The resistance mechanisms of β-Lactam antimicrobials in clinical isolates of Acinetobacter baumannii

배현주 ( Hyun Joo Pai ) 대한내과학회 2001 대한내과학회 추계학술대회 Vol.61 No.-

감염 ; 다약제 내성 Pseudomonas aeruginosa에 대한 항생제 병합 효과

배현주 ( Hyun Joo Pai ) 대한내과학회 2010 대한내과학회지 Vol.79 No.1

목적: β-lactam, fluoroquinolone 및 amikacin에 내성인 다약제 내성 Pseudomonas aeruginosa 임상균주를 대상으로 여러 항생제의 단독 혹은 병합 투여의 균 억제 효과를 실험적으로 확인하고자 하였다. 방법: Ceftazidime, cefepime, piperacillin/tazobactam, meropenem, ciprofloxacin 및 amikacin에 다양한 수준의 내성을 보이는 임상균주 10주를 대상으로 checkerboard법과 in vitro killing assay로 항생제의 병합요법의 효과를 판정하였다. 결과: Checkerboard법의 결과로는 ciprofloxacin에 비하여 amikacin을 병합하였을 때 상승효과가 높았다. Ceftazidime, cefepime, piperacillin/tazobactam 및 meropenem과의 상승효과는 ciprofloxacin의 MIC가 낮을수록 저명하였고, MIC가 16 μg/mL 이상인 균주에서는 모두 indifference 효과를 보였다. 반면에, amikacin은 MIC가 128 μg/mL인 경우도 ceftazidime, cefepime, piperacillin/tazobactam 및 meropenem과 병합시 상승효과를 보였다. 그러나 in vitro killing assay에서는 meropenem 내성이면서 ciprofloxacin의 MIC가 16 μg/mL인 균주에서도 meropenem과 ciprofloxacin의 병합요법에 상승 살균 효과를 보였다. Amikacin 은 checkerboard법의 결과와 달리 ceftazidime 혹은 piperacillin/tazobactam과 상승효과를 보이지 않았고 meropenem과 상승 효과를 보였으며 MIC가 128 μg/mL인 고도 내성균도 같은 상승효과를 보였다. 결론: 임상적으로 내성 수준을 알 수 없는 다제내성 P. aeruginosa 감염시 일단은 meropenem과 amikacin 병합요법을 써 볼 수 있을 것으로 사료되며 이후 실험적으로 checkerboard법이나 in vitro killing assay 결과를 확인한 후 약을 수정하는 것이 좋겠다. Background/Aims: The inhibitory effects of the combination of β-lactam with ciprofloxacin or amikacin against clinical isolates of multidrug-resistant Pseudomonas aeruginosa were evaluated. Methods: This study examined ten isolates with variable levels of resistance to ceftazidime, cefepime, piperacillin/tazobactam, meropenem, ciprofloxacin, and amikacin. The efficacy of the combined antibiotics was studied using a checkerboard method or in vitro killing assay. Results: The combination of ceftazidime, cefepime, aztreonam, piperacillin-tazobactam, or meropenem with amikacin showed synergistic effects for all of the strains regardless of the minimum inhibitory concentration (MIC) of amikacin, but combination with ciprofloxacin showed a synergistic effect for the isolate with a low MIC of ciprofloxacin by the checkerboard method. The isolates with a high MIC of ciprofloxacin showed an indifferent effect in combination with β-lactam and ciprofloxacin. The in vitro killing assay showed that meropenem with ciprofloxacin acted synergistically for the isolates with a MIC of 16 μg/mL of ciprofloxacin. However, amikacin showed synergistic effects with meropenem for the isolates with high-level resistance against amikacin, i.e., up to an MIC of 128 μg/mL. Contrary to the checkerboard method results, no synergy was observed for the combination of ceftazidime/piperacillin-tazobactam and amikacin. Conclusions: Meropenem with amikacin can be the first choice for infections caused by multidrug-resistant P. aeruginosa when the level of resistance is not known. (Korean J Med 79:41-47, 2010)

지역사회 단순 요로감염에서의 항생제 내성 및 최신 치료

배현주 ( Hyun Joo Pai ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6

Acute uncomplicated urinary tract infections (UTI), episodes of cystitis or pyelonephritis that occur in healthy non-pregnant women with no functional or anatomic abnormalities of the urinary tract, are among the most commonly encountered bacterial infections. Unfortunately, there has been a recent trend of increasing resistance to antibiotics among uropathogens in many countries including Korea. The resistance rates of Escherichia coli from acute uncomplicated UTI during 2009 to ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (SXT) and cefotaxime were 84.1%, 67.2% and 95.4%, respectively. Resistance both to SXT and CIP was detected in 10.6% of the E. coli isolates. Therefore, it is difficult to recommend the antibiotics which would not worsen the resistance problem and would be effective for community-acquired uncomplicated UTI as well. Considering the high resistance of uropathogens in Korea, several academic societies made the guideline for UTI, which will be briefly reviewed in this manuscript. (Korean J Med 2011;81:685-689)

의학강좌 : 개원의를 위한 모범처방전 ; 급성 감염성 설사

배현주 ( Hyun Joo Pai ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1

루푸스 신염 환자에서 발생한 폐 Nocardia 감염증

장선주 ( Sun Joo Chang ),이강녕 ( Kang Nyoung Lee ),성윤경 ( Yoon Kyoung Sung ),이혜순 ( Hye Soon Lee ),엄완식 ( Wan Sik Uhm ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),배현주 ( Hyun Joo Pai ),배상철 ( Sang Cheol Bae ),전석철 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.1

Nocardiosis is uncommon in healthy people, but occurs as an opportunistic infection in patients with connective tissue disease, solid organ transplantation, lung disease, malignancies, and the acquired immune deficiency syndrome (AIDS). Nocardia is a gram positive, variably acid-fast aerobic bacterium of the family Nocardiaceae characterized by branching and filamentous growth, with distinctive aerial hyphae. In systemic lupus erythematosus (SLE) patients, immunosuppressiion with cytotoxic drugs or corticosteroids, proteinuria, renal insufficiency, and active SLE itself are known as risk factors for serious bacterial infections and opportunistic infections. We report a case of pulmonary Nocardiosis in patient with lupus nephritis treated with cyclophosphamide and high dose corticosteroid.

피부근염 - 다발성근염 100예의 임상적 분석

김성민(Seong Min Kim),최윤호(Yoon Ho Choi),남택서(Taik Seo Nam),배현주(Hyun Joo Pai),오명돈(Myoung Don Oh),정문현(Moon Hyoun Chung),송영욱(Yeong Wook Song),최강원(Kang Won Choe) 대한내과학회 1990 대한내과학회지 Vol.39 No.6

N/A Polymyositis is a disorder of unknown etiology characterized by an inflammatory myopathy involving striated skeletal muscle. When characteristic skin lesions accompay the myositis, patients are diagnsed as dermatomyositis. We analyzed clinica1 and laboratory features of 100 patients with dermatomyositis polymyositis who were admitted to the Seoul National University Hospital hom January, 1981 to January, 1989. The observed results were as follows 1) The range of age was from 6 to 74 years, and the most frequent age group WBS the third decade (23.0% of all cases) and the next, the second decade (19.0% of all cases). Male to female ratio was 27:73. 2) Of the 100 patients, 32.0%. was classified as group I, 37.0% as group II, 9.0% as group III, 5.0g as group IV and 17.0% as group V. Among the patients, diagnosis was definite in 52.0% and probable in 48.0%. 3) Proximal muscle weakness was noted in 74%, myalgia 47%, arthralgia 47%, skin rash 52ii, dysphagia 20%, dysphonia 7%, alopecia 22%, Raynaud`s phenomenon 22%, and fever 48% as presenting symptoms at the time of diagnosis. 4) Serum CPK level was elevated in 62.0% SGOT 78.0%, SGPT 61.0%, and LDH 99.0%. 5) The electromyography was done in 95 patients, which revealed small polyphasic motor units (78.9%), fibrillation (63.2%), positive sharp wave (71.6%), in- creased insertion activity (11.6%), increaseed resting potential (3.2%), high frequency bizarre discharge (20.0%). A normal EMG was seen in 12.6%. 6) The muscle biopsy was done in 83 patients, which light microscopic findings were as follow: degeneration (56.6%), regeneration (10.8%), fibrosis (4.8%), necrosis (12.0%), inflammation (53.0%), vasculitis (18.1%), crossseetional diameter variation (30.1%), internalization of nuclei (16.1%). A normal pathology was noted in 8.4% 7) Antinuclear antibody was found in 19.0%, rheumatoid factor 23.8%, LE cell 9.1%, anti-ds-DNA antibody 9.3%, cryoglobulin 34.4%, false positive VDRL 1.1%, and decreased cnmplement level 8.7% ANA was noted in 70.6% of patients of group V, whereas 4.8% in patients of other group. 8) Heart involvement was seen in 36.0%. Congestive heart failure was detected in 4:0%, nonspecific ST-T change 12.0%, bundle branch block 5.0%, low voltage 9. 0%, poor R progression 3.0%, sinus arrythmia 2.0%, atrial fibrillation 2.0%, VPB 5.1%, SVPB 2.0%, and pericarditis 10.0%. Interatitial pulmonary disease was noted in 18.0% on chest X ray. FVC w as abnormal in 74:0% of 50 patients tested, abnormal DLCO was in 73.3% of 15 patients tested, and abnormal FEV1/FVC was in 18.0% of 50 patients tested. 9) Neoplasm were associated in 9 patients, 5 polymyositis and 4 dermatomyositis patients. Sites of neoplasm were stomach cancer (4 cases), colon cancer (1 case), lung cancer (1 case), nasopharyngeal cancer (1 case), lymphoma (1 case), and hepatocellular cancer (1 cancer). Mean age of the group III was 65 years, which was high relative to other group. 10) 17 patients were associated with other connective tissue disease, which were systemic sclerosis (S cases), systemic sclerosis and SLE (1 case), SLE (5 cases), RA (2 cases), hyperthyroidism (1 case), and ITP (1 case). Male to female ratio was 1:16. Polymyositis to dermatomyositis ratio was 10:7. 11) There were 14 patients who were affirmed to die. Cause of death was respiratory failure (4 cases), sepsis (3 cases), CHF (3 cases), asphyxia (1 case), sudden respiratory arrest (1 case), malignancy (1 case), suicide (1 case).

지역사회획득 폐렴의 치료지침 권고안

송재훈 ( Jae Hoon Song ),정기석 ( Ki Suck Jung ),강문원 ( Moon Won Kang ),김도진 ( Do Jin Kim ),배현주 ( Hyun Joo Pai ),서지영 ( Gee Young Suh ),심태선 ( Tae Sun Shim ),안중현 ( Joong Hyun Ahn ),안철민 ( Chul Min Ahn ),우준희 ( Ju 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.4

The successful treatment of community-acquired pneumonia requires appropriate, empirical antimicrobial therapy. The etiology and antimicrobial susceptibility of major pneumonia pathogens can differ by country. Therefore, the ideal treatment guidelines for community-acquired pneumonia should be based on the studies performed in each country. We developed a treatment guideline for community-acquired pneumonia for immunocompetent adults in Korea. This guideline was developed by the joint committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory diseases.

일개 병원 내 의료종사자에서의 결핵 접촉자 조사

김태희 ( Tae Hee Kim ),장윤숙 ( Yoon Suk Jang ),정선주 ( Sun Ju Jung ),김연재 ( Yeon Jae Kim ),배현주 ( Hyun Joo Pai ),오성희 ( Sung Hee Oh ) 대한소아감염학회 2016 Pediatric Infection and Vaccine Vol.23 No.2

목적: 대학병원에 근무하던 중 활동성 폐결핵으로 진단된 전공의에게 노출된 의료종사자들에 대하여 실시한 접촉자 조사의 결과를 보고한다. 방법: 활동성 폐결핵 환자와 밀접한 접촉을 한 사람(접촉자) 101명 중 89명이 접촉자 조사에 응하여 조사를 받았다. 1차 접촉자 조사는 지표환자의 증상 개시 후 30일경에, 2차 조사는 1차 조사 10주 후에 기침, 발열, 인후통, 체중 감소와 같은 임상증상 확인 및 단순흉부촬영과 함께 결핵반응검사(Tuberculinskin test, TST)/QuantiFERON-TB Gold (QFT-G) 2단계 검사법을 시행하였다. 결과: 1차 TST 양성자는 34명(38.2%)이었고, TST 양성자 중 35세 이하 접촉자에서 시행한 QFT-G양성률은 37.5% (6/16)이었다. 1차 TST 음성 대상자 41명에게서 시행한 2차 TST에서 17명(41.5%)이 양전을 보였고 그들 중 시행한 QFT-G 검사에서 3명(17.6%)이 양성이었다. 활동성 결핵으로 진단된 접촉자는 없었으며 지표환자에 노출되어 발생한 결핵 전파율은 2단계 검사법으로는 7.3% (3/41)였고, TST 진단법으로는 41.5% (17/41)였다. 결론: 국내에서 처음 보고되는 병원 내 결핵 접촉자 조사 연구로서 LTBI 발생률이 그 진단 기법에 따라 달랐으며 따라서 앞으로 발생할 수 있는 의료종사자들에 대한 병원 내 결핵 접촉자 조사를 위해 조직적이고 실용적인 가이드라인이 필요할 것이다. Purpose: This study aimed to describe the results of a contact investigation on health care workers after exposure to a house officer with smear-positive pulmonary tuberculosis (TB). Methods: Eighty nine out of 101 subjects who had close contact with the index patient agreed to be enrolled in the investigation. The first contact investigation was conducted approximately 30 days after the index patient’s onset of symptoms, followed by the second investigation after 10 weeks. In both, clinical manifestations were studied, and chest X-ray and tuberculin skin test (TST)/QuantiFERON-TB Gold (QFT-G) in dual screening strategy were conducted. Results: The first TST resulted in positive in 34 subjects (38.2%). QFT-G was conducted on 16 subjects who tested positive in the first TST and aged under 36. Six of them (37.5%) were positive. The second TST was conducted on 41 subjects with negative results in the first TST. Seventeen (41.5%) were positive and among them, three (17.6%) showed positive QFT-G. None of the subjects were diagnosed with active TB. The probability of TB infection through contact with the index patient was 7.3% (3/41) in dual screening strategy while it was 41.5% (17/ 41) in TST strategy. Conclusions: This first hospital-setting contact investigation for tuberculosis in Korea revealed that latent tuberculosis infection (LTBI) rates vary depending on different diagnostic strategies. This indicates the need for systematic guidelines for diagnosing LTBI in health care workers who have professional exposure to TB.

요조건하 몇가지 항생제에 대한 Postantibiotic Effect의 비교

배현주,최강원 대한화학요법학회 1990 대한화학요법학회지 Vol.8 No.2

The postantibiotic effect is defiend as suppression of bacterial growth that perisists after exposure of organisms to antimicrobial agents. Its clinical significance lies in impact on the frequency of antimicrobial administration. In lower urinary tract infection, single or short course therapy eliminates infection in most cases and the antibiotics used commonly were trimethoprim-sulfamethoxazole, amoxicillin, and ciprofiozacin. In this study minimal inhibitory concentraion and postantibiotic effect were tested in two conditions, Mueller Hinton broth at pH 7.4 with Mg concentration of 1.5mM and Mueller Hinton broth at pH 5.5 with Mg concentration of 8mM. PAE of S. aureus observed were 1.3 hours with amoxicillin, 0.7 hours with trimethoprim-sulfamethoxazole, 0.4 hours with ciprofloxacin in MHB at pH 5.5 with Mg concentration of 8mM and were not different from that in MHB at pH 7.4 with Mg concentration of 1.5mM. PAE of S. fecalis were 0.7 hours with amoxicillin, 0.6 hours with trimethoprim-sulfamethoxazole, 0.7 hours with ciprofloxacin. PAE of E. eoli were 0 hours with amoxicillin, 0.4 hours with trimethoprim-sulfamehoxazole, 2 hours with ciprofloxacin. PAE of K. pneumoniae and P. aeruginosa with ciprofloxacin were 1.25 hours and 1.5 hours and were similar to PAE in MHB at pH 7.4 with Mg concentration of 1.5mM.

폐외결핵 진단에서 Gallium Citrate Scan의 의의

배현주,우준희,고창순,오명돈,이명철,김양수,정문현,최강원 대한감염학회 1990 감염 Vol.22 No.2

Gallium citrate scans were performed in 20 patients with extrapulmonary tuberculosis to evaluate the diagnostic potonitial of this test. The diagnosis of extrapulmonary tuberculosis were confirmed by biopsy and culture in 17 cases and other indirect methods in 3. There were 12 patients with lymphadenopathy, 3 with peritonitis, 2 with intestinal the 1 with renal, spinal and miliary dissemination respectively. Postitive gallium citrate scintigraphy were obtained in 90% of patients. False negative results were obtained in one patient with tuberculosis of mediastrinal lymph node and another patient with renal tuberculosis. We conclude that 67-Ga citrate scintigraphy is useful screening test for the detection of extrapulmonary focus of tuberculosis, thus can be a useful adjunct test for the study of fever of unknown origin.