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Aims: Rifampicin is a key drug for the treatment of tuberculosis (TB). Little is known for the relationship between the rifampicin pharmacokinetics and genetic polymorphisms in the Asian population. We aimed to investigate relationship between genetic polymorphism of SLCO1B1 and rifampicin exposure and its impact on clinical outcomes in Korean patients with active pulmonary TB.Methods: From February 2016 to December 2019, patients with active pulmonary TB who were taking rifampicin for >1 week were prospectively enrolled. Serial or 1-time blood sampling was conducted to determine rifampicin concentrations. The genotype of 4 single nucleotide polymorphisms of SLCO1B1 was determined. To estimate the drug clearance and exposure, population pharmacokinetics analysis was conducted. Clinical outcomes such as time to acid-fast bacteria culture conversion, chest radiograph score changes from baseline, and all-cause mortality were also evaluated. The exposure among different SLCO1B1 genotype was compared and relationship between drug exposure and clinical outcomes were explored.Results: A total of 105 patients (70 males and 35 females) were included in the final analysis. The mean age of patients was 55.4 years. The mean drug clearance and exposure were 13.6 L/h and 57.9 mg h/L, respectively. The genetic polymorphisms of SLCO1B1 were not related to rifampicin clearance or exposure. As the rifampicin exposure increased, the chest radiographs improved significantly, but the duration of acid-fast bacteria culture conversion was not related to the drug exposure.Conclusion: SLCO1B1 gene polymorphisms did not influence rifampicin concentrations and clinical outcomes in Korean patients with active pulmonary TB.

BackgroundAlthough viruses are known to be the second most common etiological factor in community-acquired pneumonia (CAP), the respiratory viral profile of the patients with healthcare-associated pneumonia (HCAP) has not yet been elucidated. We investigated the prevalence and the clinical impact of respiratory virus infection in adult patients with HCAP.MethodsPatients admitted with HCAP or CAP, between January and December 2016, to a tertiary referral hospital in Korea, were prospectively enrolled, and virus identification was performed using reverse-transcription polymerase chain reaction (RT-PCR).ResultsAmong 452 enrolled patients (224 with HCAP, 228 with CAP), samples for respiratory viruses were collected from sputum or endotracheal aspirate in 430 (95.1%) patients and from nasopharyngeal specimens in 22 (4.9%) patients. Eighty-seven (19.2%) patients had a viral infection, and the proportion of those with viral infection was significantly lower in the HCAP than in the CAP group (13.8% vs 24.6%, p = 0.004). In both the HCAP and CAP groups, influenza A was the most common respiratory virus, followed by entero-rhinovirus. The seasonal distributions of respiratory viruses were also similar in both groups. In the HCAP group, the viral infection resulted in a similar length of hospital stay and in-hospital mortality as viral–bacterial coinfection and bacterial infection, and the CAP group showed similar results.ConclusionsThe prevalence of viral infection in patients with HCAP was lower than that in patients with CAP, and resulted in a similar prognosis as viral–bacterial coinfection or bacterial infection.

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BACKGROUND Caregivers of patients who wear conventional diapers are required to check voiding every hour because prolonged wearing of wet diaper causes health problems including diaper dermatitis and urinary tract infection. However, frequent checking is labor-intensive and disturbs patients’ or caregivers’ sleep. Furthermore, assessing urine output of the patients with diapers in an acute care setting is difficult. Recently, a smart diaper system with wetness-detection technologies has been developed to solve these issues. OBJECTIVE We aimed to evaluate the applicability of the smart diaper system for urinary detection, its accuracy for measuring voiding volume, and incontinence-associated dermatitis (IAD) occurrence in an acute care hospital. METHODS This prospective, observational, single-arm pilot study was conducted at a single tertiary hospital. We recruited 35 participants aged ≥50 years who were wearing diapers due to incontinence between August and November 2020. When the smart diaper was wet, the smart diaper system notified the caregiver to change the diaper and measured voiding volume automatically. Caregivers were instructed to record the weight of wet diapers on the frequency-volume charts (FVCs). We determined the voiding detection rate of the smart diaper system and compared the automatically calculated urine volume by the smart diaper system with the recorded volume on FVCs. Agreement between the two measurements was estimated using the Bland-Altman plot. We also checked the occurrence or aggravation of IAD and bed sores. RESULTS A total of 30 participants completed the protocol. Three hundred and ninety episodes of urination were recorded. There were 108 records (27.7%) on the FVCs and the smart diaper system concurrently, 258 (66.2%) on the FVCs alone, 18 (4.6%) on the smart diaper system alone, and six (1.5%) on the FVCs with sensing device lost. The detection rate of the smart diaper system was 32.8% (126/384). In analysis of records concurrently listed in both the FVCs and the smart diaper system, linear regression showed a strong correlation between the two measurements (R2=0.88, P<.001). The Bland-Altman assessment showed good agreement between the two measurements with a mean difference of –4.2 ml and 95% limits of agreement between –96.7 and 88.3 ml. New occurrence or aggravation of IAD and bed sores was not observed. Bed sore was improved in one participant. CONCLUSIONS The smart diaper system showed acceptable accuracy for measuring urine volume, and it could replace the conventional FVCs in acute setting hospitals. Furthermore, the smart diaper system showed its potential advantage to prevent IAD development and bed sore worsening. However, the detection rate of the smart diaper system was below than the researchers’ expectation. Detection rate polarization among participants was observed, and improvements in user interface and convenience are needed for aged individuals who are unfamiliar to the smart diaper system.