Shi HJ, et al. J Korean Med Sci. 2023 Jun;38(28):e217. https://doi.org/10.3346/jkms.2023.38.e217

Jeon CH, et al. Infect Chemother. 2022 Aug;54:e61. https://doi.org/10.3947/ic.2022.0025

Non-toxigenic Clostridioides difficile (NTCD) has been shown to decrease the risk of recurrent C. difficile infection (CDI) in patients following metronidazole or vancomycin treatment for CDI. Limited data on the prevalence of NTCD strains in symptomatic patients and their clinical characteristics are available. We conducted this study to investigate the prevalence of NTCD in diarrhoea patients and their clinical characteristics. Between July 2017 and June 2018, unduplicated stool specimens were collected from patients with diarrhoea. The characteristics and episodes of C. difficile infection in patients with NTCD and toxigenic strains were compared. Among the 1182 stool specimens collected, 236 (18.5%) were identified as growing C. difficile, and 19.5% of the identified isolates were found to be NTCD. Multivariate analysis showed that community-onset diarrhoea (OR = 4.13, 95% CI 1.07–15.97; p = 0.040), underlying diabetes (OR = 3.64, 95% CI 1.46–9.25; p = 0.006), previous use of glycopeptides (OR = 4.75, 95% CI 1.37–16.42; p = 0.014), and the lack of use of proton pump inhibitors (PPIs) (OR = 3.57, 95% CI 1.39–9.09; p = 0.009) were independently associated with the NTCD group. Although there was no statistical significance, the number of CDI episodes occurring after 90 days tended to be lower in the NTCD group (2.2%) than in the toxigenic group (11.2%). A considerable portion of the C. difficile strains isolated from patients with diarrhoea showed NTCD. Further, more extensive studies are needed to clearly define the protective effects of NTCD strains in patients with diarrhoea.

Kim S, et al. Infect Chemother. 2023 Aug;55:e34. https://doi.org/10.3947/ic.2023.0032

Background: The Korea Disease Control and Prevention Agency classifies healthcare workers (HCWs) into five groups based on Mycobacterium tuberculosis exposure risk and potential transmission impact to guide TB screening strategies. However, data on actual exposure frequency and latent tuberculosis infection (LTBI) incidence across these classifications remain limited. Methods: We conducted a retrospective cohort study of HCWs at a tertiary hospital between 2023 and 2024. Baseline LTBI screening was performed for all staff, with annual follow-up testing for Groups 1–4 according to national guidelines. TB exposure history and frequency were investigated and documented by the infection prevention department. LTBI incidence was assessed among HCWs with a negative test in 2023 who underwent repeat testing in 2024. Results: Among 2116 HCWs (27.7% male; mean age, 33 years), TB exposure rates increased with higher risk classification (Group 1: 46.9%, Group 2: 31.3%, Group 3: 18.5%, Group 4: 1.2%, Group 5: 0.6%; p < 0.001), as did the mean number of exposure events per person (1.39, 0.74, 0.31, 0.01, and 0.01, respectively; p < 0.001). The incidence of LTBI was 13/1323 (1.0%). After adjustment, LTBI incidence was associated with ≥2 TB exposure events (adjusted OR, 7.03; 95% CI, 1.87–26.36; p = 0.005), but did not differ significantly by group classification. Conclusions: This study suggests that occupational classification effectively predicts the frequency of TB exposure among healthcare workers. However, LTBI incidence is more closely associated with multiple TB exposure events rather than occupational classification.

The appropriate use of carbapenem is a critical concern for patient safety and public health, and is a national priority. We investigated the nationwide status of carbapenem prescription in patients within their last 14 days of life to guide judicious-use protocols from the previous study comprised of 1350 decedents. Carbapenem use was universally controlled through computerised authorisation system at all centres during the study period. Carbapenem prescribing patterns and their optimality were evaluated. A total of 1201 patients received antimicrobial agents within the last two weeks of their lives, of whom 533 (44.4%) received at least one carbapenem. The median carbapenem treatment duration was seven days. Of the 533 patients receiving carbapenems, 510 (95.7%) patients had microbiological samples drawn and 196 (36.8%) yielded carbapenem-resistant pathogens. A total of 200 (37.5%) patients were referred to infectious disease (ID) specialists. Of the 333 patients (62.5%) who did not have ID consultations, 194 (58.2%) were assessed as “not optimal”, 79 (23.7%) required escalation, 100 (30.0%) required de-escalation, and 15 (4.5%) were discontinued. Notwithstanding the existing antibiotic restriction program system, carbapenems are commonly prescribed to patients in their last days of life.