Background: The spread of antimicrobial-resistant bacteria has close relationships among humans, animals, and the environment, necessitating the implementation of the “One Health” approach. In previous study, the prevalence and molecular epidemiology of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) were investigated across multiple pig industry sectors in Korea. In this study, animal developmental stages and antimicrobial usage policies on farms were also considered. Methods: A total of 6,288 non-duplicated samples were collected from pig farms, slaughterhouses, and their personnel from three provinces in Korea between 2020 and 2022.Antimicrobial susceptibility and ESBL gene characterization were performed on the samples. Results: Overall, 1,084 ESBL-EC isolates were collected, with positivity detection rates of 24.7%, 23.3%, 12.7%, 3.9%, 17.2% in pigs, workers, the environment, meat, and total samples, respectively. Common ESBL types were blaCTX-M-55 (N = 628), blaCTX-M-15 (N = 204), and blaCTX-M-14 (N = 127). Pig-derived E. coli isolates had antimicrobial resistance (AMR) rates of 80.4%, 47.2%, 32.6%, 36.7%, 43.4%, 62.4%, and 72.1% to ampicillin, piperacillin, cefazoline, ciprofloxacin, cotrimoxazole, chloramphenicol, and tetracycline, respectively.AMR rates were lower in the finishing stage pigs than in the lactating stage pigs and tended to decrease during animal development for most antimicrobials. AMR rates were higher in pig farms with a customary antimicrobial use policy than in those with a low-level antimicrobial use policy. Conclusions The findings highlight the significance of elucidating AMR networks among humans, animals, and the environment. Prudent antimicrobial usage and continuous AMR monitoring in the pig industry are crucial to safeguard food safety.

Objective: Recently, various mental health promotion programs using virtual reality (VR) technology have been tried in the psychiatric field. Considering the importance of mental health in pregnant women, VR-assisted mental health promotion programs for pregnant women are needed to be developed. This study aimed to prospectively investigate the efficacy of a VR-assisted mental health promotion program for pregnant women. Methods: Fifty-five pregnant women were participated in this study. Mental health states such as depression, anxiety, perceived stress, and quality of life were assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale, and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) before and after using VR program treatment. Based on the mental health types of pregnant women classified by cluster analysis, the effects of the VR program were analyzed by paired t test and Wilcoxon signed rank test. Results: The VR program significantly reduced PHQ-9 (p = 0.033) and GAD-7 (p = 0.046) scores, and significantly increased WHOQOL-BREF (p = 0.026) score of the participants. Additionally, when classifying the mental health types of pregnant women, the VR program was significantly effective to improve depression, anxiety, and quality of life in the most severe group based on the cluster analysis. Conclusion The results of this study suggest that VR program may be effective to improve the mental health of pregnant women. Particularly, VR programs for the high-risk group of depression might be the most effective. Therefore, VR-assisted mental health promotion programs could be useful for managing the mental health in pregnant women.

Objective: Recently, various mental health promotion programs using virtual reality (VR) technology have been tried in the psychiatric field. Considering the importance of mental health in pregnant women, VR-assisted mental health promotion programs for pregnant women are needed to be developed. This study aimed to prospectively investigate the efficacy of a VR-assisted mental health promotion program for pregnant women. Methods: Fifty-five pregnant women were participated in this study. Mental health states such as depression, anxiety, perceived stress, and quality of life were assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale, and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) before and after using VR program treatment. Based on the mental health types of pregnant women classified by cluster analysis, the effects of the VR program were analyzed by paired t test and Wilcoxon signed rank test. Results: The VR program significantly reduced PHQ-9 (p = 0.033) and GAD-7 (p = 0.046) scores, and significantly increased WHOQOL-BREF (p = 0.026) score of the participants. Additionally, when classifying the mental health types of pregnant women, the VR program was significantly effective to improve depression, anxiety, and quality of life in the most severe group based on the cluster analysis. Conclusion The results of this study suggest that VR program may be effective to improve the mental health of pregnant women. Particularly, VR programs for the high-risk group of depression might be the most effective. Therefore, VR-assisted mental health promotion programs could be useful for managing the mental health in pregnant women.

Objective: Recently, various mental health promotion programs using virtual reality (VR) technology have been tried in the psychiatric field. Considering the importance of mental health in pregnant women, VR-assisted mental health promotion programs for pregnant women are needed to be developed. This study aimed to prospectively investigate the efficacy of a VR-assisted mental health promotion program for pregnant women. Methods: Fifty-five pregnant women were participated in this study. Mental health states such as depression, anxiety, perceived stress, and quality of life were assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale, and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) before and after using VR program treatment. Based on the mental health types of pregnant women classified by cluster analysis, the effects of the VR program were analyzed by paired t test and Wilcoxon signed rank test. Results: The VR program significantly reduced PHQ-9 (p = 0.033) and GAD-7 (p = 0.046) scores, and significantly increased WHOQOL-BREF (p = 0.026) score of the participants. Additionally, when classifying the mental health types of pregnant women, the VR program was significantly effective to improve depression, anxiety, and quality of life in the most severe group based on the cluster analysis. Conclusion The results of this study suggest that VR program may be effective to improve the mental health of pregnant women. Particularly, VR programs for the high-risk group of depression might be the most effective. Therefore, VR-assisted mental health promotion programs could be useful for managing the mental health in pregnant women.

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.

Novel antimicrobial agents are continually developed to address the global threat of multidrug-resistant Neisseria gonorrhoeae. Promising candidates include zoliflodacin and, possibly, solithromycin. We evaluated their in-vitro activities against gonococcal isolates collected in Korea. In total, 250 N. gonorrhoeae isolates obtained across Korea between 2016 and 2018 were used to determine the minimum inhibitory concentrations (MICs) of 10 therapeutic agents using the CLSI agar dilution method. Most isolates (94.8%, 237/250) demonstrated non-susceptibility to penicillin G, tetracycline, and ciprofloxacin, and susceptibility to ceftriaxone and spectinomycin was substantially high. The half-maximal IC (MIC50) and 90% IC (MIC90) values for zoliflodacin were 0.03 and 0.06 µg/mL, respectively; 0.06 and 0.12 µg/mL, respectively, for solithromycin; and 0.03 and 0.12 µg/mL, respectively, for ceftriaxone. Notably, no cross-resistance was observed between zoliflodacin and ciprofloxacin, despite both targeting DNA topoisomerase II enzymes. Zoliflodacin and solithromycin demonstrated significant in-vitro activity against multidrug-resistant N.gonorrhoeae isolates, and zoliflodacin has shown non-inferiority to ceftriaxone/azithromycin dual therapy in a clinical phase 3 trial. Collectively, our findings highlight the potential of zoliflodacin as a novel therapeutic agent for gonococcal infections, particularly in the context of rising multidrug resistance, and highlight the need for continued surveillance and development of alternative antimicrobial strategies.

Objective: Recently, various mental health promotion programs using virtual reality (VR) technology have been tried in the psychiatric field. Considering the importance of mental health in pregnant women, VR-assisted mental health promotion programs for pregnant women are needed to be developed. This study aimed to prospectively investigate the efficacy of a VR-assisted mental health promotion program for pregnant women. Methods: Fifty-five pregnant women were participated in this study. Mental health states such as depression, anxiety, perceived stress, and quality of life were assessed by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale, and World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF) before and after using VR program treatment. Based on the mental health types of pregnant women classified by cluster analysis, the effects of the VR program were analyzed by paired t test and Wilcoxon signed rank test. Results: The VR program significantly reduced PHQ-9 (p = 0.033) and GAD-7 (p = 0.046) scores, and significantly increased WHOQOL-BREF (p = 0.026) score of the participants. Additionally, when classifying the mental health types of pregnant women, the VR program was significantly effective to improve depression, anxiety, and quality of life in the most severe group based on the cluster analysis. Conclusion The results of this study suggest that VR program may be effective to improve the mental health of pregnant women. Particularly, VR programs for the high-risk group of depression might be the most effective. Therefore, VR-assisted mental health promotion programs could be useful for managing the mental health in pregnant women.

Background: Citrobacter spp. are known opportunistic pathogens. Recent reports have indicated concerningly high rates of carbapenem resistance in long-term care hospitals. In this study, we investigated the characteristics of carbapenemase genotypes in carbapenem-resistant Citrobacter spp. (CR-Citrobacter spp.) isolated from clinical and surveillance specimens. Methods: CR-Citrobacter spp. isolates were collected from Seoul Clinical Laboratories in 2023. The isolates underwent multiplex polymerase chain reaction (PCR) analysis for the detection of six carbapenemase genotypes (KPC, GES, IMP, NDM, VIM, and OXA-48-like) using the PANA Real Typer CRE Kit (PANAGENE, Korea). Results: Among 329 CR-Citrobacter spp. isolates, 289 (87.9%) were from patients aged 60 years or older, with the majority isolated from long-term care hospitals (255, 77.5%). C. koseri was predominant in both the clinical and surveillance isolates at 84.7 % (72/85) and 67.6 % (165/244), respectively. KPC (76.5%) was the most common carbapenemase genotype detected in the clinical isolates, followed by OXA-48-like (11.8%) and NDM (8.2%). Double carbapenemase genotypes were detected in eight isolates (2.4%). Conclusion This study revealed a high prevalence of CR-Citrobacter spp., particularly C. koseri, in long-term care hospitals. The predominance of KPC-producing C. koseri highlights the need for enhanced surveillance and infection control in long-term care hospitals.