광범위 베타 락탐계 항생제 분해 효소를 생성하는 폐렴간균에 의한 균혈증이 발생한 환자에서 감영의 위험 인자 및 치료 결과

강철인,김성한,방지환,김홍빈,박상원,최영주,오명돈,김의종,최강원 대한감염학회 2003 감염과 화학요법 Vol.35 No.2

목적 : 본 연구는 ESBL을 생성하는 K. pneumoniae에 의한 균혈증 환자에서 감염의 위험 인자 및 치료 결과를 알아보고자 시행하였다. 방법 : 1998년 1월부터 2002년 4월까지 혈액 배양 검사에서 동정된 K. pneumoniae를 대상으로 NCCLS guidelines과 이중 디스크 확산법(double-disk diffusion test)을 이용하여 ESBL 생성 여부를 확인하였다. ESBL 생성 균주에 의한 균혈증 환자 60명(환자군)에 대해 ESBL을 생성하지 않는 균주에 의한 균혈증 환자들(대조군)을 연령, 성별, 균혈증 발생 시점을 고려하여 1:2 또는 1:3으로 배정하였다. 총 159명의 대조군을 선정하였고 후향적인 환자-대조군 연구를 시행하였다. 결과 : 환자군과 대조군 사이에 연령, 성별, APACHE Ⅱ score, 주된 감염 부위의 유의한 차이는 없었다. ESBL을 생성하는 K. pneumoniae에 의한 균혈증이 발생할 독립적인 위험 인자에는 요관 삽입, 균혈증 발생 이전 72시간 동안 침습적인 시술을 받은 경우, 균혈증 발생 이전 30일 동안 투여받은 항생제 개수가 있었다. 초기 항생제 치료 72시간 후의 반응을 평가하였을 때, 완전 반응(complete response)은 대조군에서 더 많았고(13.3% vs. 40.3%, P<0.001), 치료 실패(treatment failure)는 환자군에서 더 많았다(33.3% vs. 11.9%, P<0.001). 7일 사망률은 환자군에서 20% (12/60), 대조군에서 15.6% (25/159)이었고(P=0.451), 30일 사망률은 환자군에서 30% (18/60), 대조군에서 24.5% (39/159)이었다(P=0.410). ESBL 생성 균주에 의한 균혈증이 있는 환자들에서 최종 항생제 치료가 부적절했던 환자들을 제외하고 30일 사망률을 분석하였을 때 효과적인 항생제 치료의 지연은 사망률을 높이지 않았다(11.1% vs. 9.1%, P=1.000). 결론 : ESBL을 생성하는 K. pneumoniae에 의한 균혈증이 있는 환자에서 초기 항균제 치료 72시간 후의 치료 반응률은 낮지만 사망률은 유의하게 증가하지 않았다. 원인균이 동정된 후 최종 치료 항생제의 선정이 적절하다면 초기에 효과적인 항생제 투여의 지연은 사망률을 유의하게 증가시키지는 않았다. Background : This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum β-lactamases(ESBL)-producing K. pneumoniae. Methods: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. Results : There were no significant differences in age, sex, APACHE Ⅱ score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7-day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P=0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. Conclusion : In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.

관해유도 항암요법을 받는 백혈병 환자에서 진균 감염증의 예방 : 무작위 배정법과 이중 눈가림법에 의한 Fluconazole과 Nystain의 효과에 관한 다기관 공동연구 A Randomized, Double-blind, Multicenter Trial to Compare Fluconazole with Nystatin

최강원,오명돈,배현주,백경란,박선양,김병국,신완식,강문원,진종률,박종원,김춘추,김동집,한지숙,민유홍,이선주,고윤웅 대한화학요법학회 1993 대한화학요법학회지 Vol.11 No.2

Fluconazole의 진균 감염증 예방 효과와 안전성에 관하여 3개 대학병원에서 관해유도화학요법을 받는 급성 백혈병환자를 대상으로 무작위 배정법과 너도나도 누가림법에 의하여 연구하였다. 모두 62명의 환자에게 fluconazole(100㎎ bid) 또는 nystatin(1,000,000IU/day)을 무작위로 투여하였다. 투약은 관해유도화학요법과 같은 날짜에 시작하여 호중구수가 1,000㎣이상으로 회복되거나 진균 감염증이 확인되거나 의심되어 Amphotericin-B를 시작하거나, 약과 관련된 부작용이 나타날 때까지 계속하였다. 진균 colonization은 fluconazole군에서 감소하였으나 nystqatin군에서는 증가하였다, 표재성 진균감염증으로 nystatin군에서 C. albicans 진균혈증 1례와 C.parasilosis 진균혈중 1례가 발생하였다. 경험적 항진균요법으로 Amphotericin-B를 투여한 경우는 fluconazolerns 34명중 7례(21%), nystatinrns 28명중 10례(36%)였다(p<0.05). Fluconazole군과 nystatin군 사이에 부작용이나 사망률에 차이는 없었다. 결론적으로, fluconazole은 관해유도화학요법을 받는 급성 백혈병환자에서 진균의 colonization을 줄이는데 효과적이고 안전한 항진균제이다. We made a randomized, double-blind, multicenter trial to compare the efficacy and safety of fluconazole with nystatin for prevention of fungal infections in patients with acute leukemia. Sixty-two adult undergoing remission induction chemotherapy for cute leukemia were enrolled. Patients were randomly assigned to receive either fluconazole (100㎎ bid) or nystatin(1,000,000IU×6/day) with corresponding placebo. The study drug was started in initiation of chemotherapy and continued until recovery of neutrophil counts(>1,000/㎣), development of proven or suspected invasive fungal infection, or the occurrence of drug-related toxicity. Fungal colonization decreased in fluconazole(F) group, however increased in nystain(n) group. Superficial fungal infection occurred in 1 of 34 F group, whereas invasive fungal infection developed in 3 of 28 N group. Empirical amphotericin-B therapy was given in 7 of 34(21%) F group and 10 of 28(36%) N group(p>0.05). The incidence of drug-related side effects and overall moratlity were similar in both study groups.

Impact of Interferon-Based Treatment on Quality of Life and Work Related Productivity from the Korean Cohort in the MOSAIC Study

( Sang Hoon Ahn ),( Won Hyeok Choe ),( Yoon Jun Kim ),( Jeong Heo ),( Dorota Latarska-smuga ),( Jiho Kang ),( Seung Woon Paik ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Chronic Hepatitis C Virus (HCV) infection increases the risk for progressive liver disease, hepatocellular carcinoma and negatively impacts the patient’s quality of life. HCV treatment is evolving with direct acting antivirals but IFN based therapy has been the standard of care for many years and remains available in some countries. The MOSAIC study aims to characterize patients with chronic HCV infection and assess the impact of IFN-containing treatment on health-related quality of life, work related productivity and health care utilization. Methods: MOSAIC is an international prospective multicenter observational study that has been conducted in 20 countries. Consecutive patients with chronic HCV infection were enrolled and those who initiated an IFN based regimen were prospectively followed for 48 weeks. We report results from the Korean cohort Results: 100 patients were enrolled: 86 were treatment naïve and 14 were treatment experienced. 33 patients initiated an IFN based regimen: 6 patients started IFN + RBV, 26 patients started Peg-IFN + RBV, none started Peg-IFN + RBV + DAA and 1 patient received other treatment. Among the treated cohort, demographic and disease characteristics were the following: the mean age was 54.5 years; 14 patients were male. 14 had minimal or no fibrosis, 2 portal fibrosis, 3 bridging fibrosis and 6 patients suffered from cirrhosis. HCV Genotype distribution was as follows: genotype 1: 11; genotype 2: 19 and genotype 3: 3. Table 1 describes the results at baseline and changes over 4, 12 and 48 weeks and end-of-treatment (EOT) for the quality of life and work productivity outcome measures (EQ-5D-5L, HCV-PRO and WPAI). Conclusions: Results from the Korean cohort of the MOSAIC study show a moderate trend for deterioration of health-related quality of life and work productivity associated with IFN based treatment for patients with chronic HCV infection during treatment period. Acknowledgements: The design, study conduct, analysis, and financial support of MOSAIC study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the content of the abstract. All authors had access to all relevant data and participated in writing, review, and approval of this abstract. Medical writing support was provided by Olivier Van de Steen of Medeor-consulting, funded by AbbVie. Disclosures: Sang Hoon Ahn: served as an advisor and lecturer for Bristol-Myers Squibb, Gilead Sciences, F.Hoffmann-La Roche, Merck, AbbVie, and has received unrestricted grants from Bristol-Myers Squibb, Gilead Sciences, and F. Hoffmann-La Roche for investigator- initiated trials Won Hyeok Choe: Nothing to disclosure Yoon Jun Kim: Nothing to disclosure Jeong Heo: received a grant from GSK; Research support from BMS, and Roche; Advisor for Abbvie, BMS, Gilead Sciences, Pharma Essentia, SillaJen, and Johnson & Johnson. Dorota Latarska-Smuga, Jiho Kang: are employees of AbbVie, Inc. and may hold stock or stock options. Seung Woon Paik: received grant and research support from AbbVie, BMS, Gilead, GSK, Merck, Novartis, and Roche

황색포도구균의 균혈증에서 초기 항생제 치료가 예후에 미치는 영향

김성한,박완범,이기덕,강철인,최영주,김홍빈,박상원,김의석,오명돈,김의종,최강원 대한감염학회 2002 감염 Vol.34 No.5

NIDDM 당뇨병 흰쥐에서 n-3 다가불포화지방산이 가자미근의 Glucose Uptake에 미치는 영향

최원경,윤옥현,강병태 한국식품영양학회 1998 韓國食品營養學會誌 Vol.11 No.5

인슐린 저항성이 발생된 흰쥐 골격근에서 n-3 다불포화지방산이 당수송에 어떤 영향을 미치는지 연구한 본 논문을 요약하면 다음과 같다. 5주간의 식이에 의한 각군간의 유의한 체중 변화는 없었다. 5주간의 고지방식이에 의하여 혈당은 정상식이군의 83mg/dl에 비하여 94mg/dl로 13% 더 증가하였다(p<0.05). n-3 다불포화지방산에 의하여서는 혈당의 유의적 감소는 없었으나 다소 감소하였다. 혈장 인슐린은 정상식이군의 11.6U/ml에 비하여 고지방식이군은 32.4U/ml로 높았으며(p<0.01), n-3 다불포화지방산에 의하여 28.7U/ml로 감소하였다(p<0.01). 가자미근의 당수송은 시험관 실험에서 고지방식이군이 정상식이군에 비하여 기초상태 뿐만아니라 인슐린 1, 10, 100nM에서도 현저히 감소하여(p<0.01) 인슐린 감수성과 반응도 모두 감소한 인슐린 저항성을 보여 주었다. 고지방식이군에 n-3 다불포화지방산의 첨가시 고지방식이군에 비하여 기초상태, 인슐린 1, 10, 100nM에서 유의하게(p<0.01) 증가하였으나 정상군의 그것에는 미치지 못하였다. 이상의 결과로 미루어 보아 5주간의 고지방식이시 당수송에 장애와 골격근의 인슐린 저항성이 발견되었으며, 고지방식이에 n-3 다불포화지방산의 첨가에 의해서 골격근 인슐린 저항성의 정도가 억제되므로 고지방식이에 의한 인슐린 저항성은 n-3 다불포화지방산이 효과적으로 예방이 가능할 것으로 생각되었다. The purpose of this study was to investigate the effects of n-3 polyunsaturated fatty acids(PUFA) on glucose and lipids metabolism in high-fat diet rats. Rats were randomly assigned to normal, high-fat with n-3 PUFA and high-fat dietary groups. Experiments were carried out after 5 weeks feeding with prescriptive diets following 7 hrs fasting. Body weight gains tended to be higher in high-fat fed rats than normal. Blood glucose was increased(p<0.05) by high-fat diet compared with normal diet, and decreased(p<0.05) to normal level by n-3 PUFA. Plasma insulin level was significantly higher(p<0.01) in high-fat diet rats than that of normal-diet rats, and also decreased(p<0.01) by n-3 PUFA. Glucose uptake of soleus muscle in vitro was decreased markedly in high-fat fed rats than normal diet rats at 0, 1, 10, and 100 nM insulin concentrations. Therefore insulin sensitivity and responsiveness were decreased by high-fat diet. Omega-3 PUFA made a recover(p<0.01) insulin sensitivity to almost normal level, and improved(p<0.05) insulin responsiveness in some extent. In conclusion, the results suggest that metabolic disorder of glucose and insulin resistance of skeletal muscle are caused by high-fat diet and n-3 PUFA can ameliorate metabolic disorder and insulin resistance.

병원근무자에서 홍역,풍진 및 수두 항체양성률에 관한 연구

최강원,김성민,오명돈,이환종,오향순,최희정,김남중,신형식 대한감염학회 1997 감염 Vol.29 No.1

목적: 홍역, 풍진, 및 수두의 병원감염 발생위험도를 평가하고 병원근무자 예방접종지침을 고안하는데 필요한 기초자료를 얻고자, 홍역, 풍진, 및 수두에 대한 병원근무자의 항체양성률을 조사하였다. 방법: 1995년 3월 서울대학교병원 산부인과 병동과 서울대학교 어린이병원에 근무하고 있는 여성을 대상으로 홍역, 풍진, 및 수두의 감염 과거력과 예방접종 과기력을 설문조사하였다. 정맥혈을 채혈하여 효소결합면역흡착검시(Enzyme linked immunosorbent assay, Behring ??? IgG kit)로 IgG 항체를 측정하였다. 결과: 홍역, 풍진, 및 수두에 대한 항체양성률은 각각 95.6%, 87.9%, 96.2% 이었다. 연령, 감염 과거력, 예방접종 과거력에 따른 항체양성률의 차이는 유의하지 않았다. 결론: 저자 등의 연구결과는 홍역과 수두, 특히 풍진의 병원감염 위험도가 높음을 시사하며, 각 개인의 건강과 전염병의 전파를 막기 위하여 병원근무자 예방접종지침이 필요하다. Background: To assess the risk of hospital outbreak and to guide immunization policy, seroprevalences of antibody to measles, rubella, and varicella-zoster were determined in hospital personnel. Methods: A cross-sectional study of 290 workers in Seoul National University Hospital was conducted in June 1995. IgG antibody status was determined with commercially available enzyme linked immunosorbent assay(Behring ??? IgG kit). Results: Seropositive rates of measles, rubella and varicella-zoster were 95.6%, 87.9% and 96.2%, respectively. There was no statistical difference in seropositive rate according to historical information. Conclusion: These results suggest potential for hospital outbreak of measles an varicella-zoster, especially of rubella. Immunization policy will be needed in hospital personnel.

건조 조건에 따른 분말 청국장의 성분 변화

강병태 ; 박동철 ;최원경 김천대학교 2004 김천대학교 논문집 Vol.25 No.-

The componenets of Chonkukjang powder produced by different drying conditions on group is freezing followed by heating at 40℃ or 60℃(FH-40 and H-60), respectively, another is heating only at 40℃ or 60℃(FH-40 and H-60), respetively - were compared with that of normal Chonkukjang.

백혈병과 과립구 감소증에서의 감시배양(surveillance culture) : 예방적항균제 사용에 따른 균총의 변화

최강원,김성민,오명돈,김병국,김의종 대한화학요법학회 1991 대한화학요법학회지 Vol.9 No.1

A surveillance culture was to monitor the changes in flora during prophylactic antibiotics(PA) in patients whith granulocytopenia. Twenty patients with granulocytopenia were included: divided into 3 PA groups. Terimthoprim-sulfamethoxazole(TS) group consisted of 7 patients who underwent induction chemotherapy, Cipprofloxacin plus nystatin(CN) group consisting of 7 patients and Gentamicin plus Nystain(GN) group consisting of 7 patients. All of the latter 2 group underwent bone marrow transplantation and were put in protected environment (laminar air flow, sterile food) in addition to PA. Normal flora and other colonizing microorganisms were replaced with antibiotic resistant bacteria and fungus : MRSA, methicillin resistant CNS, P. aeruginosa, Enterobacter spp. and candida spp. and truolopsis. Entreobacteriaceae were diminished markedly, expecially with CN. Two episodes of bacteremia were preceded by the colonization with the same organisms in the skin, throat, and stool. Surveillance culture seems useful in the helping to design prdventive measures, select antibiotics n selected cases.

Fosfomycin (Fosfocin^(�))의 臨床效果

崔康元,朴錫健 대한화학요법학회 1983 대한화학요법학회지 Vol.1 No.2

A new antibiotic, fosfomycin was administered to 27 patients with bacterial infection in urinary tract and respiratory tract. Excellent or remarkable improvement was noted in 10 of 12 patients with urinary tract in typhoid and 9 of 12 patients with respiratory infection. Similar success was noted in typhoid fever, pelvic abscess and sepsis due to Serratia marcescens, though the number of cases was limited. No serious side reaction was noted except for a case who developed anemia during treatment.

Cryptococcosis의 임상적 고찰

최강원,오명돈,고경혁 대한감염학회 1986 감염 Vol.18 No.2

The clinical aspect of 11 patients with cryptococcosis were studied. Eleven patients were admitted to the internal medicine service at SNUH between Jan. 1979 and Jun. 1986. The following result were obtained: 1) The age was distributed between 15 and 61 years.(mean 38) Male to female ratio was 7 : 4. 2) In 8 cases, underlying conditions were liver cirrhosis 2, pulmonary tuberculosis 2, renal transplant 1, systemic lupus 1, Cushing disease 1, and malignant lymphoma 1. 3) The involved organs were CNS 10, lung 3, skin 2, lymph node 2, kidney 1, liver 1, bone marrow 1. 4) Three out of 6 patients with meningitis were diagnosed as tuberculous meningitis at initial presentation. 5) With amphotericin and 5-flucytosine treatment, 4 cases were improved. Those 5 patients with serious underlying condition were fatal. Two patients discharged with neurologic sequelas.