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그람양성균으로 인한 감염 척추염에서 Linezolid의 효과와 안전성
정종탁 ( Jongtak Jung ),이은영 ( Eunyoung Lee ),송경호 ( Kyoung-ho Song ),최평균 ( Pyoeng Gyun Choe ),박완범 ( Wan Beom Park ),방지환 ( Ji Hwan Bang ),김의석 ( Eu Suk Kim ),김홍빈 ( Hong Bin Kim ),박상원 ( Sang Won Park ),김남중 ( 대한내과학회 2018 대한내과학회지 Vol.93 No.5
목적: 감염 척추염은 장기간의 항생제 치료를 필요로 하며, 이 기간 동안의 정주 항생제의 사용은 입원으로 인한 사회적 손실과 비용을 유발한다. Linezolid는 경구 생체 이용률이 100%이며 신기능과 간기능에 따라 linezolid의 약동학이 영향받지 않는 장점이 있다. Beta-lactam 항생제에 내성을 보이는 그람양성균에 의한 감염 척추염에서 linezolid의 임상적, 미생물학적 치료 효과를 분석하였다. 방법: 2006년부터 2016년까지 서울대병원, 분당서울대병원, 보라매병원에서 감염 척추염으로 진단된 환자 중 linezolid가 4주 이상 투약된 사례에서 임상정보를 후향적으로 수집하여 분석하였다. 결과: Linezolid가 4주 이상 투약된 환자는 총 20명이었다. 가장 흔한 원인균은 methicillin-resistant Staphylococcus aureus 였으며(n = 15), 다음으로 methicillin-resistant coagulase-negative Staphylococcus가 많았다(n = 3). 20명의 환자 중 14명을 성공적으로 치료하였고 4명에서는 치료에 실패하였다. 2명의 환자는 감염 척추염이 아닌 다른 원인으로 사망하였다. Vancomycin 치료 실패 환자 13명 중 10명에서 linezolid로 치료에 성공하였다. 지속적인 균혈증을 보인 10명의 환자 중 8명에서 linezolid 투약 이후 균음전이 확인되었다. Linezolid 사용 기간의 중앙값은 40.5일(28-90)이었다. 약물 이상 반응 평가에서 항생제 중단을 고려할 만한 심한 혈구감소증은 호중구감소증 11.11%, 빈혈 12.96%, 혈소판감소증이 20.37%였다. 결론: Linezolid는 감염 척추염에서 치료제로 효과적으로 사용할 수 있으며 특히 1차 치료제의 치료 실패가 예상되는 경우 구제 치료로 사용할 경우 높은 치료 성공률을 기대할 수 있다. Background/Aims: Infectious spondylitis requires long-term antibiotic treatment; however, the use of intravenous antibiotics during this period has high social and monetary costs due to hospitalization. Linezolid has high oral bioavailability and is not affected by changes in renal or hepatic function. We investigated the clinical and microbiological effects of linezolid in infectious spondylitis caused by beta-lactam resistant gram-positive bacteria. Methods: Clinical data from patients who were treated with linezolid for at least four weeks were collected retrospectively from electronic medical records at the Seoul National University Hospital, Seoul National University Bundang Hospital, and Boramae Medical Center from 2006 to 2016. Results: Twenty Korean patients were treated with linezolid for at least four weeks during the study period. Of these, 14 patients were cured, four failed, and two cases of mortality occurred due to other causes than infectious spondylitis. Ten of 13 patients who had previously been assessed as vancomycin treatment failure were cured by linezolid. Bacteremia occurred in 14 patients, and 10 of these showed persistent bacteremia at the time of linezolid administration. Eight of these cases of persistent bacteremia were cured by linezolid. Median duration of linezolid treatment was 40.5 days (28-90 days). Severe cytopenia (grade II or more of National Cancer Institute criteria) was the most common adverse event, with incidences of 11.11% for neutropenia, 12.96% for anemia, and 20.37% for thrombocytopenia. Conclusions: Linezolid can be used as an effective antibiotic agent in patients with infectious spondylitis, especially when treatment failure of the first-line treatment is expected. (Korean J Med 2018;93:464-472)
Psychological Consequences of Survivors of COVID-19 Pneumonia 1 Month after Discharge
박혜윤,정종탁,박혜연,이소희,김의석,김홍빈,송경호 대한의학회 2020 Journal of Korean medical science Vol.35 No.47
As the coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, there are growing concerns about patients' mental health. We investigated psychological problems in COVID-19 patients assessed with self-reported questionnaires including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Impact of Event Scale- Revised Korean version. Ten patients who recovered from COVID-19 pneumonia without complications underwent self-reported questionnaires about 1 month after discharge. Of them, 10% reported depression and posttraumatic stress disorder (PTSD) while 50% had depression during the treatment. Perceived stigma and history of psychiatric treatment affected PTSD symptom severity, consistent with previous emerging infectious diseases. Survivors also reported that they were concerned about infecting others and being discriminated and that they chose to avoid others after discharge. Further support and strategy to minimize their psychosocial difficulties after discharge should be considered.
만성 폐쇄성 폐질환으로 저용량 스테로이드 유지 중인 환자에게 발생한 Nocardia abscessus에 의한 다발성 근육 농양 1예
김정아,동현주,이은정,정종탁,백예지,김태형,최태윤 대한내과학회 2024 대한내과학회지 Vol.99 No.1
Nocardiosis is uncommon. Immunocompromising conditions predispose individuals to pulmonary and disseminated nocardiosis of the brain, skin, and subcutaneous tissues. The most common pathogens are Nocardia cyriacigeorgica, Nocardia nova, and Nocardia farcinica. The speciation of Nocardia to determine antimicrobial susceptibility is difficult using traditional biochemical methods. Here, we report the case of a 73-year-old man with chronic obstructive lung disease who developed a rapidly progressing intramuscular abscess around the left hip and thigh. Within 3 days, the lesions progressed to an epidural abscess at the L4 to S1 level. Although he was treated with broad-spectrum antibiotics and extensive incision and drainage, he died of rapidly progressive respiratory failure. Nocardia abscessus (N. abscessus) was identified in pus samples using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). This case shows that the diagnosis of an intramuscular abscess caused by N. abscessus is challenging and that using MALDI-TOF MS may facilitate the diagnosis and ensure appropriate treatment.
공현진,허은정,김형숙,정영미,이정화,Eunkyung Euni Lee,이주연,정종탁,송경호,김의석,김홍빈 한국병원약사회 2022 병원약사회지 Vol.39 No.4
Background : An antibiotic prescription system is introduced at Seoul National University Bundang Hospital to encourage appropriate antibiotic use. The system suggests a list of recommended antibiotics according to the tailored purpose of a prescription, such as empirical therapy, specific pathogen target, and surgical prophylaxis. The aim of this study is to describe the prescriber compliance and awareness regarding the system at a tertiary care hospital in Korea. Methods : We compared the purpose of a prescription chosen in the antibiotic prescription system with the actual infectious diseases confirmed via electronic health records (EHRs) to determine the prescriber’s compliance with the system. To investigate the perception, usability, and improvements of the antibiotic prescription system, we also conducted a survey of its users. Results : Regarding compliance, 52 out of 120 cases (43.3%) reviewed showed that the purpose of a prescription chosen in the system were consistent with those of the EHRs. Our survey of user awareness of the system garnered a 19.7% response rate (59 out of 300). About 45.8% of the respondents agreed with the necessity for such a system, while 28.8% disagreed and 88.2% noted that the system was inconvenient. 69.4% answered under 60% of purpose match rate and 77.9% answered under 60% of prescription rate within recommended lists. The most response to improvements was error or lack of information provided by the system. Conclusion : This study revealed a low match rate between the purpose of a prescription chosen in the antibiotic prescription system and those confirmed through EHRs. Periodic feedback on the use of the system and training on its use and purpose are hence necessary to increase user compliance with the system and encourage appropriate antibiotic usage.