Clinical progression over time and cytokine profiles have not been well defined in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. We included 17 patients with laboratory-confirmed MERS-CoV during the 2015 outbreak in Korea. Clinical and laboratory parameters were collected prospectively. Serum cytokine and chemokine levels in serial serum samples were measured using enzyme-linked immunosorbent assay. All patients presented with fever. The median time to defervescence was 18 days. Nine patients required oxygen supplementation and classified into severe group. In the severe group, chest infiltrates suddenly began to worsen around day 7 of illness, and dyspnea developed at the end of the first week and became apparent in the second week. Median time from symptom onset to oxygen supplementation was 8 days. The severe group had higher neutrophil counts during week 1 than the mild group (4,500 vs. 2,200/µL, P = 0.026). In the second week of illness, the severe group had higher serum levels of IL-6 (54 vs. 4 pg/mL, P = 0.006) and CXCL-10 (2,642 vs. 382 pg/mL, P < 0.001). IFN-α response was not observed in mild cases. Our data shows that clinical condition may suddenly deteriorate around 7 days of illness and the serum levels of IL-6 and CXCL-10 was significantly elevated in MERS-CoV patients who developed severe diseases.

BackgroundAsymptomatic bacteriuria (ABU) is common and often leads to unnecessary antimicrobial use. Reducing antibiotic overuse for ABU is therefore an important issue for antimicrobial stewardship. We performed this study to investigate the appropriateness of ABU management and to evaluate physicians’ knowledge and practice regarding ABU.MethodsWe reviewed all urine cultures of ≥105 cfu/mL of bacteria among inpatients in a 900-bed hospital in 2011. Each episode of bacteriuria was classified into ABU or urinary tract infection (UTI). ABU was defined as a positive urine culture (≥105 cfu/mL) without symptoms or signs suggesting UTI. In October 2012 a cross-sectional survey of resident physicians was undertaken using an anonymous, self-administered questionnaire.ResultsWe identified 219 ABU cases among 1167 positive urine cultures, of which 70 (32.0 %) were inappropriately treated. Female gender, old age, pyuria, hematuria, and positive nitrite on urinalysis were associated with inappropriate ABU treatment in a multivariate analysis (P < 0.05).The response rate to the survey was 74.2 % (95/128). The mean knowledge score was 37.3 %, and 33.7 % of respondents were able to distinguish ABU from UTI, but less than half knew the indications for treating ABU. Even after ABU was correctly diagnosed, concerns about postoperative infections (38.6 %), UTI (9.1 %), and abnormal urinalysis (29.5 %) prevented proper management. About half of the respondents reported to prescribing antibiotics for ABU despite knowing they were not indicated.ConclusionsAbout one third of ABUs were inappropriately managed. Lack of knowledge and discrepancies between knowledge and practice, contributed to antimicrobial overuse for ABU. Our findings highlight the importance of developing interventions, including education, audit and feedback, to tackle the problem of inappropriate treatment of ABU.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1044-3) contains supplementary material, which is available to authorized users.

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Novel phosphonic acid esters, O,O-di-1-phenylethyl phenylphosphonate (1), O,O-di-tert-butyl phenylphosphonate (2), and O,O-dicyclohexyl phenylphosphonate (3), were synthesized from phenylphosphonic dichloride and the corresponding alcohols. The phenylphosphonic esters 1−3 decomposed into phenylphosphonic acid and the corresponding olefins by heating at 150−170 °C. Their initiator activities were examined in the cationic polymerization of glycidyl phenyl ether (GPE). They converted GPE only 4% even at 190 °C in the absence of ZnCl2. In the presence of ZnCl2 along with 1−3, GPE did not convert below 90 °C in the case of 1 and 2, and below 140 °C in the case of 3, but it rapidly converted to afford polyGPE with M n of 2000−7000 above those temperatures. It was found that 1−3 served as thermally latent initiators in the polymerization of GPE in the presence of ZnCl2.

Routine sterile gloving before venipuncture may reduce blood culture contamination.