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)

바이오 촉진제가 첨가된 아민 흡수제를 이용하여 이산화탄소 포집 가속화 연구

장종탁(Jongtak Jang),최정호(Jeongho Choi),윤성희(Sounghee Yun),조원희(Wonhee Jo),정진영(Jinyoung Jung),전일수(Ilsoo Chun),윤여일(Yeoil Yoon) 한국신재생에너지학회 2018 한국신재생에너지학회 학술대회논문집 Vol.2018 No.11

슬래그시멘트 초기강도 증진을 위한 자극제로서 CFBC Fly ash의 활용연구

박종탁(JongTak Park),오홍섭(Hongseob Oh),정권수(Gwon Soo Jung),강창호(Chang Ho Kang) 한국건설순환자원학회 2020 한국건설순환자원학회 논문집 Vol.8 No.1

환경오염 저감을 위해 순환유동층 보일러를 활용한 발전이 증가함에 따라 CFBC 플라이애시가 많이 생산되고 있다. CFBC 플라이애시내는 수화반응 중 시멘트의 팽창과 급격한 초기응결을 발생시킬 수 있는 free CaO를 포함하고 있기 때문에 콘크리트에서의 사용이 제한적이다. 본 연구에서는 고로슬래그시멘트의 초기강도 증진을 위해 CFBC 플라이애시와 인산석고와 같이 혼합함으로서 천연석고를 대체하는 자극제로 활용하고자 하기 위하여 미세구조와 초기강도 특성을 실험적으로 분석하였다. 인산석고는 배면탈황석고와 인산중화석고를 사용하였으며, 이수상태와 무수상태로 각각 혼합하여 실험하였다. 실험결과 CFFA와 dihydrate 형태의 이수석고를 혼합하는 경우에는 상대적으로 초기강도 발현이 낮아지나, CFFA와 anhydriteII 결정형태인 무수인산석고를 혼합한 배합의 강도 증진효과가 천연석고를 사용한 경우와 유사하여 혼합시멘트로 활용 가능성이 높은 것으로 분석되었다. As the circulating fluidized bed combustor(CFBC) boilers system to generate electric power increase in order to reduce environmental pollution, a lot of CFBC fly ashes(CFFA) are produced. CFFA has limited use in concrete because it contains free CaO, which can cause cement expansion and rapid initial hydration. In this study, the microstructure and the initial development of compressive strength characteristics were experimentally analyzed to be used as a stimulant to replace natural gypsum by mixing with CFFA and phosphate gypsum to enhance the initial strength of portland blast furnace slag cement. The recycled gypsum was used as flue-gas desulfurization gypsum and phosphate gypsum. Experimental results show that the initial strength development is relatively lower when CFFA and dihydrate gypsum are mixed, but the strength improvement effect of the mixture with CFFA and anhydrous gypsum as an anhydritedII typed crystalized gypsum is similar to t hat of natural gypsum. As a result, it w as analyzed to have high possibility of use for stimulant of portland blast furnace slag cement.

Diagnostic Performance, Stability, and Usability of Self-Collected Combo Swabs and Saliva for Coronavirus Disease 2019 Diagnosis: A Case-Control Study

Choi Seong Jin,Jung Jongtak,Kim Eu Suk,Kim Hong Bin,Park Jeong Su,Park Kyoung Un,Lee Hyunju,Lee Eunyoung,Choe Pyoeng Gyun,Kim Ji-Yeon,Lee Eun Joo,Song Kyoung-Ho 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.3

Background Self-sampling procedures to detect severe acute respiratory syndrome coronavirus 2 is important for patients who have difficulty visiting the hospital and may decrease the burden for health care workers (HCWs). The objective of this study was to evaluate the diagnostic performance, stability and usability of self-collected nasal and oral combo swabs and saliva specimens. Materials and Methods We conducted a case-control study with 50 patients with coronavirus disease 2019 (COVID-19) and 50 healthy volunteers from March, 2021 to June, 2021. We performed real-time reverse-transcription polymerase chain reaction to compare the diagnostic performance of self-collected specimens using positive percent agreements (PPAs). Results The PPAs between self-collected and HCW-collected specimens were 77.3 - 81.0% and 80.5 -86.7% for the combo swabs and saliva specimens, respectively. The PPAs increased to 88.9 - 89.2% and 81.2 - 82.1% with a cycle threshold value ≤30. Conclusion The diagnostic performance of self sampling was comparable to that of HCW sampling in patients with high viral loads and may thus assist in the early diagnosis of COVID-19. Background Self-sampling procedures to detect severe acute respiratory syndrome coronavirus 2 is important for patients who have difficulty visiting the hospital and may decrease the burden for health care workers (HCWs). The objective of this study was to evaluate the diagnostic performance, stability and usability of self-collected nasal and oral combo swabs and saliva specimens. Materials and Methods We conducted a case-control study with 50 patients with coronavirus disease 2019 (COVID-19) and 50 healthy volunteers from March, 2021 to June, 2021. We performed real-time reverse-transcription polymerase chain reaction to compare the diagnostic performance of self-collected specimens using positive percent agreements (PPAs). Results The PPAs between self-collected and HCW-collected specimens were 77.3 - 81.0% and 80.5 -86.7% for the combo swabs and saliva specimens, respectively. The PPAs increased to 88.9 - 89.2% and 81.2 - 82.1% with a cycle threshold value ≤30. Conclusion The diagnostic performance of self sampling was comparable to that of HCW sampling in patients with high viral loads and may thus assist in the early diagnosis of COVID-19.

Performance of STANDARD™ M10 SARS-CoV-2 Assay for the Diagnosis of COVID-19 from a Nasopharyngeal Swab

Ham Sin Young,Jeong Hyeonju,Jung Jongtak,Kim Eu Suk,Park Kyoung Un,Kim Hong Bin,Park Jeong Su,Song Kyoung-Ho 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.2

The STANDARD™ M10 severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) assay (M10 assay) (SD Biosensor Inc., Suwon, Korea) is a rapid, fully-automated, cartridge-type molecular diagnostic assay that detects SARS-CoV-2 RNA using primers and probes for each target gene (ORF1ab gene, E gene). This study evaluated its performance by assessing its concordance with the approved SARS-CoV-2 real-time PCR assay. Tests were performed on 80 nasopharyngeal samples. The sensitivity and specificity of the M10 assay were 100%. The M10 assay effectively diagnosed SARS-CoV-2 infection, and it was comparable to the approved SARS-CoV-2 real-time PCR assay. It is a viable point-of-care test due to its short turnaround time.

Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19

Park Do Hyeon,Lee Eunyoung,Jung Jongtak,Kang Chang Kyung,Song Kyoung-Ho,Choe Pyoeng Gyun,Park Wan Beom,Bang Ji Hwan,Kim Eu Suk,Kim Hong Bin,Park Sang-Won,Kim Nam Joong,Oh Myoung-don 대한의학회 2022 Journal of Korean medical science Vol.37 No.16

Background: The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19). Methods: An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated. Results: The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score. Conclusion: Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Late-Onset Granulomatous Pneumocystis jirovecii Pneumonia in A Renal Transplant Recipient: A Clinical Grand Round Conference Case in 2022

Baek Yae Jee,Kim Kyeongmin,Nam Bo Da,Jung Jongtak,Lee Eunjung,Noh Hyunjin,Kim Tae Hyong 대한감염학회 2023 Infection and Chemotherapy Vol.55 No.3

Late-onset Pneumocystis jirovecii pneumonia (PCP) can be developed in solid organ transplant (SOT) patients. Granulomatous P. jirovecii pneumonia (GPCP) can occur in immunocompromised patients, but has rarely been reported in SOT recipients. The diagnosis of GPCP is difficult since the sensitivity of sputum and bronchoalveolar lavage is low and atypical patterns are shown. A 60-year-old man, who had undergone renal transplantation 24 years ago presented with nodular and patchy lung lesions. He was asymptomatic and stable. After empirical treatment with a fluoroquinolone, the condition partially resolved but relapsed 4 months later. The pulmonary nodule was resected, and GPCP was confirmed. The pathogenesis of GPCP remains unclear, but in SOT recipients presenting with an atypical lung pattern, GPCP should be considered. This case was discussed at the Grand Clinical Ground of the Korean Society of Infectious Disease conference on November 3, 2022.

Evaluation of Vancomycin TDM Strategies: Prediction and Prevention of Kidney Injuries Based on Vancomycin TDM Results

Kim Byungwook,황세정,Heo Eunjeong,Kim Hyung-sook,Jung Jongtak,Kim Eu Suk,김홍빈,Lee Kyunghoon,Park Jeong Su,송정한,Lee Joon Hee,Chung Jae-Yong,Song Kyoung-Ho,Yoon Seonghae 대한의학회 2023 Journal of Korean medical science Vol.38 No.14

The current guidelines for therapeutic drug monitoring (TDM) of vancomycin suggest a target 24-hour area under the curve (AUC0-24) of 400 to 600 mg*h/L for serious methicillinresistant Staphylococcus aureus infections. In this study, the predictabilities of acute kidney injury (AKI) of various TDM target parameters, target levels, and sampling methods were evaluated in patients who underwent TDM from January 2020 to December 2020. The AUC0-24 and trough values were calculated by both one- and two-point sampling methods, and were evaluated for the predictability of AKI. Among the AUC0-24 cutoff comparisons, the threshold value of 500 mg*h/L in the two sampling methods was statistically significant (P = 0.042) when evaluated for the predictability of AKI. Analysis by an receiver operating characteristic curve estimated an AUC0-24 cutoff value of 563.45 mg*h/L as a predictor of AKI, and was proposed as the upper limit of TDM target.

Comprehensive Rehabilitation in Severely Ill Inpatients With COVID-19: A Cohort Study in a Tertiary Hospital

Woo Hyeonseong,Lee Sanghee,Lee Hyun Sung,Chae Hyun Jun,Jung Jongtak,Song Myung Jin,Lim Sung Yoon,Lee Yeon Joo,Cho Young-Jae,Kim Eu Suk,Kim Hong Bin,Lim Jae-Young,Song Kyoung-Ho,Beom Jaewon 대한의학회 2022 Journal of Korean medical science Vol.37 No.34

Background: This study aimed to investigate the effects of comprehensive rehabilitation management on functional recovery and examine the correlation between clinical parameters and improvements in functional outcomes in severe-to-critical inpatients with coronavirus disease 2019 (COVID-19) in a tertiary hospital. Methods: Post-acute COVID-19 patients who had a World Health Organization (WHO) ordinal scale of 5–7, underwent intensive care, and received comprehensive rehabilitation management, including exercise programs, nutritional support, dysphagia evaluation, and psychological care were included. The appendicular skeletal muscle mass index (SMI), Medical Research Council sum score, handgrip strength, number of repetitions in the 1-minute sit-to-stand test, gait speed, Berg Balance Scale (BBS), and Functional Ambulation Classification (FAC) were evaluated at hospital stay, discharge, and 1-month follow-up. The correlation between the rehabilitation dose and improvement in each outcome measure was analyzed. Results: Overall, 37 patients were enrolled, of whom 59.5% and 32.4% had a score of 6 and 7 on the WHO ordinal scale, respectively. Lengths of stay in the intensive care unit and hospital were 33.6 ± 23.9 and 63.8 ± 36.5 days. Outcome measures revealed significant improvements at discharge and 1-month follow-up. The SMI was significantly increased at the 1-month follow-up (6.13 [5.24–7.76]) compared with that during the hospital stay (5.80 [5.39–7.05]). We identified dose-response associations between the rehabilitation dose and FAC (ρ = 0.46) and BBS (ρ = 0.50) scores. Patients with older age, longer hospitalization, longer stay at the intensive care unit, longer duration of mechanical ventilation, tracheostomy, a more depressive mood, and poorer nutritional status revealed poorer improvement in gait speed at the 1-month follow-up. Conclusion: Comprehensive rehabilitation management effectively improved muscle mass, muscle strength, and physical performance in severe-to-critical COVID-19 patients. Dose-response relationship of rehabilitation and functional improvement emphasizes the importance of intensive post-acute inpatient rehabilitation in COVID-19 survivors.

Lung ultrasound for early diagnosis and severity assessment of pneumonia in patients with coronavirus disease 2019

( Young-jae Cho ),( Kyoung-ho Song ),( Yunghee Lee ),( Joo Heung Yoon ),( Ji Young Park ),( Jongtak Jung ),( Sung Yoon Lim ),( Hyunju Lee ),( Ho Il Yoon ),( Kyoung Un Park ),( Hong Bin Kim ),( Eu Suk 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.4

Background/Aims: Current evidence supports lung ultrasound as a point-of-care alternative diagnostic tool for various respiratory diseases. We sought to determine the utility of lung ultrasound for early detection of pneumonia and for assessment of respiratory failure among patients with coronavirus disease 2019 (COVID-19). Methods: Six patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction were enrolled. All had undergone chest X-ray and chest computed tomography (CT) on the day of admission and underwent multiple point-of-care lung ultrasound scans over the course of their hospitalization. Results: Lung ultrasound detected early abnormal findings of representative B-lines in a patient with a normal chest X-ray, corresponding to ground-glass opacities on the chest CT scan. The ultrasound findings improved as her clinical condition improved and her viral load decreased. In another minimally symptomatic patient without significant chest X-ray findings, the ultrasound showed B-lines, an early sign of pneumonia before abnormalities were detected on the chest CT scan. In two critically ill patients, ultrasound was performed to assess for evaluation of disease severity. In both patients, the clinicians conducted emergency rapid sequence intubation based on the ultrasound findings without awaiting the laboratory results and radiological reports. In two children, ultrasound was used to assess the improvement in their pneumonia, thus avoiding further imaging tests such as chest CT. Conclusions: Lung ultrasound is feasible and useful as a rapid, sensitive, and affordable point-of-care screening tool to detect pneumonia and assess the severity of respiratory failure in patients hospitalized with COVID-19.