The ability to predict group mortality by the SOFA score, APACHE II score, and SAPS II method was assessed using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. A total of 131 patients (mean age, 61 yr) were enrolled. The sensitivities, specificities, and accuracies were 86.2%, 82.4%, and 83.2% for the SOFA score, respectively; 65.5%, 68.6%, and 67.9% for the APACHE II scoring system, respectively; and 86.2%, 77.5%, and 79.4% for the SAPS II, respectively. The areas under the curve in the ROC curve analysis for the SOFA score, APACHE II scoring system, and SAPS II were 0.896, 0.716, and 0.852, respectively. In conclusion, the SOFA, APACHE II, and SAPS II have different capability to discriminate and estimate early in-hospital mortality of organophosphate poisoned patients. The SOFA score is more useful in predicting mortality, and easier and simpler than the APACHE II and SAPS II.
*APACHE ; Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Humans ; *Intensive Care Units ; Male ; Middle Aged ; Organophosphate Poisoning/*diagnosis/mortality ; ROC Curve ; Sensitivity and Specificity ; *Severity of Illness Index

PURPOSE: Organophosphate poisoning is a worldwide concern and there have been many reports describing the factors affecting the severity and prognosis resulting from its toxicity. This study aims to investigate if C-reactive protein is a useful independent predictor of mortality in organophosphate poisoning patients. METHODS: This retrospective study targeted organophosphate intoxication patients who were admitted to the emergency department of Samsung Changwon Hospital from January 1st, 2006 to December 31st, 2010. The data was retrospectively collected from clinical records and laboratory files, and using multivariate logistic analysis, the total population data was retrospectively analyzed for its association with mortality. RESULTS: A total of 70 patients were enrolled in this study. Of the 70, 53 survived and 17 died. Significant clinical factors such as age, mean arterial pressure, Glasgow coma scale score, respiratory rate, PaO2/FiO2, hematocrit, albumin, glucose and C-reactive protein (measured 24 hours after admission) were associated with mortality. The fatality rate resulting from organophosphate poisoning was 24.3%, and there was an increase observed in the mortality rate of patients with higher C-reactive protein at 24 hours after admission. CONCLUSION: The initial serum C-reactive protein and acetylcholinesterase results had no significant association with the severity of acute organophosphate poisoning. However, C-reactive protein results after 24 hours were significant independent predictors of mortality in the total population of patients afflicted with acute organophosphate poisoning.
Acetylcholinesterase ; Arterial Pressure ; C-Reactive Protein ; Emergencies ; Glasgow Coma Scale ; Glucose ; Hematocrit ; Humans ; Organophosphate Poisoning ; Prognosis ; Respiratory Rate ; Retrospective Studies

PURPOSE: Organophosphate poisoning is a worldwide concern and there have been many reports describing the factors affecting the severity and prognosis resulting from its toxicity. This study aims to investigate if C-reactive protein is a useful independent predictor of mortality in organophosphate poisoning patients. METHODS: This retrospective study targeted organophosphate intoxication patients who were admitted to the emergency department of Samsung Changwon Hospital from January 1st, 2006 to December 31st, 2010. The data was retrospectively collected from clinical records and laboratory files, and using multivariate logistic analysis, the total population data was retrospectively analyzed for its association with mortality. RESULTS: A total of 70 patients were enrolled in this study. Of the 70, 53 survived and 17 died. Significant clinical factors such as age, mean arterial pressure, Glasgow coma scale score, respiratory rate, PaO2/FiO2, hematocrit, albumin, glucose and C-reactive protein (measured 24 hours after admission) were associated with mortality. The fatality rate resulting from organophosphate poisoning was 24.3%, and there was an increase observed in the mortality rate of patients with higher C-reactive protein at 24 hours after admission. CONCLUSION: The initial serum C-reactive protein and acetylcholinesterase results had no significant association with the severity of acute organophosphate poisoning. However, C-reactive protein results after 24 hours were significant independent predictors of mortality in the total population of patients afflicted with acute organophosphate poisoning.
Acetylcholinesterase ; Arterial Pressure ; C-Reactive Protein ; Emergencies ; Glasgow Coma Scale ; Glucose ; Hematocrit ; Humans ; Organophosphate Poisoning ; Prognosis ; Respiratory Rate ; Retrospective Studies

PURPOSE: The high rate of road traffic crashes and rising medical costs are critical health care problems in Korea as well as in the United States. To reduce the medical cost of minor traffic accidents, we hypothesized that implementation of a 7-day critical pathway (CP) for minor car accident patients (MCP) would decrease medical costs and hospitalization time without lowering patient satisfaction level. METHODS: A pretest-posttest experimental design was used to verify the effects of CP on MCP, from June 1 to December 31, 2010. A 7-day admission schedule with daily predefined order communication system (OCS) order set was implementated for MCP. On the day of discharge, MCP completed a satisfaction survey, and the total medical cost and cost per day were calculated. Satisfaction with physician and nursing care were also surveyed using the Brief Encounter Psycho-Social Instrument-Korea tool. RESULTS: Overall rating did not differ in patients processed normally and using the CP, but length of admission was reduced in CP patients. Total medical costs were not different in either group but cost per day was higher in the CP group. Satisfaction with physicians, but not nurses, satisfaction was improved after CP implementation. CONCLUSION: A critical pathway for MCP reduces length of admission without decreasing patient satisfaction. Total medical costs are not changed after CP implementation but cost per day is significantly increased. Improved job satisfaction in physician but not for nurses was observed after CP implementation. It seems that CP is a effective tool for MCP.
Accidents, Traffic ; Appointments and Schedules ; Critical Pathways ; Delivery of Health Care ; Hospitalization ; Humans ; Job Satisfaction ; Korea ; Motor Vehicles ; Nursing Care ; Patient Satisfaction ; Research Design ; United States

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires