아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

수평관내 3성분 혼합냉매의 핵비등 및 강제대류증발 열전달

오종택 麗水大學校 産業基術硏究所 1999 産業基術硏究所 論文集 Vol.8 No.-

The forced convective boiling heat transfer coefficients of R-407C were measured inside a horizontal tube 6.0 mm I.D. and 4.0 m long. Because of the nucleation was completely suppressed in the two-phase flow region with high quality heat transfer coefficient in forced convective evaporation was higher than it in nucleate boiling. The average heat transfer coefficients were about 30 percent lower than the pure refrigerant correlation due to the mass transfer resistance near the gas-liquid interface. The total experimental data shows agreement with the predicted heat transfer coefficients for ternary refrigerant mixtures within mean deviation of 30%.

3성분 혼합냉매의 강제대류비등 열전달 저하 예측

오종택 麗水水産大學校産業技術硏究所 1998 産業基術硏究所 論文集 Vol.7 No.-

A new theoretical model for predicting the forced convective boiling heat transfer coefficients of ternary mixtures is presented. The effect of mass diffusion near the gas-liquid interface is considered in both nucleate boiling and forced convective vaporization contributions. The predicted heat transfer coefficients are compared experimental data, which are obtained for a HFc32/125/134a(23/25/52wt%) mixture inside a horizontal tube 6.0mm ID and 4.0m long. The predictive method shows agreement with the experimental data within an accuracy of ±30%.

대칭형 보에 의해 보강된 등방성 평판의 음향방사에 관한 연구

김택현,오택열,김종태 한국공작기계학회 1998 한국생산제조학회지 Vol.7 No.1

The determination of sound pressure radiated from peoriodic plate structures is fundamental in the estimation of noise levels in aircraft fuselages and ship hull structures. As a robust approach to this problem, here a very general and comprehensive analytical model for predicting the sound radiated by a vibrating plate stiffened by periodically spaced orthogonal symmetric beams subjected to a sinusoidally time varying point load is developed. The plate is assumed to be infinite in extent, and the beams are considered to exert both line force and moment reactions on it. Structural damping is included in both plate and beam materials. A space harmonic series representation of the spatial variables is used in conjunction with the Fourier transform to find the sound pressure in terms of harmonic coefficients. From this theoretical model, The sound pressure levels on axis in a semi-infinite fluid (water) bounded by the plate with the variation in the loactions of an external time harmonic point force on the plate can be calculated efficiently using three numerical tools such as the Gauss-Jordan method, the LU decomposition method and the IMSL numerical package.

중안면부 골절이 하악 과두 골절에 미치는 영향에 관한 임상적 연구

민승기,이동근,오승환,이은택,조이수,김종구 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

This is clinico-statistical & retrospective study of 30 patients with only unilateral mandibular condyle fracture and combined with 24 midface fracture patients who were treated with open reduction in Wonkwang University Dental Hospital during the period 1993 to 2000. The results were as follows : 1. In mandibular condyle fracture combined with midface fracture, the most incident type is associated with zygomaticomaxillary complex fracture and level Ⅳ of mandibular condyle fracture combined with ZMC fracture is the most related(33.32%). 2. In the period of intermaxillary fixation, unilateral mandibular condyle fracture group (9.8 days) is shorter than combined with midface fracture group (15.3 days), but no statistical difference between two groups(p.>0.05). 3. In the mouth opening recovery, unilateral mandibular condyle fracture group is faster than combined with midface fracture group in post-operative 1 month, but no significant difference between two-groups after 3 months postoperatively (p>0.05). 4. In two-groups, treatment method is almost open reduction with internal fixation(ORIF) and overall 25% temporary complications were shown, but little lower incidence in unilateral condylar fracture group.

안와골절의 외과적 접근에 대한 증례보고

민승기,이은택,오승환,이동근,고세욱,송종민,최성림 대한악안면성형재건외과학회 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.3

The Orbital fracture which is often combined with midface fracture can cause decreased visual acuity, limitation of eyeball movement, diplopia, enophthalmos, etc. Traumatic orbital fracture causes change of orbital volume, results in diplopia and enophthalmos thus, accurate repositioning of displaced bone and reconstruction of orbital defect with autogenous materials(cranial, rib, iliac bone, cartilage and fascia lata) or alloplastic materials(gelatin film, polyglactin mesh, methylmethacrylate, Teflon, silicone, Supermid, hydroxyapatite and metal). The key point of reconstruction of orbit is accurate repositioning of displaced orbital floor, lateral, medial orbital wall and sufficient bonegraft in anatomical defect. As this cases, we obtained good results through transconjunctival and coronal approach who were required orbital reconstruction. Also, we accurately diagnosed orbital fracture with C.T., 3D model and good result for orbital reconstruction with sufficient parietal block bone graft during average 16.8 months follow-up.

뇌실외 배액술 시행과 관련된 뇌실염 : 원인균주와 경험적 치료약제의 적절성

도병훈,김신우,오종택,손종원,하상우,이응갑,장현하,이종명,김능수 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 본 연구는 뇌실외 배액술을 시행한 신경외과 환자들에서 뇌실염 발생 빈도, 원인균주와 감수성 추이 및 경험적 치료로 사용되는 항생제인 ceftazidime과 vancomycin의 적절성 여부에 대하여 조사하였다. 재료 및 방법 : 2000년 12월부터 2003년 10월까지 EVD를 시행한 경북대학교병원 신경외과 입원환자 340명 중 뇌실염이 발생한 39명을 대상으로 후향적으로 조사하였다. 결과 : 340명 중 39예 (11.5%)에서 뇌실염이 발생하였고 이들 가운데 4명이 뇌실염과 연관하여 사망하였다(10.3%). EVD 시행일로부터 뇌실염 발생까지는 평균 8.4일이었다. 원인균은 33예(87.1%)에서 확인되었으며 Aci-netobacter (19예, 45%), methicillin-resistant coagulase negative Staphylococcus (9예, 22%), methicillin-resistant Staphylococcus aureus (9예, 22%) 등의 순이었다. 가장 많이 동정된 Acinetobacter 19예 중에서 8예(42.1%)가 ceftriaxone에 내성을 보였으며 현재 경험적으로 널리 사용되는 ceftazidime에 대해서는 11예중 3예(27%)가 내성을 보였다. 결론 : 최근 EVD 시행과 관련된 뇌실염 뇌실염 최근 그람음성 non-fermenter 특히 Acinetobacter에 의한 경우가 증가하고 있으며, 이들 그람음성 non-fermenter는 현재까지 경험적으로 사용되는 ceftazidime에 점차 내성을 보이고 있다. 경험적 치료제에 대한 성공률을 높이기 위해서는 각 병원별 내실염의 원인균주의 감수성에 대한 검사가 필요하겠다. Purpose : To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. Materials and Methods : Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. Results : Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows : Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. Conclusion : These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

발포폴리스티렌비드를 사용한 경량콘크리트의 역학적 특성에 관한 실험적 연구

주재금,이종찬,오세출,유택동,정광량,서치호 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.1(구조계)

The purpose of this study is to obtain basic data on the properties of the lightweight concrete within expanded polystyrene beads for various applications in the field. Inquiring into the change of the properties as altering cement matrix mixture and the capacity mixture ratio of expanded polystyrene beads, the mixture plane of this study is set up as W/C is fixed 50%, expanded polystyrene beads is increased 10% from 0% to 80% per 1m³ and the ratio of cement:sand in the cement matrix is 1:0, 1:0.5, 1:1. The results of this study are as follow. The slump as changing the mixture ratio of expanded polystyrene beads decrease smoothly until mixture ratio 50% but decrease rapidly being in excess of 50%. The density decrease regularly as the mixture ratio of expanded polystyrene beads increase but the ratio of strength decrease. The difference of cement matrix. The strength of cement matrix having more sand mixture ratio relatively decrease rapidly as increasing the mixture ratio of expanded polystyrene beads. It is judged decreased strength phenomenon as the quantity of coherent material created in the mixture decrease rapidly.

모래 지반의 지지력증가를 위한 보강토공법의 효과

주인곤,임종철,이민희,오재택 釜山大學校生産技術硏究所 1997 生産技術硏究所論文集 Vol.53 No.-

보강토공법의 기본적원리는 이해하기에 단순하고 수세기동안 사람들이 사용해 왔었다. 보강토공법이 토목공학분야에서 실용적인 면에서 기여하고 있는 기본적인 이유는 공사비의 감소와 시공이 용이하고, 기술자에게 매력을 줄 만큼 단순한 데 있다. 보강토 공법에 대한 인식과 관심이 더욱 커진 것은 기술과 상업적인 성공이 기술자들에 의해서 증명되어졌기 때문이다. 본 연구는 성토지반에 구조물을 설치하기 위하여 지반을 보강재로 보강할 때의 지지력에 관한 것으로, 보강재의 최적의 수평길이와 수직간격을 구해 실제 설계에 적용하도록 하는 데 중요한 목적이 있다. The basic principles involved in reinforced soil are simple to grasp and have been used by man for centuries. The basic attributes of soil reinforcement which are of particular advantage in civil engineering are reductions in costs and ease of construction, coupled with a basic simplicity which provides an attraction to engineers. Recognition of, and interest in the subject have gained impetus because of the technical and commercial success that has been demonstrated by the practitioners. This study was about bearing capacity as reinforced reinforcement, get a optimum horizontal length and vertical interval of reinforcement and apply to actual design.

Squalene Adjuvant를 이용한 단백질 항원의 세포성 면역반응 유도

도현주,김성열,안종성,하영주,이승찬,오재택,장명호,정홍석,문홍모,박해준 大韓免疫學會 1996 大韓免疫學會誌 Vol.18 No.3

To investigate the role of adjuvant for cytotoxic T lymphocytes (CTL) induction, squalene-based adjuvant was studied its capability eliciting to the induction of cellular immunity as well as humoral immunity to exogeneous proteins. Ovalbumin (OVA) was used as model proteins. It was demonstrated that antigen formulation consisted of metabolizable oil squalene mixed with Tween 80 and pluronic L121 (S/TJ121) could induced the antigen specific CTL responses and antibodies irrespective of immunization routes in mice. We also demonstrated that this antigen formulation was a inducer of CD8+, major histocompatibility complex(MHC) class I-restricted, and antigen-specific C;1'Ls. These data suggest that the squalene-based emulsion system is a potent adjuvant inducing cellular immunity as well as humoral immunity.