BACKGROUND/AIMS:Infection remains the second leading cause of mortality in patients with end-stage renal disease (ESRD). Despite the direct relationship between hemodialysis vascular access-related infections (HD-VARI) and both prognosis and mortality in ESRD patients, there is a paucity of research in this area. METHODS:This retrospective study was performed at a tertiary care hospital in Seoul, Korea, from 2009 to 2020. Medical records of adult patients diagnosed with HD-VARI were assessed. We analyzed the distribution of microorganisms, clinical characteristics according to vascular access type, and evaluated risk factors for treatment failure. RESULTS:Data from a total of 367 patients were included over the 12-year study period. Based on vascular access type, 293 (79.8%) had arteriovenous graft infections, 29 (7.9%) had arteriovenous fistula infections, and 45 (12.3%) had tunneled cuffed catheter infections. Thirty-one (8.4%) patients experienced treatment failure within 90 days. Multivariate analysis identified male sex (odds ratio [OR], 2.343; 95% confidence interval [CI], 1.041-5.274) and metastatic infection (OR, 4.297; 95% CI, 1.516-12.178) as independent predictors of 90-day infection-related treatment failure. Subtotal or total excision (removal) of the infected vascular access significantly decreased the risk of 90-day infection-related treatment failure (OR, 0.337; 95% CI, 0.129-0.876). CONCLUSION:Removal of infected vascular access played a crucial role in reducing infection-related deaths or relapses within 90 days. Management of vascular access infection should be individualized based on patient-specific factors.

BACKGROUND:The incidence of syphilis, a re-emerging infection linked to human immunodeficiency virus (HIV) through shared transmission routes, is increasing among people living with human immunodeficiency virus (PLH) in Korea. This study evaluate the prevalence, temporal trends, and risk factors for syphilis among PLH in the Republic of Korea. METHODS:Data from the National Health Insurance Service of Korea between 2002 and 2021 were analyzed to determine the incidence of syphilis in PLH. Syphilis was defined by the assigned Korean Standard Classification of Diseases code, with prescription codes for benzathine penicillin G, ceftriaxone, and doxycycline. Syphilis was classified as early or late based on the antibiotic dose. Multivariable logistic regression analysis was performed to assess risk factors for syphilis among PLH. RESULTS:The prevalence of syphilis in PLH was 25.53% (4,193/16,422 patients). Early syphilis accounted for 85.19% (3,572/4,193) of cases, and 34.80% of PLH with syphilis experienced multiple episodes. Additionally, 23.73% of PLH with syphilis received treatment for syphilis before HIV diagnosis. In the multivariable analysis, male sex (adjusted odds ratio [aOR], 10.78; 95% confidence interval [CI], 7.87-14.78), living in the Seoul metropolitan area (comprising Seoul, Incheon, and Gyeonggi-do) (aOR, 1.24; 95% CI, 1.15-1.34), the presence of acquired immunodeficiency syndrome-related cancer (aOR, 1.36; 95% CI, 1.24-1.48), longer duration of HIV diagnosis (pre-2009 vs. 2019-2021: aOR, 1.94; 95% CI, 1.71-2.20), and the lowest economic status (aOR, 1.35; 95% CI, 1.18-1.54) were associated with higher risks of syphilis. New PLH cases and early syphilis among PLH revealed correlated trends over the study period (Spearman's ρ = 0.71, P < 0.01). CONCLUSION:Syphilis is highly prevalent among PLH, particularly low-income males in the Seoul metropolitan area with longer HIV disease duration. Enhanced surveillance and targeted interventions are urgently needed to control syphilis transmission among high-risk PLH.

INTRODUCTION:The global incidence of syphilis has been increasing in recent years, with multiple factors contributing to this trend. Syphilis disproportionately affects specific populations. We aimed to evaluate trends in the incidence and geographical distribution of syphilis at the provincial level among people living with human immunodeficiency virus (PLWH) and the total population in Korea. METHODS:PLWH were enrolled from the Korea National Health Insurance Service Database. Early syphilis was defined as having an International Classification of Diseases, 10th revision diagnostic code and the prescription codes for medications. Between 2014 and 2019, syphilis was designated as a nationally notifiable infectious disease, facilitating comprehensive data collection. We compared the number of syphilis cases in the total population and the PLWH cohort. The incidence rates of early syphilis were estimated using Poisson regression, complemented by provincial mapping among the national and PLWH populations. RESULTS:The prevalence of early syphilis among PLWH was 22.4%, with 58.6% occurring after HIV diagnosis. In the total population, primary syphilis accounted for 69.8% of early cases. The age distribution and regional epidemiology of syphilis among PLWH differed from those in the total population. HIV infection was associated with a 5.04-fold higher incidence rate of syphilis (Incidence rate ratio (IRR), 95% Confidence interval (CI): 5.04 [4.77-5.34]), and as the years elapsed, the incidence rate of syphilis increased by 14.5% (IRR, 95% CI: 1.15 [1.13-1.16]). Since 2015, the incidence of new syphilis cases has increased notably in the total population, whereas it remained relatively stable among PLWH, indicating that the absolute rate and trajectories differed from those of the national population. CONCLUSION:Syphilis is prevalent among PLWH; however, the epidemiology differs from that of the national population. This highlights the need for multifaceted policies to prevent syphilis transmission.

A sudden surge in multidrug-resistant Acinetobacter baumannii (MRAB) incidence in a medical-surgical intensive care unit (ICU) in Seoul, Republic of Korea, in December 2023 prompted a molecular epidemiological investigation and the implementation of multimodal infection control interventions. We aimed to evaluate the effects of these interventions on the outbreak. This study was conducted in a 28-bed mixed medical-surgical ICU. Environmental cultures were collected from 27 high-touch surfaces surrounding MRAB-colonised patients. Whole-genome sequencing (WGS) and single-nucleotide polymorphism (SNP)-based phylogenetic analyses were performed on 14 isolates (10 clinical and four environmental) to determine clonality. The multimodal intervention included admission screening, weekly surveillance, pre-emptive contact precautions, increased frequency of cleaning with sodium dichloroisocyanurate, adenosine triphosphate monitoring, and terminal disinfection using aerosolised hydrogen peroxide. The monthly MRAB acquisition rate was analysed using Poisson regression. MRAB was isolated from four environmental samples: three ventilator tubes and one blood pressure cuff. SNP-based analysis revealed that 13 isolates belonged to a single outbreak clone (ST195/ST2) with ≤ 7 pairwise SNP differences. Notably, the environmental isolate from the blood pressure cuff exhibited no SNP differences from the subsequent clinical isolate, suggesting a direct epidemiological linkage. Post-intervention, the MRAB acquisition rate per 1000 patient-days decreased significantly, from 18.56 in December 2023 to zero in February 2025 (relative risk, 0.79; 95

BACKGROUND:People living with human immunodeficiency virus (PLHIV) commonly experience psychological issues, including anxiety disorders and depression, which may affect their adherence to antiretroviral therapy. This study aimed to explore the mental health status of PLHIV and identify the factors associated with poor compliance (PC) with antiretroviral therapy. MATERIALS AND METHODS:A structured questionnaire survey was administered to PLHIV who were regularly followed up at a university hospital from September 19 to 20, 2020. The survey encompassed assessments of depression (by using the Patient Health Questionnaire-9), anxiety (by using the Beck Anxiety Inventory-Primary Care), suicidality, and meaning in life (by using the Meaning in Life Questionnaire). For participants who provided consent for identification, demographic information was merged to facilitate the analysis. PC was determined based on whether individuals made themselves available for routine clinical visits. RESULTS:Among 327 eligible PLHIV, 150 individuals (45.9%) completed the survey. Forty-one out of the 150 individuals (27.3%) screened positive for depression, while 52 (34.7%) screened positive for anxiety disorders. Thirty-two participants (21.3%) presented with symptoms indicative of both depression and anxiety. The most prevalent depressive symptom was trouble sleeping, accounting for 29.3% of respondents, followed by fatigue (26.0%). Over nervousness was the most commonly reported anxiety symptom (22.7%). Furthermore, 32 individuals (21.3%) reported experiencing suicidal ideation or engaging in self-injury. Among the 123 participants who agreed to identify themselves, suicide attempts and low CD4 counts were positively correlated with PC (adjusted odds ratio [aOR], 3.34; 95% confidence interval [CI], 1.29-8.91 and OR, 5.46; 95% CI, 1.27-24.78, respectively), and younger age was found to be associated with PC (aOR, 0.93; 95% CI, 0.88-0.97; P=0.004). When measures of anxiety disorder and depression were incorporated into the analysis, depression exhibited an OR of 14 for PC (aOR, 13.98; 95% CI, 3.29-98.65; P=0.001). Anxiety disorders were found to be inversely associated with PC. History of opportunistic infection and Meaning in Life Questionnaire scores were not significantly associated with PC. CONCLUSION:The prevalence of depression and anxiety disorders was high in PLHIV. Depression and low CD4 counts under regular follow-up were associated with PC. Thus, screening for depression can be effective in reducing non-adherence to antiretroviral therapy.

BICtegravir Single Tablet Regimen is a multi-national observational cohort study evaluating the effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in people with human immunodeficiency virus. We present 24-month data from participants in Korea. Eighty-eight participants (36 treatment-naïve [TN], 52 treatment-experienced [TE]) were included. At 24 months, 100% (29/29) of TN and 100% (37/37) of TE participants had HIV-1 RNA <50 copies/mL (missing=excluded analysis). BIC/FTC/TAF persistence was 100% (33/33) and 96.1% (49/51) in TN and TE participants, respectively. Drug-related adverse events occurred in 2 TN participants. Improvements in some patient-reported outcomes were observed. BIC/FTC/TAF maintained effectiveness, persistence, and tolerability over 24 months.

Background. When treating diabetic foot osteomyelitis (DFO), it remains difficult to determine the presence of residual infection and the optimal treatment after bone resection. In this study, we aimed to investigate the clinical characteristics of and prognostic factors in patients with DFO undergoing amputation. Methods. This retrospective study involved 101 patients with DFO who underwent amputation. Data on their demographics, clinical characteristics, tissue culture, and surgery type were collected. Patients were grouped according to primary closure status and clinical outcome postamputation. A good outcome was defined as a successful complete remission, characterized by the maintenance of complete wound healing with no sign of infection at 6 months postamputation. Multivariate logistic regression analysis was performed. Outcomes according to surgery type were also analyzed. Results. Staphylococcus aureus (17%) and Pseudomonas species (14%) were the most prevalent pathogens. Gram-negative bacteria were isolated from 62% of patients. In patients with primary closure, hemodialysis and ankle brachial index (ABI) <0.6 were associated with poor outcomes. In patients with DFO, ABI <0.6 was the only prognostic factor associated with treatment failure. Antimicrobial stewardship allows patients who underwent major amputation to reduce the duration of antibiotic therapy compared to those after minor amputation, although it did not contribute to reducing mortality. Conclusions. Peripheral artery disease and hemodialysis were associated with poor outcomes despite radical resection of the infected bone. Vigilant monitoring after amputation and antimicrobial stewardship implemented based on microbiological epidemiology, prognostic factors, and the type of surgery are important. A multidisciplinary team could assist in these activities to ensure treatment success.

Purpose: This study evaluated the effect of virtual reality (VR)-based infection control (IC) education program on IC knowledge, awareness, performance confidence, and self-efficacy in nursing students.Methods: A single-group pretest-posttest design was employed. The study participants consisted of 86 nursing students. The VR-based IC education program was developed by applying the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model. The subject of the VR-based IC education program was isolation precautions. The effects of the VR-based educational program were measured via a questionnaire.Results: There were no significant differences in IC knowledge before and after the VR-based IC education program. However, IC awareness (t=2.31, p=.023), IC performance confidence (t=2.19, p=.031), and self-efficacy (t=3.43, p=.001) exhibited statistically significant increases after the VR-based IC education program. Satisfaction with the VR-based IC education program was relatively high, at 4.71±0.59 points.Conclusion: IC education using VR effectively strengthened IC competency by improving IC awareness, performance confidence, and self-efficacy. Therefore, it is necessary to develop and utilize various VR-based IC education content for nursing students.

The emergence of invasive infections attributed to group A Streptococcus (GAS) infections, has resurged since the 1980s. The recent surge in reports of toxic shock syndrome due to GAS in Japan in 2024, while sensationalized in the media, does not represent a novel infectious disease per se, as its diagnosis, treatment, and prevention are already well-established. However, due to signs of increasing incidence since 2011, further research is needed. Health authorities in neighboring countries like The Republic of Korea should not only issue travel advisories but also establish meticulous surveillance systems and initiate epidemiological studies on the genotypic variations of this disease while awaiting various epidemiological research findings from Japan.

Moraxella catarrhalis commonly colonizes the upper respiratory tract of humans, but infection caused by M. catarrhalis after orthopedic surgery is rare. Here, we report the first case of septic arthritis of the shoulder caused by an M. catarrhalis infection and outline the diagnosis and treatment steps as well as differences compared with other cases.

We investigated the usefulness of quantitative 99mTc-white blood cell (WBC) single photon emission computed tomography (SPECT)/computed tomography (CT) for predicting lower extremity amputation in diabetic foot infection (DFI). A total of 93 feet of 83 consecutive patients with DFI who underwent WBC SPECT/CT for treatment planning were retrospectively analysed. The clinical and SPECT/CT parameters were collected along with the measurements of the maximum standardized uptake value (SUVmax) at DFI. Statistical logistic regression analysis was performed to explore the predictors of LEA and receiver operating characteristic (ROC) curve was analysed to assess the predictive value of SPECT/CT. The independent predictors of amputation were previous amputation (OR 11.9), numbers of SPECT/CT lesions (OR 2.1), and SUVmax of DFI; either continuous SUVmax (1-increase) (OR 1.3) or categorical SUVmax > 1.1 (OR 21.6). However, the conventional SPECT/CT interpretation failed to predict amputation. In ROC analysis, the SUVmax yielded a fair predictor (area under the curve (AUC) 0.782) of amputation. The model developed from these independent predictors yielded an excellent performance for predicting amputation (AUC 0.873). Quantitative WBC SPECT/CT can provide new information useful for predicting the outcomes and guiding treatment for patients with DFI.

BACKGROUND:The incidence of healthcare-associated infections, particularly injection-related infections, can increase patient comorbidities even in countries with adequate medical resources. Although there are clear guidelines for injection practices to prevent infections, their application in clinical settings is insufficient. Therefore, the objective of this study was to identify factors affecting injection practices associated with reduced infections by conducting surveys targeting practicing healthcare providers involved in administering injections at each healthcare organization and performing data analysis. METHODS:We administered a survey to healthcare providers responsible for injection practices at each healthcare organization that included items related to infection-safe injection practice guidelines. All survey questions were reviewed by an expert panel of infectious disease and infection control nurses. Survey contents were subjected to exploratory factor analysis (EFA), confirmatory factor analysis, and multivariable robust regression tests to determine the impact of each factor and their correlations. RESULTS:A total of 842 questionnaires were analyzed. Each questionnaire was classified into four factors: reuse and contamination, compliance with aseptic technique, exchange of infusion set, and use of multidose vials. Nurses with higher careers showed more compliance. Education within one year and awareness of each item of the questionnaire had positive associations with proper injection practice. CONCLUSIONS:Education is thought to be the most important factor in good injection practices that could reduce infections. Relevant knowledge through timely training is expected to have a positive impact on performance and compliance related to safe injections.

For the prevention of carbapenem-resistant Enterobacterales (CRE) acquisition in the intensive care unit (ICU), the effectiveness of universal contact precautions (UCP) and chlorhexidine gluconate (CHG) bathing is controversial. With the aim of evaluating the effectiveness of UCP and CHG on CRE acquisition, this study was conducted in an ICU at a university-affiliated hospital in Seoul. Beginning in April 2017, all patients admitted to the ICU underwent weekly CRE screening and surveillance tests, and beginning in January 2018, UCP and CHG bathing were implemented for all patients. The pre-intervention period spanned from April to December 2017; the post-intervention period spanned from January 2018 to December 2019. The pre- and post-intervention CRE acquisition rates were subsequently compared using Kaplan–Meier analysis and log-rank tests, and independent risk factors for CRE acquisition were analysed using Cox proportional hazard modelling. Of 1,747 patients, 35 acquired CRE during their ICU stay. The CRE acquisition rate was 1.94 and 1.45 per 1,000 patient-days before and after the intervention, respectively, with no significant difference (p = 0.357). The incidence rate of multidrug-resistant organism (MDRO) colonisation decreased from 19.33 to 13.57 per 1,000 patient-days, with Poisson regression analysis showing a relative risk of 0.85 (95

Nocardiosis is uncommon. Immunocompromising conditions predispose individuals to pulmonary and disseminated nocardiosis of the brain, skin, and subcutaneous tissues. The most common pathogens are Nocardia cyriacigeorgica, Nocardia nova, and Nocardia farcinica. The speciation of Nocardia to determine antimicrobial susceptibility is difficult using traditional biochemical methods. Here, we report the case of a 73-year-old man with chronic obstructive lung disease who developed a rapidly progressing intramuscular abscess around the left hip and thigh. Within 3 days, the lesions progressed to an epidural abscess at the L4 to S1 level. Although he was treated with broad-spectrum antibiotics and extensive incision and drainage, he died of rapidly progressive respiratory failure. Nocardia abscessus (N. abscessus) was identified in pus samples using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). This case shows that the diagnosis of an intramuscular abscess caused by N. abscessus is challenging and that using MALDI-TOF MS may facilitate the diagnosis and ensure appropriate treatment.

Objective: We investigated gender differences in psychosocial determinants that affect hand hygiene (HH) performance among physicians. Design: The survey included a structured questionnaire with 7 parts: self-assessment of HH execution rate; knowledge, attitude, and behavior regarding HH; internal and emotional motivation for better HH; barriers to HH; need for external reminders; preference for alcohol gel; and embarrassment due to supervision. Setting: The study was conducted across 4 academic referral hospitals in Korea. Participants: Physicians who worked at these hospitals were surveyed. Methods: The survey questionnaire was sent to 994 physicians of the hospitals in July 2018 via email or paper. Differences in psychosocial determinants of HH among physicians were analyzed by gender using an independent t test or the Fisher exact test. Results: Of the 994 physicians, 201 (20.2%) responded to the survey. Among them, 129 (63.5%) were men. Male physicians identified 4 barriers as significant: time wasted on HH ( P = .034); HH is not a habit ( P = .004); often forgetting about HH situations ( P = .002); and no disadvantage when I do not perform HH ( P = .005). Female physicians identified pain and dryness of the hands as a significant obstacle ( P = .010), and they had a higher tendency to feel uncomfortable when a fellow employee performed inadequate HH ( P = .098). Among the respondents, 26.6% identified diversifying the types of hand sanitizers as their first choice for overcoming barriers to improving HH, followed by providing reminders (15.6%) and soap and paper towels in each hospital room (13.0%). Conclusion: A significant difference in the barriers to HH existed between male and female physicians. Promoting HH activities could help increase HH compliance.

Background: Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities.Method: We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year.Results: In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P = .018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P = .123).Discussion: HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category.Conclusions: HH promotion team activities improved and maintained optimal HH compliance among HCWs.& COPY; 2023 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.