Background: Although small- and medium-sized hospitals comprise most healthcare providers in South Korea, data on antibiotic usage is limited in these facilities. We evaluated the pattern of antibiotic usage and its appropriateness in hospitals with <400 beds in South Korea. Methods: A multicenter retrospective study was conducted in 10 hospitals (6 long-term care hospitals, 3 acute-care hospitals, and 1 orthopedic hospital), with <400 beds in South Korea. We analyzed patterns of antibiotic prescription and their appropriateness in the participating hospitals. Data on the monthly antibiotic prescriptions and patient days for hospitalized patients were collected using electronic databases from each hospital. To avoid the effect of the COVID-19 pandemic, data were collected from January to December 2019. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital over 2 separate periods. Due to the heterogeneity of their characteristics, the orthopedics hospital was excluded from the analysis. The collected data were reviewed, and the appropriateness of antibiotic prescriptions was evaluated by 5 specialists in infectious diseases (adult and pediatric). Data from 2 hospitals were assigned to each specialist. The appropriateness of antibiotic prescriptions was evaluated from 3 aspects: route of administration, dose, and class. If the 3 aspects were ‘optimal,’ the prescription was considered ‘optimal.’ If only the route was ‘optimal,’ and the dose and/or class was ‘suboptimal,’ but not ‘inappropriate,’ it was considered ‘suboptimal.’ If even 1 aspect was ‘inappropriate,’ it was classified as ‘inappropriate.’ Results: The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by β-lactam/β-lactamase inhibitor (antipseudomonal). In acute-care hospitals, these were third-generation cephalosporin, followed by first-generation cephalosporin and second-generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first-generation cephalosporin. Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions: The antibiotic usage patterns vary between small- and medium-sized hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.

Funding: None

Disclosures: None

Background: The δ (delta) variant has spread rapidly worldwide and has become the predominant strain of SARS-CoV-2. We analyzed an outbreak caused by a vaccine breakthrough infection in a hospital with an active infection control program where 91.9% of healthcare workers were vaccinated. Methods: We investigated a SARS-CoV-2 outbreak between September 9 and October 2, 2021, in a referral teaching hospital in Korea. We retrospectively collected data on demographics, vaccination history, transmission, and clinical features of confirmed COVID-19 in patients, healthcare workers, and caregivers. Results: During the outbreak, 94 individuals tested positive for SARS-CoV-2 using reverse transcription-polymerase chain reaction (rtPCR) testing. Testing identified infections in 61 health care workers, 18 patients, and 15 caregivers, and 70 (74.5%) of 94 cases were vaccine breakthrough infections. We detected 3 superspreading events: in the hospital staff cafeteria and offices (n = 47 cases, 50%), the 8th floor of the main building (n = 22 cases, 23.4%), and the 7th floor in the maternal and child healthcare center (n = 12 cases, 12.8%). These superspreading events accounted for 81 (86.2%) of 94 transmissions (Fig. 1, 2). The median interval between completion of vaccination and COVID-19 infection was 117 days (range, 18–187). There was no significant difference in the mean Ct value of the RdRp/ORF1ab gene between fully vaccinated individuals (mean 20.87, SD±6.28) and unvaccinated individuals (mean 19.94, SD±5.37, P = .52) at the time of diagnosis. Among healthcare workers and caregivers, only 1 required oxygen supplementation. In contrast, among 18 patients, there were 4 fatal cases (22.2%), 3 of whom were unvaccinated (Table 1). Conclusions: Superspreading infection among fully vaccinated individuals occurred in an acute-care hospital while the δ (delta) variant was dominant. Given the potential for severe complications, as this outbreak demonstrated, preventive measures including adequate ventilation should be emphasized to minimize transmission in hospitals.

Funding: None

Disclosures: None

Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7–8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.

The present study aimed to determine thiamine intake levels and the association between thiamine intake, diabetes, cardiovascular diseases and mental health. Participants were interviewed to obtain data on socio-demographic characteristics, lifestyle, current medications, medical and family history. The daily intake of thiamine was assessed by a 24-h recall. The mean age of the 34 700 study subjects was 42⋅9 years (sd 22⋅8, min–max: 1–80) and 19 342 (55⋅7 %) were women. The levels of thiamine intake were 1⋅126 mg (2016), 1⋅115 mg (2017) and 1⋅087 mg (2018) for women, which were equal to or only slightly above the recommended intake of 1⋅10 mg/d for women. The levels of thiamine intake from 2014–15 and 2016–18 significantly decreased. The estimated percentage of insufficient thiamine intake was 37⋅8 % (95 % CI 37⋅3, 38⋅4). Multivariable regression analysis adjusted for potential confounders showed that thiamine intake was critically associated with lower risks of hypertension, MI or angina, type 2 diabetes, depression and dyslipidemia. The daily thiamine intake from food can reversal the risks of hypertension (OR 0⋅95; 95 % CI 0⋅90, 0⋅99), MI or angina (OR 0⋅84; 95 % CI 0⋅74, 0⋅95), type 2 diabetes (OR 0⋅86; 95 % CI 0⋅81, 0⋅93), depression (OR 0⋅90; 95 % CI 0⋅83, 0⋅97) and dyslipidemia (OR 0⋅90; 95 % CI 0⋅86, 0⋅95), respectively. Further works are needed to identify the effects of thiamine and non-communicable diseases (NCDs) and mental health. A preventive thiamine supplementation strategy should be adopted to target NCDs and mental health and risk factors associated with thiamine deficiency. The optimisation of NCD control and mental health protection is also a vital integral part of Korea's public health system.

This study compares the investigated water vapor diffusion coefficient in the neat polyurethane (PU) membrane, the silica–PU nanocomposite membrane, and two surface-modified silica–PU nanocomposite membranes. The silane first surface modifier is with an amine functional group known as N-[3-(trimethoxysilyl)propyl]ethylenediamine, while the second one is with an aniline functional group known as N-[3-(trimethoxysilyl)propyl]aniline. The enhancement of water vapor diffusivity values through the polymer nanocomposite is desirable for the membrane air dehumidification application. The diffusivities were calculated via molecular dynamics simulations at the temperature of 298.15 K. The Einstein's relationship known as the mean square displacement method was used to obtain the diffusivity for the membranes. The results showed a significant effect on the diffusivity of water vapor for the surface-modified silica–PU nanocomposite membrane as compared with the neat PU and the unmodified silica–PU nanocomposite membranes. For the amine-modified silica, the diffusion coefficient increased by 80.3% compared with the unmodified silica–PU nanocomposite membrane. On the other hand, the aniline-modified silica outperformed the amine-modified one in terms of the diffusion coefficient by 22.4%.

The study of extremely metal-poor (EMP; [Fe/H] <−3.0) and ultra metal-poor (UMP; [Fe/H] <−4.0) stars is crucial for better understanding first-star nucleosynthesis and constraining the initial mass function in the early Universe. However, UMP stars discovered in the past 25 years only number ~25. A few recent theoretical studies have pointed out that there is likely to exist large numbers of EMP and UMP stars in the periphery of the Galactic halo, at distances exceeding 30-50 kpc. We present identifications of several new EMP/UMP stars and introduce a survey to expedite discovering hundreds to thousands of EMP/UMP stars in the outermost halo (as well as in the local volume) over the next few years, which could revolutionize chemical-evolution studies of the Galaxy.

There is growing evidence that, among the various subclasses of carbon-enhanced metal-poor (CEMP) stars, the outer halo of the Milky Way exhibits a higher frequency of CEMP-no stars (those having no over-abundances of heavy neutron-capture elements) compared with the CEMP-s stars (those with over-enhancements of the s-process elements), while the inner halo shows a higher frequency of CEMP-s stars. We map out fractions of CEMP-no and CEMP-s stars in the inner- and outer-halo populations, separated by their spatial distribution of carbonicity ([C/Fe]), a so-called “carbonicity map”, based on a sample of over 100,000 main-sequence turnoff stars with available spectroscopy from the Sloan Digital Sky Survey. The CEMP-no and CEMP-s objects are classified by different levels of absolute carbon abundances for our sample, A(C). We also present kinematic and orbital characteristics of these subclasses for each population. The contrast appearing in these characteristics provides critical constraints on the assembly history of the two primary stellar components of the Galactic halo.

To trace the surficial responses of lowlands to past climate change, we investigated δ13C in total organic carbon (TOC), C/N ratios, magnetic susceptibility (MS), and silicon (Si) intensity (directly proportional to concentration) in wetland sediments collected from the Gimpo area of central Korea, covering 6600–4600 cal yr BP. Two organic layers with high TOC%, negatively depleted δ13CTOC values (− 27 to − 29‰), low MS values, and low Si intensities were found at 6200–5900 and 5200–4800 cal yr BP, respectively. These middle Holocene wet periods corresponded to relatively intensified summer monsoon and solar activity periods. The intervening dry period (5900–5200 cal yr BP) with high MS, high Si, and low TOC% corresponded to an intensified dust-activity interval and stronger winter monsoon. This multi-centennial climatic fluctuation of wet periods (6200–5900 cal yr BP and 5200–4800 cal yr BP) and an intervening dry period (5900–5200 cal yr BP) in central Korea was more synchronous with climate change in the arid inner part of China than with that in South China, suggesting possible strong high-latitude-driven climatic influences (e.g., North Atlantic cooling events) during the middle Holocene.