7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

Pressurized Drop Tunbe Reactor를 이용한 다양한 석탄 Char의 가스화 반응 특성 연구

윤성민(Sungmin Yoon),문태영(Taeyoung Moon),서명원(Myungwon Seo),문지홍(Jihong Moon),윤상준(Sangjun Yoon),라호원(Howon Ra) 한국신재생에너지학회 2017 한국신재생에너지학회 학술대회논문집 Vol.2017 No.5

공동주택에 있어서 급수 배관 방식의 현황 및 설계 방안

문성민(Sungmin Moon),이시환(Sihwan Lee),김용경(Yongkyung Kim) 대한설비공학회 2017 대한설비공학회 학술발표대회논문집 Vol.2017 No.11

Wavelength Interrogation System for Quasi-Distributed Fiber Bragg Grating Temperature Sensors Based on a 50-GHz Array Waveguide Grating

Moon, Hyung-Myung,Kwak, Seung-Chan,Im, Kiegon,Kim, Jin-Bong,Kim, Sungmin IEEE 2019 IEEE SENSORS JOURNAL Vol.19 No.7

<P>We present a fiber Bragg grating (FBG) interrogation system equipped with a 50-GHz, 96-channel array waveguide grating (AWG), which was developed for temperature measurement. We have studied the linearity of the FBG-AWG system, in which the Bragg wavelength of one FBG was shifted over several AWG channels. We investigated the dependence of the linearity both on the FBG bandwidth and on the spectrum restoring algorithm. Packaging of FBG using epoxy-resin was tested in the range of −25 °C ~ 85 °C in order to increase the temperature sensitivity. A standard deviation error of 7 pm or 0.2 °C was obtained for 0.3 nm bandwidth epoxy-packaged FBG.</P>

달리기 시 인솔의 굽힘 강성 증가에 따른 발목과 중족골 관절의 운동학적 변인 및 관절 협응에 미치는 영향

( Sungmin Kim ),( Jeheon Moon ) 한국운동역학회 2021 한국운동역학회지 Vol.31 No.3

Objective: The aim of this study was to analyze body stability Joint coordination pattern though as bending stiffness of shoes during stance phase of running. Method: 47 male subjects (Age: 26.33 ± 2.11 years, Height: 177.32 ± 4.31 cm, Weight: 65.8 ± 3.87 kg) participated in this study. All subjects tested wearing the same type of running shoes by classifying bending stiffness (A shoes: 3.2~4.1 N, B shoes: 9.25~10.53 N, C shoes: 20.22~21.59 N). They ran 10 m at 3.3 m/s (SD ±3%) speed, and the speed was monitored by installing a speedometer at 3 m intervals between force plate, and the measured data were analyzed five times. During running, ankle joint, MTP joint, coupling angle, inclination angle (anterior-posterior, medial-lateral) was collected and analyzed. Vector coding methods were used to calculate vector angle of 2 joint couples during running: MTP-Ankle joint frontal plane. All analyses were performed with SPSS 21.0 and for repeated measured ANOVA and Post-hoc was Bonferroni. Results: Results indicated that there was an interaction between three shoes and phases for MTP (Metatarsalphalangeal) joint angle (p = .045), the phases in the three shoes showed difference with heel strike~ impact peak (p1) (p = .000), impact peak~active peak (p2) (p = .002), from active peak to half the distance to take-off until take-off (p4) (p = .032) except for active peak~from active peak to half the distance to take-off (p3) (p = .155). ML IA (medial-lateral inclination angle) for C shoes was increased than other shoes. The coupling angle of ankle angle and MTP joint showed that there was significantly difference of p2 (p = .005), p4 (p = .045), and the characteristics of C shoes were that single-joint pattern (ankle-phase, MTP-phase) was shown in each phase. Conclusion: In conclusion, by wearing high bending stiffness shoes, their body instability was increased during running.

드롭랜딩 시 국소부위 온열처치와 동적 준비운동이 하지의 운동역학적 변인에 미치는 영향

( Sungmin Kim ),( Jooho Song ),( Sanghyuk Han ),( Jeheon Moon ) 한국운동역학회 2021 한국운동역학회지 Vol.31 No.4

Objective: The aim of this study was to analyze kinetic variables between thermotherapy and dynamic warm-up during drop-landing. Method: Twenty male healthy subjects (Age: 21.85 ± 1.90 years, Height: 1.81 ± 0.06 cm, Weight: 68.5 ± 7.06 kg) underwent three treatments applied on the thermotherapy of femoral muscles and a dynamic warm-up. The thermotherapy was performed for 15 minutes while sitting in a chair using an electric heating pad equipped with a temperature control device. Dynamic warm-up performed 14 exercise, a non-treatment was sitting in a chair for 15 minutes. Core temperature measurements of all subjects were performed before landing at a height of 50 cm. During drop-landing, core temperature, joint angle, moment, work of the sagittal plane was collected and analyzed. All analyses were performed with SPSS 21.0 and for repeated measured ANOVA and Post-hoc was Bonferroni. Results: Results indicated that Thermotherapy was increased temperature than other treatments (p = .000). During drop-landing, hip joint of dynamic warm-up was slower for angular velocity (p < .005), and left ankle joint was fastest than other treatments (p = .004). Maximum joint moment of dynamic warm-up was smaller for three joints (hip extension: p = .000; knee flexion/extension: p = .001/.000; ankle plantarflexion: p = .000). Negative work of dynamic warm-up was smaller than other treatments (p = .000). Conclusion: In conclusion, the thermotherapy in the local area doesn't affect the eccentric contraction of the thigh. The dynamic warm-up treatment minimized the joint moment and negative work of the lower joint during an eccentric contraction, it was confirmed that more active movement was performed than other treatment methods.

Experimental Verification of Overlimiting Current by Surface Conduction and Electro-Osmotic Flow in Microchannels

Nam, Sungmin,Cho, Inhee,Heo, Joonseong,Lim, Geunbae,Bazant, Martin Z.,Moon, Dustin Jaesuk,Sung, Gun Yong,Kim, Sung Jae American Physical Society 2015 Physical Review Letters Vol.114 No.11

플라스틱 라이너를 가진 복합재 용기 돔형상에 따른 파열현상 연구

조성민(Sungmin Cho),이선규(Sunkyu Lee),문종삼(Jongsam Moon),이승국(Seungkuk Lee) 한국가스학회 2017 한국가스학회 학술대회논문집 Vol.2017 No.5

Rear Surface Passivation of Silicon Solar Cell with AlON Layer by Reactive Magnetron Sputtering

Sunwoo Moon,Eunkyeom Kim,Won-Woong Park,Kyunghoon Kim,Sungmin Kim,Donghwan Kim,Seung-Hee Han 한국진공학회 2012 한국진공학회 학술발표회초록집 Vol.2012 No.8

내부식성 경량 공기호흡기용 복합재 용기 개발 연구

조성민(Sungmin Cho),이선규(Sunkyu Lee),문종삼(Jongsam Moon),이승국(Seungkuk Lee) 한국가스학회 2018 한국가스학회 학술대회논문집 Vol.2018 No.5