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동종골수이식후 감염양상의 변화 : 1983년~1988년과 1989~1992년 사이의 비교 Comparison Between 1983~1988 and 1989~1992
최종영,신완식,유진흥,김양리,강문원,김학기,김원일,김동욱,이종욱,민우성,박종원,김춘추,김동집 대한화학요법학회 1993 대한화학요법학회지 Vol.11 No.2
저자들은 골수이식 후 감염양상의 변화를 보기위하여 1989년 2월부터 1992년 10월까지 카톨릭 대학교 의과대학 부속 성모병원에 입원하여 이식을 받은 87명의 환자를 대상으로 조사하였고, 1983년 3월부터 1989년 2월까지 동 병원에서 얻은 결과와 비교하여 다음과 같은 결과를 얻었다. 1. 총발열 횟수는 양 기간동안에 유의한 차이가 없었고, 발열시기를 보면 이식편의 생착전 발열횟수가 전반기에는 37.4%였으나 최근에는 53.3%로 증가하였고 이식 후기 발열 횟수는 29.3%에서 13.3%로 감소하는 양상을 보였다. 2. 원인균은 전반기에 그람 양성균이 31.7%, 그람 음성균이 34.1%였으나 최근에는 각각 36.8%, 31.6%로 큰 차이를 나타내지 않았다. 그람 양성균중에는 포도구균이 64.2%, 그람 음성균 중에는 녹농균이 66.6%로 가장 높은 빈도를 보였다. 3. 감염 부위는 호흡기 감염이 40.7%에서 17.9%로 감소하였고, 세균 혈증 및 인두부 감염이 각각 16.9%, 10.2%로 증가하였다. 4. 감시배양에서 비인두부에서는 coagulase 음성 포도구균이 25.7%에서 56.9%로 증가하였고 특히 황색포도구균의 빈도가 증가하였다. 녹농균은 19.6%에서 5.9%로 감소하는 양상을 보였다. 대변에서는 최근에 Candida albicans Torulopsis glabrata, Enterococcus가 증가하였다. 5. 발열 당시 흉부 XTJS 양상은 양 기간동안에 간질형 침윤이 과반수 이상의 빈도를 보였고 결절성 및 고형질화 침윤은 유의한 차이를 보이지 않았다. 골수이식 후 감염을 이식의 성공을 좌우하는 중요한 요인으로서 감염으로 인한 사망을 줄이기 위하여 감염의 조기 진단이 필요하고 과립구 감소기 감염의 대책으로 GM-CSF 등의 사용이 필요하다고 생각된다. We have compared eighty0seven allogeneic one marrow transplanation(BMT0 recipient from March-1989 to October 192 with sixty-four post-BMT patients from March-1983 February-1989 in terms of infection trend. The results were as follow;s; 1. The incidence of early post-BMT infection increased to 56 cases(53.3%, wheres that of late infection 100days after BMT decreased to 14 cases(13.3%). The total febrile episodes were 105. 2. Microbiologically defined infections(MDI) were reported in 17 cases(30.3%), and clinically defined infections(CDI) were determined in 22 cases, The majority of infection iste was blood and oropharyngeal area. 3. Among the isolated microorganisms in MDI, gram negative bacteria appeared in 12 cases(31.6%), gram positive bacteria were in 14 cases(36.85), fungi were shown in 6 cases, and mixed infection occurred in 6 cases. 4. Surveillance culture on nasopharyngeal area showed significantly increased incidence of coagulase-negative Staphylococci from 20 cases(20/660 to 41 cases(41/86). 5. The incidence of granulocyle counts over 1000/㎣ on febile episodes decreased to nine cases(12%), whereas that below 500/㎣ increase to 56 cases(75%).
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Staphylococcus aureus와 Coagulase-Negative Staphylococcus Species에 대한 Arbekacin의 시험관내 항균력
위성헌,강진한,허동호,이동건,김상일,김양리,최정현,김종현,유진흥,허재균,신완식,강문원 대한감염학회 2001 감염 Vol.33 No.4
Background : Most strains of methicillin-resistant Staphylococcus aureus (MRSA) now exhibit high-level resistance to various antibiotics, such as β -lactam antibiotics, aminoglycosides, macrolides, tetracyclines and quinolones. Recent reports describing the therapeutic failure of vancomycin for MRSA infections have arisen considerable concerns regarding the emergence of MRSA strains, which will require new therapeutic agents. Arbekacin, an aminoglycoside antibiotic, has antibacterial activity against both gram-positive and gram-negative bacteria and is stable in the presence of aminoglycoside inactivating enzymes produced by S. aureus. In this study, we compared the antibacterial activity of arbekacin with those of vancomycin, gentamicin, and amikacin against Staphylococcus aureus (S. aureus) and coagulase-negative staphylococci (CNS). Methods : For a collection of 549 S. aureus and 251 CNS isolates from three Catholic University Hospitals in Korea, minimum inhibitory concentrations (MICs) of arbekacin, vancomycin, amikacin and gentamicin were determined by agar dilution method using Mueller-Hinton agar according to NCCLS (National Committee for Clinical Laboratory Standards, USA)criteria. Results : Among 549 S. aureus isolates, 278 isolates were MRSA and 271 isolates were methicil sensitive S. aureus (MSSA). MIC50 & MIC90 of arbekacin against 549 S. aureus were 0.5 & 1 ㎍/mL, and MIC50 & MIC90 of vancomycin were 1 & 1 ㎍/mL. MIC of arbekacin against 549 S. aureus isolates ranges from 0.03 to 4 ㎍/mL, and MIC of vancomycin against 549 S. aureus ranges from 0.25 to 2 ㎍/mL. MIC90 of amikacin against 549 S. aureus was 32㎍/mL, and that of gentamicin was 128 ㎍/mL. MICs of amikacin and gentamicin were variable, ranging from 0.125 to 256, and otherwise arbekacin and vancomycin revealed relatively narrow range of MICs. MIC90 of arbekacin against 278 MRSA isolates & 271 MSSA were 1 & 0.5 ㎍/mL, and those of vancomycin against MRSA & MSSA were 1 & 1 ㎍/mL. MIC90 of amikacin against 278 MRSA & 271 MSSA isolates were 32 & 4 ㎍/mL, and that of gentamicin against MRSA & MSSA isolates were 128 & 32 ㎍/mL respectively. Among 251 CNS isolates, 122 isolates were MRCNS and 129 were MSCNS. MICSO & MIC90 of arbekacin against 251 CNS isolates were 0.25 & 2 ㎍/mL, and those of vancomycin were 1 & 2 ㎍/mL. MIC of arbekacin against 251 CNS isolates ranges from 0.015 to 32 ㎍/mL, and that of vancomycin isolates ranges from 0.25 to 2 ㎍/mL, MIC90 of arbekacin against 122 MRCNS & 129 MSCNS isolates were 2&0.3 ㎍/ML, and those of vancomycin were 2&s ㎍/ML. MIC90 of amikacin against 251 CNS isolates was 32 ㎍/ML, and that of gentamicin was 128 ㎍/ML for CNS. MIC90 of amikacin against 122 MRCNS & 129 MSCNS isolates were 128 & 8㎍/mL, and those of gentamicin ere 256 & 32 ㎍/mL. Conclusion : Considering above results, arbekacin can be useful agent against most strains of MRSA and MRCMS, which exhibit high-level resistance to amikacin and gentamicin. (Korea J Infect Dis 33:254~260, 2001)
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