Background: Bacteroides fragilis group (BFG) isolates are the most frequently isolated gram-negative anaerobic bacteria and exhibit higher levels of antimicrobial resistance than other anaerobic bacteria. Reliable susceptibility testing is needed because of reports of resistance to the most active antibiotics. Recently, the European Committee on Antimicrobial Susceptibility Testing (EUCAST) introduced disk zone diameter breakpoints. We evaluated the disk diffusion test (DDT) for susceptibility testing of BFG isolates compared with the agar dilution method. Methods: In total, 150 BFG isolates were collected from three institutes in Korea. The agar dilution method was conducted according to the CLSI guidelines. DDT was performed following the EUCAST guideline. Fastidious anaerobe agar supplemented with 5% defibrinated horse blood was used as the culture medium. Nine antimicrobials were evaluated:penicillin, cefoxitin, cefotetan, imipenem, meropenem, piperacillin-tazobactam, clindamycin, moxifloxacin, and metronidazole. Results: The categorical agreement (CA) between the two methods was > 90.0% for imipenem, meropenem, clindamycin, and metronidazole. However, the CA for piperacillintazobactam was low, at 83.2%. Major errors were found: 5.4% for imipenem, 7.4% for meropenem, and 12.8% for piperacillin-tazobactam. All minor errors were < 10%. We propose using the area of technical uncertainty (ATU) zone-overlapping area for susceptible and resistant strains to reduce errors in the DDT. Outside the ATU, the CAs of cefoxitin, cefotetan, and piperacillin-tazobactam were > 90.0%, whereas that of moxifloxacin was increased to 88.5%. Conclusions The DDT can be a useful alternative antimicrobial susceptibility test for BFG isolates when using the ATU zone to reduce errors.

Bacteroides fragilis is the most common opportunistic anaerobic pathogen. In the absence of appropriate antimicrobial therapy, mortality rates associated with B. fragilis group infections can reach as high as 50%. Therefore, we aimed to elucidate the clinical characteristics and outcomes of B. fragilis infections and the molecular genetic characteristics of B. fragilis isolates. Forty B. fragilis clinical isolates were collected at Hanyang University Hospital between January 2022 and December 2023. Antimicrobial susceptibility was tested using the agar dilution method. Whole-genome sequencing was conducted using the Illumina platform (Illumina, San Diego, CA, USA). Various multilocus sequence types of B. fragilis were identified, including ST149 (N = 4), ST11 (N = 4), ST1 (N = 3), ST21 (N = 2), and ST157 (N = 1). The insertion sequence (IS) IS1187, located upstream of cfiA, was associated with high-level carbapenem resistance in the ST157 isolate. B. fragilis toxin genes (bft) were identified in 30% of isolates. The most common comorbidities were diabetes mellitus (26.5%) and non-metastatic cancer (23.5%). Five patients (14.7%) died within 30 days, and two (5.9%) deaths were directly attributable to B. fragilis infection. The emergence of high-level MIC carbapenem-resistant B. fragilis ST157 has led to caution in the presence of B. fragilis infections.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries. Methods Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method. Results A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost. Conclusion This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.

No abstract available.
Herbaspirillum ; Pneumonia ; Sepsis

No abstract available.
Bacteremia ; Immunocompromised Host ; Korea

PURPOSE: The purpose of the study was to explore the experience of patients with facial burn injuries regarding their interpersonal relationships. METHODS: The phenomenological research method was used. Participants of the study consisted of five males and three females. Data were collected through individual in-depth interviews from November, 2014 to February, 2015 and analyzed using Colaizzi's method. RESULTS: Five theme clusters were extracted that described patients' experiences. They are “being a lonely foreigner,” “closing my mind toward the world,” “hiding hurt feelings,” “companion of my face,” and “communicating with the world”. CONCLUSION: The results of this study provide a deep understanding and insight into the experience of interpersonal relationships among facial burn patients. The development of a comprehensive program including physical, psychological, and social aspects is recommended to address the problems facial burn patients encounter in interpersonal relationships and to facilitate interaction.
Burns ; Facial Injuries ; Female ; Humans ; Interpersonal Relations ; Male ; Methods ; Qualitative Research

PURPOSE: The purpose of the study was to explore the experience of patients with facial burn injuries regarding their interpersonal relationships. METHODS: The phenomenological research method was used. Participants of the study consisted of five males and three females. Data were collected through individual in-depth interviews from November, 2014 to February, 2015 and analyzed using Colaizzi's method. RESULTS: Five theme clusters were extracted that described patients' experiences. They are “being a lonely foreigner,”“closing my mind toward the world,”“hiding hurt feelings,”“companion of my face,” and “communicating with the world”. CONCLUSION The results of this study provide a deep understanding and insight into the experience of interpersonal relationships among facial burn patients. The development of a comprehensive program including physical, psychological, and social aspects is recommended to address the problems facial burn patients encounter in interpersonal relationships and to facilitate interaction.

BACKGROUND: Listeriosis caused by Listeria monocytogenes has a high case-fatality rate (CFR) of approximately 20% to 30%. An increasing incidence of listeriosis has been reported in many countries recently. We investigated the annual incidence, clinical characteristics, and outcomes of listeriosis at three different hospitals in Korea and evaluated the effects of appropriate empiric antimicrobial treatments on patient outcomes. METHODS: We retrospectively collected the data of all culture-positive cases of human listeriosis from three hospitals of different sizes in Korea during 2006–2016 and calculated the annual number of cases and incidence per 100,000 admissions. RESULTS: A total of 58 patients with L. monocytogenes were included in this study. The incidence of listeriosis was significantly higher in 2013–2016 than in 2006–2012 (RR 3.1; 95% CI 1.79–5.36; P < 0.001), mainly because of an increase in patients over 60 years of age (RR 3.69; 95% CI 1.70–8.02; P < 0.001). Multivariate analysis showed that healthcare-associated infection (adjusted OR, 12.15; 95% CI, 2.56–86.01; P=0.004) and empirical treatment with first-line antimicrobial agents (adjusted OR, 0.08; 95% CI, 0.00–0.63; P=0.044) were associated with CFR. CONCLUSIONS: Healthcare-associated infections caused by L. monocytogenes are associated with high CFR. Adequate initial empirical treatments could reduce CFR, suggesting that careful consideration of an empirical antimicrobial regimen is warranted for elderly or immunocompromised patients admitted to the hospital.
Aged ; Anti-Infective Agents ; Humans ; Immunocompromised Host ; Incidence* ; Korea ; Listeria monocytogenes ; Listeriosis* ; Multivariate Analysis ; Retrospective Studies

BACKGROUND: Early and appropriate antibiotic treatment improves the clinical outcome of patients with septicemia; therefore, reducing the turn-around time for identification (ID) and antimicrobial susceptibility test (AST) results is essential. We established a method for rapid ID and AST using short-term incubation of positive blood culture broth samples on solid media, and evaluated its performance relative to that of the conventional method using two rapid ID systems and a rapid AST method. METHODS: A total of 254 mono-microbial samples were included. Positive blood culture samples were incubated on blood agar plates for six hours and identified by the MicroFlex LT (Bruker Daltonics) and Vitek-MS (bioMeriéux) systems, followed by AST using the Vitek2 System (bioMeriéux). RESULTS: The correct species-level ID rates were 82.3% (209/254) and 78.3% (199/254) for the MicroFlex LT and Vitek-MS platforms, respectively. For the 1,174 microorganism/antimicrobial agent combinations tested, the rapid AST method showed total concordance of 97.8% (1,148/1,174) with the conventional method, with a very major error rate of 0.5%, major error rate of 0.7%, and minor error rate of 1.0%. CONCLUSIONS: Routine implementation of this short-term incubation method could provide ID results on the day of blood culture-positivity detection and one day earlier than the conventional AST method. This simple method will be very useful for rapid ID and AST of bacteria from positive blood culture bottles in routine clinical practice.
Agar ; Bacteria* ; Humans ; Methods ; Sepsis