3개월 이하 영아기 열성 요로감염증에 대한 임상적 관찰

은병욱,정유미,강희경,하일수,정해일,이환종,최용,Eun, Byung Wook,Chung, Yoo Mi,Kang, Hee Gyung,Ha, Il Soo,Cheong, Hae Il,Lee, Hoan Jong,Choi, Yong 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.3

목 적 : 3개월 이하 연령의 요로감염증 환자 41례의 임상 양상과 특히 균혈증과 뇌수막염의 동반 양상을 관찰하고자 하였다. 방 법 : 5년 9개월 동안 서울대학교병원 소아과에서 요로감염증을 진단 받고 퇴원한 환자 중에서 연령이 3개월 이하이고 요세균 배양 검사에서 집락형성단위가 $10^5/mL$ 이상이면서 내원 당시 발열과 농뇨가 있었던 예의 의무기록을 분석하였다. 이전에 알려진 비뇨기계 기형이나 면역결핍증이 있거나 원내감염의 경우는 조사대상에서 제외하였다. 결 과 : 남녀 비는 5.8 : 1이었다. 요 세균 배양 검사 결과 41례의 요로감염증 환자에서 40례(97.6%)에서는 단일 균주가, 1례에서는 2개의 균주가 배양되었다. 이 중 E. coli가 34주(83%)로 가장 많았다. 5례(12%)에서 균혈증이 동반되었다. 이중 E. coli가 4주, Enterococcus faecalis가 1주였다. 배양검사 양성의 뇌수막염이 동반된 예는 없었고 뇌척수액의 세포증다증(pleocytosis)도 없었다. 균혈증이 동반된 군과 동반되지 않은 군간에 임상 양상의 차이는 없었다. 방관요관역류의 빈도는 배뇨중 방광요도 조영술을 시행받은 환자의 44%였다. 초음파검사의 방광요관 역류 발견에 대한 민감도는 38%, 특이도는 50%였다. 결 론 : 임상적 특징과 검사 결과는 증상 발현 당시에 균혈증이 동반된 환자를 발견하는데 도움을 주지 못했다. 따라서 모든 3개월 이하 열성 요로감염증 환자에서 혈액배양검사는 필요하다. 열성 요로감염증 소아 환자에서 뇌척수액 검사의 적응증을 밝히기 위한 대규모의 연구를 비롯하여 3개월 이하 연령의 요로감염증 환자군의 진단적 접근과 치료에 대한 연구가 진행되어야 하겠다. Purpose : To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis Methods : Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of ${\geq}10^5$ colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study. Results : The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%. Conclusion : Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.

임신전 여성의 감염관리 및 필수 예방접종

은병욱 한국모자보건학회 2009 한국모자보건학회 학술대회 연제집 Vol.2009 No.2

소아 및 청소년 결핵의 특징

은병욱 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.5

In childhood tuberculosis, it is possible to clearly distinguish among three basic stages: exposure, infection, and disease. The incidence of tuberculosis in children is low compared with that in adults, but latent infection is a major concern because children, who are exposed to Mycobacterium tuberculosis especially early in childhood, are at increased risk of developing the disease. Younger children particularly infants have a high relative risk of miliary or meningeal disease. The clinical manifestations of childhood tuberculosis differ noticeably from those of the disease seen in adults. Adolescents with tuberculosis have different demographic and clinical features from those of adults or children. Tuberculosis in adolescents has become relatively more important as the incidence of infection in childhood has decreased.

소아에서 신이식후 발생한 Posttransplant Lymphoproliferative Disease(PTLD) 1례

은병욱,박은실,이성용,한혜원,장주영,박경미,김철우,강진한,고재성,하일수,이환종,정해일,서정기,Eun, Byung-Wook,Park, Eun-Sil,Lee, Seong-Yong,Hahn, Hye-Won,Jang, Ju-Young,Park, Kyung-Mi,Kim, Chul-Woo,Kang, Gin-Han,Ko, Jae-Seong,Ha, Il-Soo,Lee, 대한소아신장학회 2002 Childhood kidney diseases Vol.6 No.1

이식후 발생하는 림프증식성 질환(PTLD)은 양성 다크론성 B림프구 증식증으로부터 악성의 단크론 림프종에 이르기까끼 다양한 임상상을 보이는 질환이다. PTLD는 Epstein-Barr virus(EBV)와 과도한 면역억제와 밀접한 관계가 있다. 국내에서는 1997년 성인에서 신 이식 후 발생한 예가 처음 보고되었으며, 소아에서는 간 이식 후 발생한 예가 있을 뿐 신 이식 후 발생한 증례의 보고는 없어 이 보고가 국내 최초로 신이식 소아에서 발생한 PTLD 증례이다. 환자는 9세 남아로서 긴이식후 4개월후에 PTLD가 발생하였으며 주된 임상 양상은 발열, 림프절 종대와 혈변이었다. 림프절과 대장의 생검조직 에서 EBV in situ hybridization이 양성이고, 조직학적으로 B 세포계열의 PTLD에 합당한 소견이었다. 모든 증상은 면역억제제 감소와 ganciclovir 치료로 완전 관해되었다. Posttransplant lymphoproliferative disease (PTLD) represents a diverse lymphoproliferative disorder ranging front nonspecific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus (EBV) infection and high dose immunosuppression. PTLD after renal transplantation was reported at first in adult in Korea in 1997. In children there have been several cases of PTLD after liver transplantation but PTLD after renal transplantation has not been reported. This is a case report of PTLD developed 4 months after renal transplantation in a 9-year-old boy. The major clinical manifestations were fever, multiple lymph nodes enlargement and blood-tinged stool. EBV was detected by in-situ hybridization in the enlarged cervical lymph node and the colonic tissue. Histological examination revealed B-cell lineage. Use of ganciclovir and reduction of the immunosuppression level resulted in complete remission of PTLD. This is the first pediatric case report of PTLD following renal transplantation in Korea. (J Korean Soc Pediatr Nephrol 2002 ; 6 : 123-30)

장구균에 의한 소아 균혈증 : 50예에 대한 분석 A Review of Fifty Episodes in a Pediatric Hospital

은병욱,정은희,김영지,김제학,이환종 대한감염학회 2003 감염과 화학요법 Vol.35 No.3

목적 : 미국에서는 지난 15년간 장구균(enterococcus)에 의한 균혈증이 증가하고 있는 추세이지만, 국내에서 특히 소아 연령에서는 이에 대한 체계적인 연구가 미흡하다. 이에 본 연구에서는 장구균에 의한 소아 균혈증의 역학과 임상 경과 등을 분석하였다. 방법 : 서울대학교 어린이병원에서 1992년 11월부터 2001년 8월까지 9년간 진단된 장구균 균혈증 50예의 임상적, 미생물학적 자료를 후향적으로 분석하였다. 결과 : 기저 질환은 47예(94%)에서 관찰되었으며 심장 또는 복부 수술이 44%, 심질환이 30%, 만성 소화기계 질환이 16% 등이었다. 38예(76%)는 병원내 감염이었고 14예(28%)는 중복감염이었다. 균혈증의 원발병소가 16예(32%)에서 발견되었으며 중심정맥용 도관이 가장 많았다. 47예에서 장구균의 종을 밝혔으며 Enterococcus faecium이 20예, Enterococcus faecalis이 26예, Enterococcus avium이 1예 있었다. E. faecium의 72%가 ampicillin에 내성이었다. Gentamicin과 streptomycin에 고도내성을 보인 균주가 각각 36균주(80%)와 15균주(36%)였다. Vancomycin에 내성인 균주는 없었다. 임상경과를 세 가지로 분류할 수 잇었다. 자연 호전되는 균혈증 : 20%, 적절한 치료로 양호한 예후를 보인 경증의 패혈증 : 42%, 중증의 장기간의 감염 : 30%, 미분류군 : 8%, 전체 사망률은 10.8%였다. 결론 : 소아 장구균 균혈증은 병원내 감염에 의한 경우가 대부분이었으며, 대다수가 중증의 기저 질환을 갖고 있었고 임상 경과가 이질적인 군이 있었다. 그리고 균혈증을 일으킨 장구균은 높은 빈도에서 gentamicin에 고도내성을 보였다. Background: Episode of Enterococcal bacteremia has increasingly been reported for the past 15 years in USA, but there have been few systematic studies on its occurrence among Korean children. This study was carried out to determine the epidemiologic, clinical and laboratory characteristics of enterococcal bacteremia in Korean children. Methods: Fifty episodes of enterococcal bacteremia among Korean children were retrospectively analyzed. Clinical and microbiological data were collected for all episodes of enterococcal bacteremia which occurried during 9-year period between November, 1992, and August, 2001 at the Seoul National University Children's Hospital. Results: Significant underlying diseases were present in 47 (94%) episodes, including cardiac or abdominal surgery (44%), cardiac disease (30%), and chronic gastrointestinal disorders (16%). Thirty-eight (76%) episodes were nosocomial in origin, and 14 (28%) episodes were polymicrobial bacteremia. The source of bacteremia was identified in 16 (32%) episodes, intravascular device being the most common identifiable source. Of the 47 isolates identified at species level, 20 strains were Enterococcus faeciurn, 26 Enterococcus faecalis and one Enterococcus avium. Seventy-two percent of E. faecium cases were resistant to ampicillin. 36 cases (80%) had high-level resistance to gentamicin and sixteen cases (36%) to streptomycin. There was no strain resistant to vancomycin. Three clinical patterns were identified; self-limited bacteremia, 20%; low grade sepsis with favorable outcome after specific therapy, 42%; severe and prolonged infection, 30%; and unclassified, 8%. The overall mortality rate was 10.8%. Conclusion: Enterococcal bacteremia in children was usually nosocomial and comprised a heterogeneous group. The majority of cases occurred in children with serious underlying diseases. The frequency of high-level resistance to gentamicin in enterococcal isolates was high.

장구균에 의한 소아 균혈증 : 50예에 대한 분석

은병욱,정은희,김영지,김제학,이환종 대한감염학회 2003 Infection and Chemotherapy Vol.35 No.3

소아청소년 영역에서의 새로운 항미생물제

은병욱 대한소아감염학회 2009 Pediatric Infection and Vaccine Vol.16 No.1

There are relatively few novel antimicrobial agents despite the dramatic increase in antimicrobial resistance and multiple drug resistance of clinical isolates worldwide. Vancomycin is still the most widely used antibiotic for treating resistant Gram-positive coccal infections in children, especially for methicillin-resistant Staphylococcus aureus. For children with Gram-positive coccal infections where vancomycin is not effective or older therapeutic agents cannot be tolerated, linezolid, quinupristin-dalfopristin or daptomycin may be useful in the appropriate clinical setting. For Gram-negative bacterial infections, new carbapenems await clinical application. Tebipenem pivoxil is a novel oral carbapenem undergoing clinical trials for acute otitis media in pediatric patients. Antiviral drug development is now progressing at the pace of antibiotic development 30 years ago. Newer antiviral agents used for the treatment of herpes viruses and hepatitis C virus infections in children are included in this review.

신생아중환자실 감염관리 국내 표준지침

은병욱 한국모자보건학회 2018 한국모자보건학회 학술대회 연제집 Vol.2018 No.2

소아 외래 호흡기계 질환 항생제 처방의 적절성 평가

김동숙,은병욱,이근우,김묘정,이은지,박수은,조대선,최수한 건강보험심사평가원 심사평가연구소 2018 연구보고서 Vol.2018 No.10

Diagnosis of Pneumococcal Pneumonia: Current Pitfalls and the Way Forward

송준영,은병욱,Moon H. Nahm 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.4

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomaticallycolonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizingthe upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is achallenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcalpneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relativelyslow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularlyantigen (teichoic acid and capsular polysacc arides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, it can also asymptomatically colonize the upper respiratory tract. Because of the need to distinguish between S. pneumoniae that is simply colonizingthe upper respiratory tract and S. pneumoniae that is causing pneumonia, accurate diagnosis of pneumococcal pneumonia is a challenging issue that still needs to be solved. Sputum Gram stains and culture are the first diagnostic step for identifying pneumococcal pneumonia and provide information on antibiotic susceptibility. However, these conventional methods are relatively slow and insensitive and show limited specificity. In the past decade, new diagnostic tools have been developed, particularlyantigen (teichoic acid and capsular polysaccharides) and nucleic acid (ply, lytA, and Spn9802) detection assays. Use of the pneumococcal antigen detection methods along with biomarkers (C-reactive protein and procalcitonin) may enhance the specificity of diagnosis for pneumococcal pneumonia. This article provides an overview of current methods of diagnosing pneumococcal pneumonia and discusses new and future test methods that may provide the way forward for improving its diagnosis.