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내시경적 역행성 담췌관조영술 후의 발열에 대한 연구 - 위험인자와 예방적 항생제 사용 효과 분석 -
서승오(Seong O Seo),천재희(Jae Hee Chun),김상균(Sang Kyun Kim),김진(Jin Kim),장유현(Yoo Hyun Chang),김용태(Yong Tae Kim),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Background/Aims : Fever and cholangitis can be serious complications after endoscopic retrograde cholangiopancreatography (ERCP). The risk factors of these complications and the efficacy of prophylactic antibiotics are not clearly verified yet. In this study, we investigated the frequency, risk factors, pathogens of the fever after ERCP, and evaluated the effect of prophylactic antibiotics. Methods : Retrospective analysis was performed on 674 patients who underwent ERCP between 1996 and 1999. Results : Fever after ERCP occurred in 68 of 674 cases (10.1%). Twenty-six kinds of bacteria were isolated in 23 of 68 febrile cases (33.8%). Fever occurred more frequently in patients (33.4%) in whom therapeutic ERCP failed to remove common bile duct (CBD) stones or to drain obstructed bile duct than in patients (7.3%) with effective drainage (p<0.001). Therapeutic procedure after ERCP caused fever more frequently (16.7%) than diagnostic ERCP only (4.2%)(p=0.03). Moreover, fever was also developed frequently after endoscopic retrograde biliary drainage (ERBD). Prophylactic administration of more than 2 kinds of antibiotics can reduce the rate of fever occurrence after ERCP. Conclusions : Therapeutic ERCP procedures especially after ERBD or unsuccessful biliary drainage were the high risk factors for fever after ERCP. Prophylactic antibiotic treatment using more than two kinds of antibiotics can reduce the incidence of the fever after ERCP. (Kor J Gastroenterol 2000;36:390 - 397)
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지역사회획득 메티실린 내성 황색포도알균에 의한 연조직 감염 1예
유서희 ( Seo Hee Ryu ),유창민 ( Chang Min Yu ),서승오 ( Seong O Suh ),김준환 ( Jun Hwan Kim ),고유진 ( Yu Jin Ko ),박재현 ( Jae Hyun Park ),조재현 ( Jae Hyun Cho ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2
메티실린 내성 황색포도알균 Methicillin-resistant Staphylococcus aureus (MRSA)는 우리나라를 비롯한 전 세계 여러 지역에서 병원 내 감염의 중요한 원인균으로 전 세계 여러 지역에서 위험인자가 전혀 없는 건강한 일반인에서 의지역사회 관련 MRSA (community-associated MRSA, CA-MRSA)에 의한 감염증 보고가증가하고 있다. CA-MRSA감염증은 기존의MRSA감염증과는 구별되는 특징들을 가지는데 임상적으로는 피부 및 연조직 감염증이 흔하고 실험실적으로는 비베타락탐(non-beta lactam)계 항생제에 감수성인 경우가 많아서 국외의 연구와 치료 지침에서는 통상적인 vancomycin 외에 비베타락탐(non-beta lactam)계 항생제 치료를 제시하고 있으며 CA-MRSA에 의한 피부 및 연조직 감염증의 대다수의 환자들은 항생제 사용 없이도 절개와 배농만으로도 임상적 호전을 보인다는 보고가 많아서 적절한 항생제의 사용과 더불어 적극적으로 외과적 배농술을 시행하여야 한다고 권고하고 있다.이러한 기존의 연구 자료와 문헌의 내용을 바탕으로 연자들은 CA-MRSA에 의한 연조직 감염에서 감수성으로 확인된 여러 가지비베타락탐계 항생제로 치료를 시도하였으나 치료에 반응을 보이지 않았고 vancomycin에만 치료에 반응을 보여 vancomycin의 적극적인 투여와 수술적 배액으로 성공적으로 치료한 연조직 감염 1예를 경험하였기에 국내에서도 지역사회획득 메티실린 내성 황색포도알균에 의한 감염 질환이 발생 할 수 있다는 점에 대해서 다시 인식하고 치료에 있어서 vancomycin 투여를 보다 적극적으로 고려하고자 문헌고찰과 함께 보고하는 바이다. Methicillin-resistant Staphylococcus aureus (MRSA) is a prime infection-causing bacterium in various parts including South Korea around the world. Reports are increasing that in various parts of the world, in general people without no risk factors, community-associated MRSA or CA-MRSA infection occurs. CA-MRSA infection symptoms have characteristics different from the existing MRSA infection symptom; clinically, they are characterized by frequent skin and soft-tissue infection, while experimentally, they are sensitive to non-beta lactam antibiotics. Thus, overseas stud iesand treatment guidelines present non-beta lactam antibiotics treatment in addition to the usual vancomycin. Many reports say that most of patients suffering skin and soft-tissue infection due to CA-MRSA have improved clinically only with incision and draina gewithout using antibiotics, thus offering a recommendation that along with appropriate use of antibiotics, surgical drainage should be positively performed. Based on such existing studies, authors attempted to treat soft-tissue infection caused by CA-MRSA, using various non-beta lactam antibiotics as confirmed by such infection, but found that the disease did not respond to such treatment attempts, while it responded only to the treatment by vancomycin. Thus, one case is hereby reported in which, with a positive injection of vancomycin and surgical drain, a successful treatment was achieved in soft-tissue infection. This report also aims to indicate the possibility that in South Korea as well, CA-MRSA-infected diseases may occur, alerting the awareness thereof, and to more positively consider the injection of vancomycin along with literature studies.
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만성 신부전 환자에서 발생한 대장암과 유사한 거대세포바이러스 대장염 1예
김준환 ( Jun Hwan Kim ),김윤권 ( Youn Kwon Kim ),정준오 ( Jun Oh Jung ),서승오 ( Seong O Suh ),이세한 ( Se Han Lee ),고유진 ( Yu Jin Ko ),박재현 ( Jae Hyun Park ),유서희 ( Seo Hee Ryu ),유지원 ( Ji Won Yoo ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2
Cytomegalovirus (CMV) colitis is common among immunocompromised patients, those with Human Immunodeficiency Virus (HIV) infection, those undergoing immunosuppressant therapy after organ transplantation, those undergoing anti-cancer chemotherapy and long-term steroid users. Though some patients with chronic renal failure also have a defective immune response, CMV colitis is extremely rare in them. Colonoscopy in patients with CMV colitis usually shows diffuse or localized ulceration although mucosal friability, erosions, hemorrhage and plagues such as pseudomembranes may be observed. Rare cases of discrete gastrointestinal mass lesions caused by CMV have been also reported. A 69 year-old male with chronic renal failure who was undergoing hemodialysis therapy visited our hospital for regular checkup. He had no symptoms but his colonoscopic exam showed 2cm sized mass like lesion suggesting coloncancer. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis. A colonoscopic follow-up showed complete healing of the mass lesion and he is doing well now without further treatment. Although CMV colitis is rarely associated with chronic renal failure and mass formation, it could be considered.
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