Acute and Critical Care

Original Articles

Pulmonary
Real-world experience using multiplex polymerase chain reaction in intensive care unit patients with hospital-acquired and ventilator-associated pneumonia in South Korea: Eun Chong Yoon, Sang-Ho Choi, Heungsup Sung, Yong Pil Chong, Euijin Chang, Kyung-Hyun Do, Su Yeon Lee, Dong-gon Hyun, Jee Hwan Ahn, Jin Won Huh, Chae-Man Lim, Sang-Bum Hong; Acute Crit Care. 2026;41(1):87-96. Published online February 27, 2026; DOI: https://doi.org/10.4266/acc.005100

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Abstract PDF Supplementary Material: Background
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are common among critically ill patients, leading to increased morbidity and mortality rates. Conventional culture-based diagnostics require 48–72 hours, which delays pathogen identification and prolongs the use of broad-spectrum antibiotics. Multiplex polymerase chain reaction (mPCR) enables the rapid detection of pathogens and resistance genes, but its effects on real-world antibiotic decision-making remain unclear.
Methods
This retrospective study included patients in the intensive care unit who were diagnosed with HAP or VAP at a tertiary medical center between July 2023 and June 2024. All patients underwent both mPCR and respiratory culture. The primary outcome was the time to the first antibiotic modification based on mPCR or respiratory culture. The secondary outcome was the rate of antibiotic de-escalation from carbapenem or teicoplanin/vancomycin based on mPCR findings.
Results
In total, 75 patients were included (median age, 68 years; 61.3% male). mPCR identified bacterial pathogens in 45.3% cases, with a median turnaround time of 281 minutes. The median time to antibiotic modification was 5.8 hours for mPCR versus 122.32 hours for culture (P<0.01). Despite negative mPCR results for gram-negative bacilli, carbapenem therapy was discontinued in only 1 of 24 cases (4.2%). Among 39 patients with negative results for Staphylococcus aureus, vancomycin or teicoplanin was discontinued in only 3 cases (7.7%).
Conclusions
mPCR provided faster pathogen identification and earlier antibiotic modifications than conventional respiratory culture. However, antibiotic discontinuation remained uncommon despite negative mPCR results, highlighting challenges in real-world antimicrobial stewardship.

Infection
Association between emergency department–to–intensive care unit transfer time and mortality in patients with septic shock: a target trial emulation with septic shock in South Korea: Ji Hyun Cha, Danbee Kang, Ryoung-Eun Ko, Won Young Kim, Dong-gon Hyun, Yeon Joo Lee, Woo Hyun Cho, Sunghoon Park, Juhee Cho, Gee Young Suh; Acute Crit Care. 2025;40(4):548-556. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.003575

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Abstract PDF Supplementary Material: Background
Emergency department (ED) overcrowding poses a global challenge, particularly for critically ill patients requiring intensive care unit (ICU) admission. Although delays in ICU transfer increase mortality in critically ill populations, the optimal timing for septic shock remains uncertain.
Methods
We conducted a target trial emulation using a prospective cohort of 815 septic shock patients from 19 Korean hospitals. Delayed ICU transfer was defined using restricted cubic splines. The primary outcome was in-hospital mortality. Multivariable logistic regression and inverse probability treatment weighting were used to adjust for confounders of age, sex, comorbidities, severity of illness, and mechanical ventilation use. Subgroup analyses were performed to assess the effect across patient characteristics.
Results
The median time of ED-to-ICU transfer was 6.7 hours (interquartile range, 4.7–11.4), and only 7% of patients were transferred within 3 hours. ICU transfer within 3 hours was associated with significantly lower in-hospital mortality (odds ratio, 0.48; 95% CI, 0.24–0.94) compared to later transfers. Mortality risk increased with elapsing time up to 6 hours and then plateaued. The benefit of early ICU transfer was consistent across subgroups but was particularly pronounced in patients requiring extracorporeal membrane oxygenation or continuous renal replacement therapy (P for interaction=0.02).
Conclusions
Early ICU transfer within 3 hours significantly reduces mortality in patients with septic shock, with the greatest benefit observed in those requiring advanced organ support. These findings highlight the need for system-wide strategies to reduce ED boarding time and prioritize timely ICU admission for septic shock management.

Rapid response system
Impact of the National Early Warning Score-based sepsis response system on hospital-onset sepsis in a tertiary hospital in South Korea: Dong-gon Hyun, Sohyeon Lee, Sunhui Choi, Jeongsuk Son, So-Hee Park, Sang-Bum Hong, Chae-Man Lim; Acute Crit Care. 2025;40(2):186-196. Published online May 20, 2025; DOI: https://doi.org/10.4266/acc.000625

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3 Crossref

Abstract PDF Supplementary Material

Background
The effectiveness of electronic medical record-based alert systems, response protocols for sepsis diagnosis, and treatment in hospitalized patients remains unclear. This study aimed to determine whether the introduction of an electronic medical record-based sepsis response protocol (SRP) along with a 24/7 operating rapid response system affects the prognosis for patients with hospital-onset sepsis.
Methods
In August 2022, a SRP based on the National Early Warning Score was implemented in the electronic medical record system at Asan Medical Center. We retrospectively analyzed patients screened by the detection system for 1 year after the SRP implementation. Patients of the first 6 months (preliminary group) and those of the second 6 months (SRP group) were matched 1:1 based on propensity scores. The primary outcome was 30-day mortality.
Results
Of the 608 hospitalized patients screened by the system, 176 were assigned to each group after 1:1 propensity score matching. Patients in the SRP group were significantly more likely to receive blood cultures (58.5%) compared with the preliminary group (45.5%) (P=0.019). The SRP group showed a lower 30-day mortality risk (hazard ratio, 0.56; 95% CI, 0.36–0.86; P=0.017) compared to the preliminary group. A restricted cubic spline curve showed that SRP survival benefit began to manifest after the first 4 months (P=0.036).
Conclusions
Alongside an existing rapid response system, the National Early Warning Score-based SRP in the electronic medical record reduced mortality for hospital-onset sepsis within 1 year.

Citations

Citations to this article as recorded by

Sepsis precoz detectada mediante el National Early Warning Score (NEWS) por enfermería
Narcisa de Jesus Marcillo Peralta, Doris Grace Alvario Pillajo, Wilmer Mauricio Arguello Pazmiño , Cecilia Maribel Fiallos Miranda, Elsa Patricia Guerrero Romero
Arandu UTIC.2026; 13(1): 949. CrossRef
Collective agency in the implementation of computerized clinical decision support: an interpretive description study
Manasha Fernando, Sundresan Naicker, Bridget Abell, Steven M. McPhail, Zephanie Tyack
JBI Evidence Implementation.2026;[Epub] CrossRef
Characteristics and management of mechanically ventilated patients in South Korea compared with other high-income Asian countries and regions
Kyung Hun Nam, Kyeongman Jeon, Suk-Kyung Hong, Ah Young Leem, Jee Hwan Ahn, Hang Jea Jang, Ki Sup Byun, So Hee Park, Sojung Park, Yoon Mi Shin, Jisoo Park, Sung Wook Kang, Jin Hyoung Kim, Jinkyeong Park, Deokkyu Kim, Bo young Lee, Woo Hyun Cho, Kwangha Le
Acute and Critical Care.2025; 40(3): 413. CrossRef

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