카바페넴 내성 그람 음성균 감염의 항생제 치료

위유미 ( Yu Mi Wi ),강철인 ( Cheol-in Kang ) 대한내과학회 2019 대한내과학회지 Vol.94 No.2

카바페넴 내성 그람음성균 감염의 항생제 치료

위유미 ( Yu Mi Wi ),강철인 ( Cheol-in Kang ) 대한내과학회 2018 대한내과학회지 Vol.93 No.5

Carbapenem-resistance emerging in Gram-negative pathogens, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, has become a major human health problem globally. The therapeutic options available for carbapenem- resistant pathogens are very limited. Antibiotics such as colistin, tigecycline, fosfomycin, and aminoglycosides are often the only ones that can be used to treat carbapenem-resistant pathogens. Carbapenem may still be an option in certain circumstances. The administration of combination therapy for carbapenem-resistant pathogens is controversial. This review presents the current knowledge of available antimicrobial therapeutic options for infections due to carbapenem-resistant pathogens in Korea. (Korean J Med 2018;93:439-446)

동종 조혈 모세포 이식 환자에서 감염증의 양상에 대한 고찰

이지영 ( Ji Young Rhee ),장은희 ( Eun Hee Jang ),김승태 ( Seung Tai Kim ),위유미 ( Yu Mi Wi ),손경목 ( Kyong Mok Son ),정혜숙 ( Hae Suk Cheong ),기현균 ( Hyun Kyun Ki ),오원섭 ( Won Sup Oh ),김기현 ( Ki Hyun Kim ),정철원 ( Chul Wo 대한내과학회 2007 대한내과학회지 Vol.72 No.2

목적: 조혈 모세포 이식을 받은 환자의 감염증의 양상을 분석하고, 감염증이 사망률에 미치는 영향과 사망률에 대한 위험인자의 예측 근거를 제시 하고자 한다. 방법: 1996년 2월에서 2003년 10월까지 본원에서 동종 조혈 모세포 이식을 받은 환자를 대상으로 후향적으로 조사하였다. 결과: 총 139명의 환자들이 조혈 모세포 이식을 시행 받았으며, 연령의 중앙값은 33.9세였고 추적관찰기간의 중앙값은 18.8개월이었으며, 감염성 합병증의 평균 발생빈도는 3.24±3.00회/인이었다. 총 450회의 감염증이 관찰되었고, 이 중 미생물학적으로 확인된 감염이 41.6%였으며 임상적으로 확인된 감염증은 34.0%, 불명열이 24.4%를 차지하였다. 감염성 합병증은 대부분 조기 회복기에 발생하였으며 전체의 39.6%가 이 시기에 발생하였고, 만기 회복기, 중간 회복기 순으로 각각 32.4%, 24.4%를 차지하였다. 미생물학적으로 확인된 감염의 187개의 사례 중에 세균감염이 94회였고, Coagulase-negative staphylococci가 15회로 가장 많이 분리되는 균종이었다. 미생물학적으로 확인된 감염 중 바이러스 감염은 78회로 41.7%를 차지하였으며, CMV감염증이 가장 많았다. 진균의 경우 전체 미생물학적으로 확인된 감염 중 7.5%를 차지하였으며, 이 중 Aspergillus spp.가 가장 많았다. 감염과 연관되어 사망한자 19명 중 12명(63.2%)이 만기회복기에 발생하였다. 감염성 사망률에 대한 위험요인으로는 기저 질환의 위험도, 호중구 감소 기간, 조혈 모세포 생착 실패, 급성/만성 이식 편대 숙주 반응등이 통계적으로 유의하게 나왔다(p<0.05). 결론: 급성/만성 이식 편대 숙주 반응과 연관하여 높은 감염성 사망률을 보였으며, 이는 특히 후기 감염과 연관된다. 또한, 진균감염 특히, candida 감염증의 빈도가 낮은 병원에서는 fluconazole 예방적 사용의 임상적 효과는 분명치 않다. Background: We wanted to investigate the effect of infectious complications on the outcome of patients who received allogeneic hematopoietic stem cell transplantation (HSCT), and we determined the risk factors for predicting infectious complication and the mortality in allogeneic HSCT recipients. Methods: We enrolled all the patients who underwent allogeneic HSCT at Samsung Medical Center from February 1996 to October 2003. Results: A total of 139 patients were enrolled. A total of 450 infectious episodes were observed in 131 allogeneic recipients (90.8%). Infectious complications occurred in the allogeneic recipients [3.243.00 episodes/patient]. Microbiologically documented infection (MDI), clinically documented infection (CDI), and unknown fever (UF) accounted for 41.6%, 34.0% and 24.4%, respectively, of the total infections. Pneumonia (15.1%) was the most common infection. Among the 187 MDIs, bacterial infection, viral infection and fungal infection accounted for 50.3%, 39.6%, and 7.5%, respectively. Twelve of 24 deaths in the late post-transplantation period were related with infection. The statistically significant risk factors for infection related to mortality, by multivariate analysis, were the underlying disease risk, the duration of neutropenia, the failure of stem cell engraftment, acute GVHD, MDI, UF, the number of infectious episodes, bacteremia, fungemia, pneumonia, genitourinary tract infections, S. aureus, E. coli, Pseudomonas spp., Aspergillus spp., Non-albicans candida and CMV diseases. Conclusions: The incidence of fungal infections was still low in our institute, even though prophylaxis for fungal infections was not applied, except for gargling with nystatin. In addition, most of them were non-albican Candida and Aspergillus species. Therefore, routine fluconazole prophylaxis may not be needed in our institute. (Korean J Med 72:200-208, 2007)

황색포도알균에 의한 감염성 심내막염의 임상적 특성

백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ),김은석 ( Eun Seok Kim ),주은정 ( Eun Jeong Joo ),하영은 ( Young Eun Ha ),위유미 ( Yu Mi Wi ),정혜숙 ( Hae Suk Cheong ),이진서 ( Jin Seo Lee ),강철인 ( Cheol In Kang ),정두련 ( Doo 대한내과학회 2009 대한내과학회지 Vol.76 No.3

Background/Aims: The risk factors and clinical outcome of infective endocarditis (IE) have changed over the past few decades. Recently, the incidence of Staphylococcus aureus IE (SAIE) has increased. We investigated the clinical and microbiological characteristics and clinical outcomes of SAIE. Methods: All patient cases that were diagnosed as IE according to the modified Duke criteria in Samsung Medical Center during the period of January 1995 to December 2006 were reviewed retrospectively. The clinical and microbiological characteristics of patients with SAIE were compared to those of non-SAIE patients with IE. Results: We enrolled 304 patients with IE. Of these, 240 cases were IE culture-positive, including 73 cases of SAIE. The mean age of patients with SAIE was 48.15±19.87 years, with male patients accounting for 71.2% of our study group. Congenital heart disease (8.2%) was less common among SAIE patients. Hospital-acquired IE was significantly more common in SAIE than in non-SAIE cohorts (p<0.05). Surgical treatment was performed in 33 cases (45.2%). Valvular regurgitation with heart failure was the most frequent cause of surgery (39.3%). Twenty-three cases exhibited complications, including extra cardiac embolization (16.4%) and heart failure (5.6%). Fever persisting for a period longer than seven days was more common among those in the SAIE group. Twelve patients (16.4%) died and four patients (5.4%) were discharged without hope of improvement. The in-hospital mortality rate was higher among SAIE patients (17.3%) compared to that among non-SAIE patients (11%), although this comparison was not statistically distinct (p>0.05). Methicillin resistance and non-surgical treatment were significant risk factors for in-hospital mortality. Conclusions: SAIE is more strongly associated with systemic embolization, persistent fever, and longer hospital stays compared to non-SAIE. Further studies are warranted to evaluate adequate treatment and to improve the outcome of patients with SAIE. (Korean J Med 76:329-337, 2009)

증례 : 감염; 패혈증 비브리오균에 의한 위장관염에 이은 급성 화농성 척추염 1예

옥혜성 ( Hea Sung Ok ),김병기 ( Byeong Ki Kim ),김기훈 ( Ki Hoon Kim ),박만제 ( Man Je Park ),이현수 ( Hyoun Soo Lee ),위유미 ( Yu Mi Wi ),강철인 ( Cheol In Kang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4

본 저자들은 문헌에 보고된 바가 없는 패혈증 비브리오균에의한 위장관염에 이은 급성 화농성 척추염을 경험하였기에문헌고찰과 함께 보고하는 바이다. Vibrio vulnificus is a halophilic gram-negative bacillus capable of causing severe to life-threatening infections in high-risk populations. Osteomyelitis caused by V. vulnificus is extremely rare, and a previously reported case had been associated with an adjacent soft-tissue infection. Herein we report the first case of vertebral osteomyelitis resulting from hematogenous spread of V. vulnificus gastroenteritis. The patient was successfully treated with a combination of cefotaxime and ciprofloxacin. (Korean J Med2014;86:519-522)

폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예

이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.

폐렴구균 감염에 의한 복부 대동맥류 1예

최소연,백경란,기현균,문치숙,오원섭,송재훈,신동현,위유미,고영혜 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

폐렴구균은 폐렴, 수막염, 중이염 등의 감염증을 일으키나 감염성 대동맥류를 유발하는 경우는 매우 드물다. 저자들은 고혈압, 당뇨병 등을 가지고 있으며 대동맥류가 확인되지 않았던 78세 남자 환자에서 감염증의 증상없이 대동맥류 파열로 내원하여 폐렴구균에 의한 대동맥류로 진단되었던 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Streptococcus pneumoniae has been an important etiologic agent of community-acquired pneumonia, meningitis, and otitis media. S. pneumoniae is also an important cause of bacteremia, especially in a community setting and it may cause intravascular infection. S. pneumoniae has been rarely been reparted to cause mycotic aneurysm and three is no case report on abdominal aneurysm caused by S. pneumoniae in Korea, yet. We experienced a case of abdominal aneurysm caused by S. pneumoniae infection. A 78-year old male with hypertension and diabetes mellitus was transferred to our hospital due to ruptured abdominal aortic aneurysm. Surgical intervention was done for removal of hematoma and vascular anastomosis. Ascending aorta showed atheromatous plaque with dystrophic calcification and thrombus. S. pneumoniae was isolated from the culture of the surgical specimen. After successful treatment with antibiotics for 7 weeks, he has been followed up uneventfully in outpatient clinic for 1 year.