인공호흡기 튜브교환주기에 따른 인공호흡기 관련 폐렴발생률

김남초,김양리 성인간호학회 2003 성인간호학회지 Vol.15 No.3

Purpose: This study was aimed at providing scientific evidence for minimizing ventilator-associated pneumonia (VAP) by identifying appropriate timing of exchange of circuit for mechanical ventilator that is well suitable for the medical environment of intensive care units of hospitals in Korea. Method: This was quasi-experimental study with a convenience sample of 19 adult subjects aged over 18 years who were admitted to the NS ICU of C university hospital, and placed on mechanical ventilator. The subjects were placed in two groups, compared on the incidence rate of VAP after they received exchange of circuit either at 1-week interval (N=10) or 2-week interval (N=9). Result: 1) When considering 1000 days as the standard unit of analysis fro incidence, the incidence rate of VAP was 7.19 cases at the 1-week cycle exchange group and 15.23 at the 2-week cycle exchange group, showing no statistically significant difference between the two groups. 2) There were a total of 3 types of bacteria isolated from the patients with VAP, including 2 cases with P. aeruginosa, 1 case with Streptococcus group F and A. baumannii. Conclusion: With thorough hand washing and strict management of tracheal tube of mechanical ventilator as well as use of tracheal intubation techniques, exchange cycle of circuit of mechanical ventilator by nurses may be changed from 1-week to 2-week interval.

병원 내 환자에서 분리한 Klebsiella pneumoniae에서 광범위 β-lactamase의 분자생물학적 특성

위성현,김수영,김상일,김양리,유진홍,신완식,강문원 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.2

Characterization of a Constitutive β-Lactamase from a Pseudomonas aeruginosa

유진홍,허동호,최정현,김양리,신원식,강문원 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.2

Objective : We analyzed some physicochermical chracteristics of a constitutive β-lactamase from a clinical isolate of a Pseudomonas aeruginosa which resistant to various β-lactams except imipenem and susceptible to aminoglycosides the proportion of its contribution to such resistance profile. Method : 1. Antimicrobial susceptibility test was done by the broth dilution method. 2. In hibition profile was done using EDTA, HgCl₂ and p-chloromercuribenzoate (pCMB). We also measured 50% inhibitory concentration(IC??) using β-lactamase inhibitors, such as clavulanic acid, sulbactam. 3. Kinetics study for substrate profile was performed by spectrophotometric assay using crude extracts and various antimicrobial agents. Relative hydropysis rates were determined. 4. The isoelectric point(pI) was determined by isoelectric focusing. The molecular weight was estimated by SDS-polycrylamide gel electrophoresis. Results : 1. The strain was resistant to ceftriaxone, sulperazon, piperacillin, ceftazidime, and aztreonam, while it was susceptible to gontamicin, tobramycin, amikacin and imipenem. 2. The β-lactamase was not inhibited by EDTA, and pCMB, whereas it was inhibited by HgCI₂. The IC?? of clavulanic acid was over 100μM and that of sulbactam was 22μM. 3. The relative maximal hydrolysis rate was calculated by setting V_(max) for cephaloridine at 100. The enzyme hydrolyzed cephalosporins more rapidly than penicillins. 4. The pI was 9.3 by isoelectric focusing. The molecular weight was estimated to be 40kDa. Conclusion : According to its substrate profile, pI and molecular weight, the β-lactamase from a clinical isolate of P. aeruginosa was a cephalosporinase belonging to group 1 in the Bush-Jacoby-Medeiros classification scheme.

Staphylococcus aureus와 Coagulase-Negative Staphylococcus Species에 대한 Arbekacin의 시험관내 항균력

위성헌,강진한,허동호,이동건,김상일,김양리,최정현,김종현,유진흥,허재균,신완식,강문원 대한감염학회 2001 감염 Vol.33 No.4

Background : Most strains of methicillin-resistant Staphylococcus aureus (MRSA) now exhibit high-level resistance to various antibiotics, such as β -lactam antibiotics, aminoglycosides, macrolides, tetracyclines and quinolones. Recent reports describing the therapeutic failure of vancomycin for MRSA infections have arisen considerable concerns regarding the emergence of MRSA strains, which will require new therapeutic agents. Arbekacin, an aminoglycoside antibiotic, has antibacterial activity against both gram-positive and gram-negative bacteria and is stable in the presence of aminoglycoside inactivating enzymes produced by S. aureus. In this study, we compared the antibacterial activity of arbekacin with those of vancomycin, gentamicin, and amikacin against Staphylococcus aureus (S. aureus) and coagulase-negative staphylococci (CNS). Methods : For a collection of 549 S. aureus and 251 CNS isolates from three Catholic University Hospitals in Korea, minimum inhibitory concentrations (MICs) of arbekacin, vancomycin, amikacin and gentamicin were determined by agar dilution method using Mueller-Hinton agar according to NCCLS (National Committee for Clinical Laboratory Standards, USA)criteria. Results : Among 549 S. aureus isolates, 278 isolates were MRSA and 271 isolates were methicil sensitive S. aureus (MSSA). MIC50 & MIC90 of arbekacin against 549 S. aureus were 0.5 & 1 ㎍/mL, and MIC50 & MIC90 of vancomycin were 1 & 1 ㎍/mL. MIC of arbekacin against 549 S. aureus isolates ranges from 0.03 to 4 ㎍/mL, and MIC of vancomycin against 549 S. aureus ranges from 0.25 to 2 ㎍/mL. MIC90 of amikacin against 549 S. aureus was 32㎍/mL, and that of gentamicin was 128 ㎍/mL. MICs of amikacin and gentamicin were variable, ranging from 0.125 to 256, and otherwise arbekacin and vancomycin revealed relatively narrow range of MICs. MIC90 of arbekacin against 278 MRSA isolates & 271 MSSA were 1 & 0.5 ㎍/mL, and those of vancomycin against MRSA & MSSA were 1 & 1 ㎍/mL. MIC90 of amikacin against 278 MRSA & 271 MSSA isolates were 32 & 4 ㎍/mL, and that of gentamicin against MRSA & MSSA isolates were 128 & 32 ㎍/mL respectively. Among 251 CNS isolates, 122 isolates were MRCNS and 129 were MSCNS. MICSO & MIC90 of arbekacin against 251 CNS isolates were 0.25 & 2 ㎍/mL, and those of vancomycin were 1 & 2 ㎍/mL. MIC of arbekacin against 251 CNS isolates ranges from 0.015 to 32 ㎍/mL, and that of vancomycin isolates ranges from 0.25 to 2 ㎍/mL, MIC90 of arbekacin against 122 MRCNS & 129 MSCNS isolates were 2&0.3 ㎍/ML, and those of vancomycin were 2&s ㎍/ML. MIC90 of amikacin against 251 CNS isolates was 32 ㎍/ML, and that of gentamicin was 128 ㎍/ML for CNS. MIC90 of amikacin against 122 MRCNS & 129 MSCNS isolates were 128 & 8㎍/mL, and those of gentamicin ere 256 & 32 ㎍/mL. Conclusion : Considering above results, arbekacin can be useful agent against most strains of MRSA and MRCMS, which exhibit high-level resistance to amikacin and gentamicin. (Korea J Infect Dis 33:254~260, 2001)

동종 골수이식 후 만성 이식편대숙주반응 환자에서 발생한 폐렴구균에 의한 수막뇌염 1예

신완식,김병욱,유진홍,김동집,김춘추,박종원,이종욱,김동욱,강문원,김양리 대한감염학회 1993 감염 Vol.25 No.3

Graft-versus-host disease (GVHD) is a frequent complication after bone marrow transplantation. Infectious complications are common in GVHD patients due to defect in cell-mediated immunity. A rare case of S. pneumoniae meningoencephalitis occured in a patient with extensive form of chronic GVHD after allogeneic bone marrow transplantation. He was immediately treated with full dosage of ceftriaxone and ampicillin. He suffered from various complications such as sepsis, acute renal failure, atelectasis, and seizure. Despite of aggressive treatment, he died probably due to renal shutdown and massive subacute cerebral infarction of left cerebral hemisphere. This report showed two unusual and rare features. First, the infection site was CNS rather than respiratory system. Second, the causative organism was S. pneumoniae, which is rare cause of CNS infection in immunocompromised patients.

Pharmacokinetics of Primaquine and Carboxyprimaquine in Korean Patients with Vivax Malaria

Yang-Ree Kim,Hyo-Jeong Kuh,Mi-Young Kim,Yo-Sook Kim,Woo-Chul Chung,Sang-Il Kim,Moon-Won Kang 대한약학회 2004 Archives of Pharmacal Research Vol.27 No.5

Primaquine is used for relapses caused by vivax malaria hypnozoites. No studies on the pharmacokinetics of primaquine (PMQ) has been reported in Korean patients. In our study, thirty vivax malaria patients were given 15 mg primaquine daily for 14 days after 3 days of chloroquine treatment. Plasma samples were taken at intervals after each daily dose of PMQ for 3 days. Plasma concentrations of PMQ and carboxyprimaquine (CPMQ), the major metabolite of primaquine, were measured by HPLC. The PMQ concentrations reached a maximum of 0.28±0.18 mg/mL at 1.5 h after the first dose. The maximum concentration of CPMQ was 0.32±0.13 mg/mL at 4 h. Higher drug concentrations with repeated dosing were observed for CPMQ, but not for the parent drug, PMQ. The elimination half-life was 3.76±1.8 h and 15.7±12.2 h, for PMQ and CPMQ, respectively. Large variation in the plasma concentrations of both drugs was observed. Overall, PMQ is absorbed and metabolized rapidly after oral administration. It was noted that the mean peak plasma concentration of PMQ was significantly higher and that of CPMQ was lower in our patients compared to other studies. This suggests a potential difference of inter-ethnic groups, which warrants further investigations.

Immunogenicity of Vi Capsular Polysaccharide Vaccine Evaluated for Three Years in Korea

Yang Ree Kim Korean Academy of Medical Science 1995 Journal of Korean medical science Vol.10 No.5

Case Reports : A Case of Descending Thoracic and Abdominal Aortic Aneurysm with Ankylosing Spondylitis

( Yeo Ree Yang ),( Rae Seok Lee ),( Tae Hyun Ban ),( Jae Hyun Seo ),( Dae Jun Kim ),( Seung Min Jung ),( Sung Hwan Park ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.1

Ankylosing spondylitis (AS) is a systemic inflammatory disorder that affects the axial skeleton. It often involves the extra-articular organs. Cardiovascular involvement is one of the extra-articular manifestations, which is mostly represented by aortic root, valvular heart disease, and conduction disturbances. An aortic sclerosing inflammatory process induces aortic root thickening and rigidity. An aortic aneurysmal change is a rare complication that often leads to life threatening conditions. A few cases regarding aortic aneurysm have been reported, but there are no reported cases in Korea. We report the first case of descending thoracic and abdominal aortic aneurysm in a patient with ankylosing spondylitis.

심포지움 : 병원감염의 치료와 예방

김양리 ( Yang Ree Kim ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

복강 내 결핵성 농양의 CT 소견과 임상경과

김양리 ( Yang Ree Kim ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3

Paradoxical response during antituberculosis treatment occurs frequently in non-HIV-infected patients as well as in HIV-infected patients, and intraperitoneal tuberculous abscess can develop as paradoxical response in tuberculous peritonitis patients rarely. The unique CT findings are not present and microbiologic or pathologic confirm is needed for diagnosis of intraperitoneal tuberculous abscess. Further study is needed to define steroid use or operation indication of intraperitoneal tuberculosis abscess. (Korean J Med 74:233-234, 2008)