다제내성 그람양성균에 대한 Linezolid(Zyvox^(�))의 시험관내 항균력 비교

박대원,정희진,엄중식,황병연,김성범,이재갑,이연주,정혜원,정성주,박재형,이진수,손장욱,김우주,김민자,박승철 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

배경 : MRSA, VRE, VRSA같은 다제 내성 그람 양성균의 등장에 따라 glycopeptide를 대체할 새로운 항생제의 개발이 필요하게 되었고 결과적으로 새로운 항생제인 linezolid라는 항생제가 개발되었다. Linezolid는 이전의 항생제와는 다른 새로운 계열의 oxazolidinone으로 경구 이용률이 우수하다. 원내 및 원외감염의 중요한 원인균이 되고 있는 MRSA, VRE에 대한 적절한 경구용 항균제가 없는 국내에서 폐렴 및 피부 연조직 감염에서 경구용으로 사용해 볼 수 있는 약제이다. 본 연구에서는 고대 구로 병원에서 분리된 MRSA, VRE 등을 대상으로 다른 여러 항균제와 비교한 linezolid의 시험관내 항균력을 조사하고자 하였다. 재료 및 방법 : 연구대상은 1998년 1월부터 2000년 12월까지 본원에서 입원 및 외래를 통하여 피부 연조직 감염증 및 호흡기 감염증, 요로감염증으로 진단된 환자들의 가검물로부터 분리된 MRSA 60균주, VRE 43균주, PRSP 25균주를 액체배지 또는 한천배지 희석법을 통하여 linezolid 및 기타 항균제에 대한 최소발육억제농도를 구하였다. 결과 : 실험에 사용한 S. aureus는 모두 MRSA였고 이들은 linezolid에 대해 MIC_(90) 2㎍/㎖(MIC 범위 1-2㎍/㎖), Enterococcus spp는 모두 VRE로 linezolid의 MIC_(90)은 2㎍/㎖로 MIC 범위는 1-4㎍/㎖였다. 한 개의 균주에서 MIC 4㎍/㎖로 중등도 감수성을 보였으나 MIC breakpoint가 (8㎍/㎖인 내성균주는 없고 모두 감수성을 보였다. S. pneumoniae의 경우 penicillin 내성이었고, linezolid MIC_(90) 1㎍/㎖ (MIC 범위 0.5-1㎍/㎖)로 전부 감수성을 보였다. 결론 : Linezolid는 MRSA를 위시한 VRE, PRSP 등의 다제 내성 그람 양성균에 대하여 우수한 시험관내 항균력을 보임을 알 수 있었다. Background : The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. Material and Methods : By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. Results : All of S. aureus used in this study were MRSA, and MIG_(90) of linezolid was below 2 ㎍/㎖ (MIC ranged between 1-2 ㎍/㎖). All of Enterococcus spp. were VRE, and had MIG_(90) of 2 ㎍/㎖ (MIC ranged between 1 to 4 ㎍/㎖). One of the VRE showed intermediate susceptibility with MIC of 4 ㎍/㎖. However, none was resistant with MIC breakpoint above 8 ㎍/㎖. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MICao of 1 ㎍/㎖(MIC range 0.5-1㎍/㎖). Conclusion : In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.

서울 강서지역 1개 대학병원에서 성인 급성 신우신염의 원인균과 항생제 감수성

황병연,이재갑,박대원,이연주,김성범,엄중식,손장욱,정희진,김우주,김민자,박승철 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

목적 : 3년간 서울시 강서지역의 1개 대학병원에서 입원치료를 받은 성인 급성 신우신염 환자를 대상으로 원인균과 항생제 감수성을 조사하고, 향후 급성 신우신염의 초기 경험적 치료 항생제를 제안하고자 하였다. 방법 : 1999년 1월부터 2001년 12월까지 3년간 고려대학교 의과대학 구로병원에 상부요로감염으로 내원한 16세 이상 환자 229명의 의무 기록을 검토를 통하여, 인구학적 특성, 원인균, 항생제 감수성, 초기 항생제 사용 양상과 입원기간을 조사하였다. 결과 : 연구에 포함된 229명을 118명의 단순 신우신염군과 111명의 복잡 신우신염군으로 구분 하였다. 단수 신우신염의 평균 발생 연령은 38.2세와 복잡 신우신염 56.1세로 복잡 신우신염 환자의 연령이 유의하게 높았다(P<0.001). 양군 모두에서 원인균 중 E. coli의 분리율이 가장 높았으며 항생제 감수성 결과 ampicillin, trimethoprim-sulfame-thoxazole에는 높은 내성률을 보였고, ciprofloxacin, gentamicin, cefotaxime에 대한 감수성은 비교적 높았으나 복잡 신우신염의 경우 단순 신우신염에 비하여 ciprofloxacin, gentamicin에 대한 감수성이 다소 낮은 것을 확인할 수 있었다. 평균 입원 기간, 항생제 투여 기간에 있어서도 복잡 신우신염군에서 유의하게 길었다. 결과 : 본 연구의 결과 서울의 강서 지역에서 대학병원급에 치료 의뢰되는 단순 급성 신우신염의 치료에 있어 1차 항생제로 3세대 cephalosporin, aminoglycoside, quinolone 중 한가지를 초기 경험적 치료제로 사용을 고려하여야 할 것으로 사료된다. Background : The purpose of this study is to recommend the initial therapeutic regimen for adult patients with acute pyelonephritis (APN) according to the changes of antimicrobial susceptibility patterns of causative microorganisms isolated from patients with APN. Methods : We reviewed medical charts of 229 APN patients, who had been treated at Korea University Guro Hospital from 1st of January. 1999 to 31st of December, 2001. We investigated the demographic data, clinical findings, durations of hospital treatment, antimicrobial susceptibility patterns of the causative microorganisms and initial antibiotic regimens in patients with APN. Results : In this study, 229 adult patients with APN were classified into simple APN patients (118 patients, 51.5%) and complicated APN patients (111 patients, 48.4%). Mean age of patients with simple APN was 38.2±14.1 years old and that of patients with complicated APN was 56.1±14.9 years old. Mean age of patients with complicated APN was significantly higher than that of simple APN patients (P<0.0001). Escherichia coli was the most common microorganism both in simple APN (96.7%) group and in complicated APN (90.6%) group. Antimicrobial susceptibility of E. coli was at the low level of ampicillin (31%/20%) and trimethoprim-sulfamethoxazole (42.6%/34.2%) in each group. In contrast, ciprofloxacin (11.5%/22.7%), gentamicin (16.4%/22%) and cefotaxime (0%/8.2%) resistance remained at relatively lower level. In comparison of simple APN with complicated APN, ciprofloxacin and gentamicin resistances were higher in complicted APN group. Average duration of hospitalization (5.9±2.3 days/8.2±4.6 days) and duration of antibiotic use (12.1±3.9 days/15.3±10.0 days) were significantly longer in complicated APN. Conclusions: The results of this study suggests that 3rd cephalosporin, aminoglycoside or quinolone antibiotic would considered as one of the initial therapeutic regimen for patients with simple APN in southwestern Seoul.

Right Atrial Maass Associated with Hepatoma -2 Case Reports

Jang Won Sohn,Young Moo Yoon,Min Ho Lee,Joon Soo Hahm,Choon Shuk Kee,Bang Hun Lee,Kyung Nam Park 대한내과학회 1994 The Korean Journal of Internal Medicine Vol.9 No.2

Acute Eosinophilic Pneumonia

Jang Won Sohn 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.2

Acute eosinophilic pneumonia is a severe and rapidly progressive lung disease that can cause fatal respiratory failure. Since this disease exhibits totally different clinical features to other eosinophilic lung diseases (ELD), it is not difficult to distinguish it among other ELDs. However, this can be similar to other diseases causing acute respiratory distress syndrome or severe community-acquired pneumonia, so the diagnosis can be delayed. The cause of this disease in the majority of patients is unknown, even though some cases may be caused by smoke, other patients inhaled dust or drugs. The diagnosis is established by bronchoalveolar lavage. Treatment with corticosteroids shows a rapid and dramatic positive response without recurrence.

Furongian trilobites from the Asioptychaspis and Quadraticephalus zones of the Hwajeol Formation, Taebaeksan Basin, Korea

Jang Won Sohn,Duck K. Choi 한국지질과학협의회 2007 Geosciences Journal Vol.11 No.4

This paper describes the upper Furongian trilobites from the Hwajeol Formation and, based on these trilobite faunal assemblages, proposes formally two trilobite biozones, the Asioptychaspis and Quadraticephalus zones. A total of 14 species belonging to ten genera are described: i.e., Micragnostus sp., Pseudagnostus planulatus, Koldinioidia sp., Hamashania pulchera, Hamashania sp. cf. H. busiris, Asioptychaspis subglobosa, Changia sp., Quadraticephalus elongatus, ptychaspidid genus and species indeterminate, Lophosaukia orientalis, Lophosaukia? sp., Tsinania canens, Tsinania sp., and Haniwa sosanensis. The Asioptychaspis Zone is characterized by predominance of Asioptychaspis subglobosa, while the succeeding Quadraticephalus Zone is dominated by Quadraticephalus elongatus, Lophosaukia orientalis, Haniwa sosanensis, and Micragnostus sp. The Asioptychaspis and Quadraticephalus zones are well correlated with the Ptychaspis-Tsinania and Changia (or Quadraticephalus) zones of North China, respectively. These two trilobite assemblages of the Hwajeol Formation support a strong paleogeographical link between the Taebaeksan Basin and North China Platform during the late Furongian.

Critical Care Paper Review 2012

Sohn, Jang Won The Korean Academy of Tuberculosis and Respiratory 2012 Tuberculosis and Respiratory Diseases Vol.73 No.1

Care of patients with sepsis has improved over the last decade. However, in the recent two years, there was no significant progress in the development of a new drug for critically ill patients. In January 2011, it was announced that the worldwide phase 3 randomized trial of a novel anti-Toll-like receptor-4 compound, eritoran tetrasodium, had failed to demonstrate an improvement in the mortality of patients with severe sepsis. In October 2011, Xigris (drotrecogin alfa, a recombinant activated protein C) was withdrawn from the market following the failure of its worldwide trial that had attempted to demonstrate improved outcome. These announcements were disappointing. The recent failure of 2 promising drugs to further reduce mortality suggests that new approaches are needed. A study was published showing that sepsis can be associated to a state of immunosuppression and loss of immune function in human. However, the timing, incidence, and nature of the immunosuppression remain poorly characterized, especially in humans. This emphasizes the need for a better understanding of sepsis as well as new therapeutic strategies. Many clinical experiences of the extracorporeal membrane oxygenator (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) patients, which is caused by the H1N1 influenza A virus, were reported. The use of ECMO in severe respiratory failure, particularly in the treatment of adult ARDS, is occurring more commonly.

Review : Critical Care Paper Review 2012

( Jang Won Sohn ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.73 No.1

Care of patients with sepsis has improved over the last decade. However, in the recent two years, there was no significant progress in the development of a new drug for critically ill patients. In January 2011, it was announced that the worldwide phase 3 randomized trial of a novel anti-Toll-like receptor-4 compound, eritoran tetrasodium, had failed to demonstrate an improvement in the mortality of patients with severe sepsis. In October 2011, Xigris (drotrecogin alfa, a recombinant activated protein C) was withdrawn from the market following the failure of its worldwide trial that had attempted to demonstrate improved outcome. These announcements were disappointing. The recent failure of 2 promising drugs to further reduce mortality suggests that new approaches are needed. A study was published showing that sepsis can be associated to a state of immunosuppression and loss of immune function in human. However, the timing, incidence, and nature of the immunosuppression remain poorly characterized, especially in humans. This emphasizes the need for a better understanding of sepsis as well as new therapeutic strategies. Many clinical experiences of the extracorporeal membrane oxygenator (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) patients, which is caused by the H1N1 influenza A virus, were reported. The use of ECMO in severe respiratory failure, particularly in the treatment of adult ARDS, is occurring more commonly.

Acute Eosinophilic Pneumonia

Sohn, Jang Won The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.74 No.2

Acute eosinophilic pneumonia is a severe and rapidly progressive lung disease that can cause fatal respiratory failure. Since this disease exhibits totally different clinical features to other eosinophilic lung diseases (ELD), it is not difficult to distinguish it among other ELDs. However, this can be similar to other diseases causing acute respiratory distress syndrome or severe community-acquired pneumonia, so the diagnosis can be delayed. The cause of this disease in the majority of patients is unknown, even though some cases may be caused by smoke, other patients inhaled dust or drugs. The diagnosis is established by bronchoalveolar lavage. Treatment with corticosteroids shows a rapid and dramatic positive response without recurrence.

Comparison of Auto-PEEP Levels Measured by End-expiratory Port Occlusion Method and Trapped Lung Volume

Jang Won Sohn,Chae Man Lim,Younsuck Koh Korean Society of Critical Care Medicine 2005 Acute and Critical Care Vol.20 No.2

BACKGROUND: There are several METHODS: for auto-PEEP measurement during mechanical ventilation. The end-expiratory port occlusion (EEPO) method is simple and easy. Theoretically, auto- PEEP level can be also calculated by using trapped lung volume and static compliance. However, the relationship between measured auto-PEEP by EEPO method and the calculated auto-PEEP has not been studied. The purpose of this study is to observe the relationship between the measured and the calculated auto-PEEP. METHODS: 15 patients with auto-PEEP during mechanical ventilation were included. Auto-PEEP was measured by EEPO method, and calculated by using a formula; trapped lung volume/static compliance. All of the patients were paralyzed during the study. If the measured auto-PEEP is higher than calculated auto-PEEP, this patient was included in `high group'; in the opposite case, `low group'. We compared respiratory mechanics between these two groups. RESULTS: Measured auto-PEEP was 9.60+/-2.82 cmH2O, and calculated auto-PEEP was 9.78+/-2.90 cmH2O. There was statistically significant relationship between measured and calculated auto-PEEP (r=0.81, p

자가 호기말 양압(auto-PEEP)을 보인 환자에서 원인질환에 따른 PEEP 적용 효과의 차이

손장원 ( Jang Won Sohn ),고윤석 ( Youn Suck Koh ) 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.6