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Lee KH, Kim D, Hong JS, Park SY, Cho NH, Kim MN, Lee YJ, Wi Y, Lee EH, Han SH, Jeong SH, Song YG. Prevalence of carbapenemase producing Enterobacterales colonization and risk factor of clinical infection. J Infect Public Health 2023; 16:1860-1869. [PMID: 37837922 DOI: 10.1016/j.jiph.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) are global concerns in infection control, and the number of CPE outbreaks in hospitals is increasing despite the strengthening of contact precautions. This study aimed to confirm the prevalence and transition rate of CPE infection from stool surveillance culture and to identify the acquisition pathway of CPE. METHODS This is a longitudinal review of patients with stool surveillance cultures at a tertiary center in Seoul, South Korea, from July 2018 to June 2020. Pulsed-field gel electrophoresis, multi-locus sequence typing, and whole genome sequencing were performed for carbapenemase-producing Klebsiella pneumoniae and Escherichia coli strains. RESULTS Among 1620 patients who had undergone stool CPE surveillance cultures, only 7.1% of active surveillance at the Emergency Room (ER) and 4.4% of universal surveillance in the Intensive Care Unit (ICU) were stool CPE positive. The transition rates from stool carriers to clinical CPE infections were 29.4% in the ER and 31.3% in the ICU. However, it was significantly high (55.0%) in the initial stool CPE-negative ICU patients. Among the initial stool CPE-positive patients, hypertension (61% vs. 92.3%, P = 0.004), malignancy (28.8% vs. 53.8%, P = 0.027), and mechanical ventilation (25.4% vs. 53.8%, P = 0.011) were significant risk factors for clinical CPE infection. Molecular typing revealed that sequence type (ST) 307 and ST 395 were dominant in K. pneumoniae, and ST 410 was dominant in E. coli isolates. CONCLUSIONS Active surveillance showed a higher detection rate than universal stool CPE screening, and one-third of positive stool CPE specimens ultimately developed subsquent clinical CPE infection. According to the molecular typing of the identified CPE strains, in-hospital spread prevailed over external inflow, and the transition rate to clinical CPE was particularly high in the ICU. Therefore, in order to control CPE propagation, not only active surveillance to block inflow from outside, but also continuous ICU monitoring within the hospital is necessary.
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Affiliation(s)
- Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dokyun Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Sung Hong
- Department of Companion Animal Health and Science, Silla University, Busan, Republic of Korea
| | - Soon Young Park
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nan Hyoung Cho
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Mi Na Kim
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yun Jung Lee
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yeonji Wi
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Eun Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Colas A, Regad M, Faivre V, Conrath E, Lizon J, Florentin A. Carbapenemase-producing Enterobacteriaceae and vancomycin-resistant Enterococcus faecium: The value of a computerized monitoring system to limit their spread. Infect Dis Now 2023; 53:104724. [PMID: 37209829 DOI: 10.1016/j.idnow.2023.104724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To quickly implement Infection Prevention and Control measures ("search and isolate" strategy), a computerized monitoring system for carbapenemase-producing Enterobacteriaceae (CPE) and Vancomycin-resistant Enterococcus faecium (VRE) carrier and contact patients has been developed in our hospital since 2014. The objectives were to assess the value of a computerized monitoring system in CPE and VRE management and to evaluate the relevance of extended monitoring of all contact patients. METHODS Using the data extracted from the computerized system, we conducted a descriptive analysis of CPE and VRE carriers detected from 2004 to 2019 and CPE and VRE extensive contact patients (when hospital stay overlapped with the stay of a carrier in the same unit) from 2014 to 2019. RESULTS Between 2015 and 2019 (microbiological data only available during this period), 113 CPE and 558 VRE carriers were registered in the database (DB). Among them, 33.9% CPE and 12.8% VRE carriers were infected (p = 0.02). The most frequent infections were urinary tract infections (52.0%), bloodstream infections (20.0%) and pneumonia (16.0%). Close to 8000 (7679) extended contact patients were exposed. Only 26.2% of them were removed from the DB because of appropriate negative post-exposure rectal screenings. No rectal screening was performed in 33.5% of contact patients. Between 2014 and 2019, 16 outbreaks occurred. The proportion of infected carriers differed significantly between outbreaks (index cases) and non-epidemic episodes (50.0% and 20.5% respectively, p = 0.03). The detection system was able to control diffusion in 99.7% of readmissions of known carriers. Among the 360 readmissions detected by the system, only one was involved in an outbreak due to non-compliance with infection control measures. CONCLUSION Given the low screening completion rate (26.2%) and the low detection rate (1.3%), extended monitoring of contact patients does not seem relevant. After five years of use, the computerized monitoring system has demonstrated its effectiveness in terms of responsiveness and limitation of the spread of multidrug-resistant organisms.
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Affiliation(s)
- Anaïs Colas
- CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France; Université de Lorraine, Faculté de Médecine, F-54505 Vandœuvre-lès-Nancy, France
| | - Marie Regad
- CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France; Université de Lorraine, Faculté de Médecine, F-54505 Vandœuvre-lès-Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France
| | | | | | - Julie Lizon
- CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France
| | - Arnaud Florentin
- CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France; Université de Lorraine, Faculté de Médecine, F-54505 Vandœuvre-lès-Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France
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Timler M, Timler W, Bednarz A, Zakonnik Ł, Kozłowski R, Timler D, Marczak M. Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1960. [PMID: 36767330 PMCID: PMC9915316 DOI: 10.3390/ijerph20031960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Drug-resistant bacteria are one of the main reasons of deaths worldwide. One of the significant groups of these bacteria are carbapenemase-producing Enterobacteriaceae (CPE). The goal of this cross-sectional study was the identification and hierarchisation of selected risk factors of CPE colonisation. To achieve that goal, we examined 236 patients for the presence of CPE using the standard method of anal swabs. The patients were divided into three groups: hospitalised patients; those chronically dialysed; those requiring home care. A very thorough medical interview was conducted for comorbidities. A statistical analysis relationship between comorbidities and locations of the patient's stay with the positive result of the culture was investigated. A significant relationship was demonstrated between the positive result of the culture and confirmed dementia, heart failure, connective tissue diseases, and established irregularities in the level of leukocytes. No significant relationship was demonstrated with the remaining comorbidities considered in the study. Afterwards these factors were compared for importance for the assessment of risk of a positive swab result-the biggest importance was found in establishing connective tissue disease. Next were dementia, abnormal values of leukocytes, heart failure, and at the end, stay at the orthopaedics ward. Conclusions: The study identified asymptomatic carriers of CPE, which demonstrates the need for further studies in order to identify infection risk factors. The connective tissue diseases are the most important variable which enable the prediction of CPE colonisation-the next ones are dementia, abnormal values of leukocytes, heart failure, and stay at the orthopaedics ward.
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Affiliation(s)
- Małgorzata Timler
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
| | - Wojciech Timler
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
| | - Ariadna Bednarz
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
| | - Łukasz Zakonnik
- Faculty of Economics and Sociology, University of Lodz, 90-214 Lodz, Poland
| | - Remigiusz Kozłowski
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, 92-212 Lodz, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, 92-212 Lodz, Poland
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
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Kang CI. Antibiotics for multidrug-resistant gram-negative bacteria. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.8.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Increase in antimicrobial-resistant bacteria continues to be challenge to physicians. Particularly, multidrug-resistant (MDR) gram-negative bacilli (GNB), such as extended-spectrum beta-lactamase (ESBL)-producers and carbapenem-resistant pathogens, are becoming a major human health problem globally.Current Concepts: Gram-negative bacteria have developed resistance via mechanisms encoding AmpC beta-lactamases, ESBLs, and carbapenemases. The therapeutic options available for these pathogens are extremely limited. Infection by MDR bacteria is associated with ineffective antimicrobial therapy, which poses a major threat to the survival of patients with serious infections. Physicians should be familiar with the local epidemiology of MDR bacterial infections and the available therapeutic options. Carbapenems are considered as the drugs of choice for treating ESBL or AmpC-producers. However, increased use of carbapenems in response to an increased prevalence of MDR pathogens could be associated with the rapid emergence of carbapenem resistance. Therefore, there is an ongoing quest for carbapenem-sparing regimens for the treatment of MDR-GNB. Treatment of MDR-GNB infections need not be limited to carbapenems as novel antimicrobial agents are now available.Discussion and Conclusion: This comprehensive review aims to describe therapeutic options available for MDR-GNB infections in Korea, a country with a high prevalence of MDR pathogens. Recently developed antimicrobial agents that should be urgently introduced in Korea include ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, and cefiderocol. These drugs have been shown to be effective against carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.
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Lee HJ, Lee DG. Urgent need for novel antibiotics in Republic of Korea to combat multidrug-resistant bacteria. Korean J Intern Med 2022; 37:271-280. [PMID: 35272440 PMCID: PMC8925957 DOI: 10.3904/kjim.2021.527] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022] Open
Abstract
Multidrug resistance in bacteria is an important issue and is increasing in frequency worldwide because of the limitations of therapeutic agents. From 2010 to 2019, 14 new systemic antibiotics received regulatory approval in the United States. However, few new antibiotics have been introduced in Republic of Korea to combat multidrug-resistant pathogens. Here, we introduce six novel antibiotics for Gram-positive bacteria and five for Gram-negative bacteria approved by the United States Food and Drug Administration and the European Medicines Agency from 2009 to October 2021, and recommend that they be approved for use in Republic of Korea at the earliest possible date.
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Affiliation(s)
- Hyo-Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Catholic Hematology Hospital, The Catholic University of Korea, Seoul,
Korea
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Chang E, Chang H, Shin I, Oh Y, Kang C, Choe P, Park W, Choi E, Oh M, Park K, Kim N. Investigation on the transmission rate of carbapenemase-producing carbapenem-resistant Enterobacterales among exposed persons in a tertiary hospital using whole-genome sequencing. J Hosp Infect 2022; 124:1-8. [DOI: 10.1016/j.jhin.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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Stein C, Lange I, Rödel J, Pletz MW, Kipp F. Targeted Molecular Detection of Nosocomial Carbapenemase-Producing Gram-Negative Bacteria-On Near- and Distant-Patient Surfaces. Microorganisms 2021; 9:microorganisms9061190. [PMID: 34073008 PMCID: PMC8229168 DOI: 10.3390/microorganisms9061190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Here, we describe an integrative method to detect carbapenemase-producing Gram-negative bacteria (gn-Cp) on surfaces/fomites in the patient environment. We examined environmental samples from 28 patient rooms occupied with patients who were proven to be colonised with gn-Cp by rectal screening. Methods: We took samples after 24 h, 72 h and one week. For sampling, we divided the patient environment into four parts and took samples from near- and extended patient areas. To obtain a representative bacterial swab from a larger surface, such as the patient cabinet, we used Polywipes. Bacterial DNA was isolated. Carbapenemase was detected with specific qPCR primers. Results: With this culture- and molecular-based approach, we could control the effectiveness of cleaning and disinfection in everyday clinical practice. Therefore, we could track the spread of gn-Cp within the patient room. The number of positive detections fluctuated between 30.5% (mean value positive results after 72 h) and 35.2% (after 24 h and one week). Conclusion: The method used to detect multidrug-resistant bacteria in the environment of patients by using PolywipesTM is reliable and can therefore be used as an effective, new tool in hygiene and infection control.
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Affiliation(s)
- Claudia Stein
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; (I.L.); (M.W.P.); (F.K.)
- Correspondence:
| | - Isabel Lange
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; (I.L.); (M.W.P.); (F.K.)
| | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany;
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; (I.L.); (M.W.P.); (F.K.)
| | - Frank Kipp
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany; (I.L.); (M.W.P.); (F.K.)
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Prolonged Carriage of Carbapenemase-Producing Enterobacteriaceae: Clinical Risk Factors and the Influence of Carbapenemase and Organism Types. J Clin Med 2021; 10:jcm10020310. [PMID: 33467637 PMCID: PMC7830152 DOI: 10.3390/jcm10020310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022] Open
Abstract
Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan–Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05–41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73–26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29–12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.
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Park JJ, Seo YB, Lee J, Eom JS, Song W, Choi YK, Kim SR, Son HJ, Cho NH. Positivity of Carbapenemase-producing Enterobacteriaceae in Patients Following Exposure within Long-term Care Facilities in Seoul, Korea. J Korean Med Sci 2020; 35:e303. [PMID: 32924341 PMCID: PMC7490199 DOI: 10.3346/jkms.2020.35.e303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) are emerging as a worldwide threat. Long-term care facilities (LTCFs) are considered a reservoir for CPE and play a central role in transmission to acute care hospitals. We investigated the CPE positivity in patients exposed to CPE in LTCFs. Furthermore, we analyzed the CPE positivity rates in the environment exposed to CPE. METHODS We collected rectal swab specimens from patients residing in LTCFs who were exposed to CPE. Environmental sampling was performed by infection control practitioners from sites classified as patient private space, common space in the patient room, common space other than patient rooms, and nursing station. Each sample was cultured on a Chrom Klebsiella pneumoniae carbapenemase (KPC) agar for CPE screening. The positive isolates were subjected to a polymerase chain reaction to identify the presence of blaKPC, blaVIM, blaIMP, blaOXA-48, and blaNDM and determine CPE genotype. RESULTS From 65 index cases, a total of 24 hospitals and 481 patients were enrolled; 414 patients who had resided in the same patient room as a patient with confirmed CPE and 67 patients who were newly admitted to that patient room. A total of 117 (24.3%) patients were positive for CPE among which 93 (22.5%, 93/414) were already admitted patients and 24 (35.8%, 24/67) were newly admitted patients. A total of 163 CPEs were detected and K. pneumoniae (n = 104, 63.8%) was the most common bacteria followed by Escherichia coli (n = 43, 26.4%) and Citrobacter koseri (n = 11, 6.7%). Environmental sampling was performed in 24 hospitals and 604 sites. A total of 12 sites (2.0%) were positive for CPE and sink in the nursing station (n = 6, 4.2%) was the most contaminated space. CONCLUSION CPE colonization rates in patients exposed to CPE in LTCFs were higher than those found in acute care hospitals. Proper infection control measures for detecting and reducing CPE colonization in patients residing in LTCFs are required. Newly admitted patients could also be carriers; therefore, infection control for newly admitted patients also needs to be thorough.
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Affiliation(s)
- Jin Ju Park
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
| | - Joong Sik Eom
- Division of Infectious Disease, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Wonkeun Song
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Young Kyun Choi
- Department of Critical Care Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Sung Ran Kim
- Department of Infection Control, Korea University Guro Hospital, Seoul, Korea
| | - Hee Jung Son
- Department of Infection Control, Ewha Womens University Mokdong Hospital, Seoul, Korea
| | - Nan Hyoung Cho
- Department of Infection Control, Kangnam Severance Hospital, Seoul, Korea
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