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지역사회획득 폐렴의 원인 미생물에 대한 전향적 다기관 연구: 세균성 폐렴의 원인균 분석
정용필,정기석,이관호,김미나,문송미,박성훈,허지안,김동민,전민혁,우준희 대한감염학회 2010 Infection and Chemotherapy Vol.42 No.6
Background: Successful therapy for community-acquired pneumonia (CAP)requires appropriate empirical antimicrobial therapy based on the local microbe and resistance patterns. However, the available data on the bacterial etiology and antimicrobial susceptibility of CAP in Korea is very limited. Materials and Methods: A nationwide prospective multicenter study of CAP in adult patients was carried out between March 2009 and February 2010. Most patients underwent detailed assessment for bacterial and viral pathogens (cultures, urinary antigen testing, serological methods and polymerase chain reaction). Results: A total of 619 patients were studied. More than half (50.4%) of the patients were ≥65 years, 59.3% were males and 48.1% had underlying illness. The etiology was identified in 246 (39.7%) of the patients. The most common etiologic agent was Streptococcus pneumoniae (52 episodes, 21.1%), and the majority (36/52) of which were diagnosed by a positive urinary antigen test alone. The other common bacterial agents included Mycoplasma pneumoniae (41, 16.7%), Klebsiella pneumoniae (26,10.6%), Chlamydia pneumoniae (13, 5.3%), Pseudomonas aeruginosa (11, 4.3%)and Staphylococcus aureus (8, 3.1%). All S. pneumoniae isolates were susceptible to penicillin with MIC of 2 μg/mL or less, only 1/16 (6.2%) was resistant to levofloxacin and 10/16 (62.5%) were resistant to erythromycin. Of the 26 K. pneumoniae isolates,25 (96.2%) were susceptible to cefotaxime and ciprofloxacin. Conclusions: S. pneumoniae remains the most frequent pathogen in adults with CAP and this should be covered with empirical antimicrobial treatment. Atypical pathogens such as M. pneumoniae and C. pneumoniae were the second most common etiologic agents and they should be tested for. The rate of CAP caused by gram-negative bacilli such as K. pneumoniae and P. aeruginosa was high, which is similar to that of the previous Korean studies. Further study, with excluding healthcare-associated pneumonia, is needed to clarify the etiology of CAP in Korea.
대동맥 판막 치환술 후 반복되는 Acinetobacterbaumannii 균혈증의 원인이 된 대동맥염 1예
정용필,김성철,송은희,장은영,김은경,김윤지,성홍섭,김미나,최상호,우준희,김양수 대한감염학회 2007 Infection and Chemotherapy Vol.39 No.3
nfectious aortitis is an uncommon yet, life threatening disease. Early surgical treatment and prolonged antibiotic therapy is crucial to survival. Salmonella sp. and Staphylococcus aureus are the most common organisms isolated. There is no case report of infectious aortitis caused by Acinetobacter baumannii, which has recently emerged as a major cause of health care-associated infections. Here, we describe a 76-year-old male with infectious aortitis who experienced recurrent bacteremia due to A. baumannii in spite of adequate antimicrobial therapy after aortic valve replacement. 감염성 대동맥염은 흔하지 않지만 매우 위중한 질병으로 Salmonella sp.와 S. aureus가 주된 원인균이다. 아직까지 병원내 감염의 주요 원인균인 Acinetobacter baumannii에 의한 감염성 대동맥염은 보고된 바가 없었다. 저자들은 대동맥 판막 치환술을 시행받은 76세 남자 환자에서 적절한 항생제 투여에도 반복되는 A. baumannii 균혈증의 원인이 감염성 대동맥염으로 진단되었던 1예를 경험하였기에 보고하는 바이다.
Antiviral Treatment Guidelines for Middle East Respiratory Syndrome
정용필,송준영,서유빈,최재필,신형식,Rapid Response Team 대한감염학회 2015 Infection and Chemotherapy Vol.47 No.3
Middle East respiratory syndrome (MERS) is an acute infectious disease of the respiratory system caused by the new betacoronavirus (MERS coronavirus, MERS-CoV), which shows high mortality rates. The typical symptoms of MERS are fever, cough, and shortness of breath, and it is often accompanied by pneumonia. The MERS-CoV was introduced to Republic of Korea in May 2015 by a patient returning from Saudi Arabia. The disease spread mostly through hospital infections, and by the time the epidemic ended in August, the total number of confirmed diagnoses was 186, among which 36 patients died. Reflecting the latest evidence for antiviral drugs in the treatment of MERS-CoV infection and the experiences of treating MERS patients in Republic of Korea, these guidelines focus on antiviral drugs to achieve effective treatment of MERS-CoV infections.
대동맥 판막 치환술 후 반복되는 Acinetobacter baumannii 균혈증의 원인이 된 대동맥염 1예
정용필,김성철,송은희,장은영,김은경,김윤지,성흥섭,김미나,최상호,우준희,김양수 대한감염학회 2007 감염과 화학요법 Vol.39 No.3
감염성 대동맥염은 흔하지 않지만 매우 위중한 질병으로 Salmonella so.와 S. aureus가 주된 원인균이다. 아직까지 병원내 감염의 주요 원인균인 Acinetobacter baumannii에 의한 감염성 대동맥염은 보고된 바가 없었다. 저자들은 대동맥 판막 치환술을 시행받은 76세 남자 환자에서 적절한 항생제 투여에도 반복되는 A. baumannii 균혈증의 원인이 감염성 대동맥염으로 진단되었던 1예를 경험하였기에 보고하는 바이다. Infectious aortitis is an uncommon yet, life threatening disease. Early surgical treatment and prolonged antibiotic therapy is crucial to survival. Salmonella sp. and Staphylococcus aureus are the most common organisms isolated. There is no case report of infectious aortitis caused by Acinetobacter baumannii, which has recently emerged as a major cause of health care-associated infections. Here, we describe a 76-year-old male with infectious aortitis who experienced recurrent bacteremia due to A. baumannii in spite of adequate antimicrobial therapy after aortic valve replacement.
정용필,김신,고옥배,구자은,이단비,박상형,박수정,김상위,서철원,이대호 대한의학회 2008 Journal of Korean medical science Vol.23 No.5
Immunoglobulin (Ig) D multiple myeloma (MM) accounts for 2% of all MM cases and has been reported to be associated with poor prognosis compared with other MM subtypes. The aim of the present study was to compare the effects of high-dose melphalan treatment and autologous stem cell transplantation (ASCT) on the survival of patients with IgD MM and patients with other MM subtypes. Between November 1998 and January 2005, a total of 77 patients with MM who underwent ASCT at the Asan Medical Center were enrolled in this study. High-dose melphalan (total 200 mg/m2) was used as high-dose chemotherapy. The study population was divided into two groups based on MM subtype: those with IgD MM; and those with other MM subtypes. A total of 8 patients with IgD MM were identified, accounting for about 10% of the study population. Thirty-six patients (47%) had IgG MM, 17 patients (22%) had IgA MM, and 16 patients (20%) had free light-chain MM. The two groups were similar in baseline characteristics. The median follow-up was 17 months and the median overall survival (OS) was 39 months. In the IgD MM group, median eventfree survival (EFS) and OS were 6.9 and 12 months, respectively. In the patients with other MM subtypes, median EFS and OS were 11.5 and 55.5 months (p=0.01, p<0.01), respectively. Multivariate analysis of all patients identified IgD subtype (p=0.002) and Southwest Oncology Group (SWOG) stage 2 or greater at the time of ASCT (p=0.01) as adverse prognostic factors for survival. In this small study at a single center in Korea, patients with IgD MM had poorer outcomes after ASCT than did patients with other MM subtypes.
김탁,정용필,박기호,방경미,박수진,김성한,정진용,이상오,최상호,우준희,김양수 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.1
Background/Aims: Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is a major bloodstream infection with a high mortality rate. Identification of factors associated with early mortality in MRSAB patients would be useful for predicting prognosis and developing new therapeutic options. Methods: A prospective cohort of MRSAB patients was examined between August 2008 and June 2011. Early and late mortality was defined as death within 2 and 28 days of blood culture, respectively. The clinical and microbiological characteristics in the early and late mortality and survival groups were compared. Risk factors associated with severe sepsis or septic shock were also investigated. Results: A total of 385 adult MRSAB patients whose S. aureus isolates were available were enrolled; of these patients, 25 patients (6.5%) and 50 (13%) died early and late, respectively. Compared with both the late-mortality group and the survival group, severe sepsis or septic shock was a statistically significant independent risk factor associated with early mortality. Rapidly or ultimately fatal McCabe and Jackson classification (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.25 to 3.02) and pneumonia (aOR, 2.04; 95% CI, 1.03 to 4.02) were independently associated with severe sepsis or septic shock. A vancomycin minimum inhibitory concentration (MIC) ≥ 1.5 μg/mL was associated with a reduced incidence of severe sepsis or septic shock (aOR, 0.53; 95% CI, 0.34 to 0.84). Conclusions: Severity of illness seems to be the most important risk factor associated with early mortality in MRSAB. Although vancomycin MIC was not independently associated with early mortality, reduced vancomycin susceptibility appears to be linked to reduced disease severity.
박기호,정용필,김성한,이상오,이미숙,성흥섭,김미나,김양수,우준희,최상호 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.1
We evaluated the impact of revised Clinical and Laboratory Standards Institute (CLSI) breakpoints for broad-spectrum cephalosporins(BSCs) on the susceptibilities of 1,742 isolates of Enterobacter species, Serratia marcescens, Citrobacter freundii, andMorganella morganii. The 2011 CLSI criteria for cefotaxime and ceftazidime reduced the rates of susceptibility by 2.9% and5.9%, respectively. The 2014 CLSI criteria for cefepime reduced the rate of susceptibility by 13.9%, and categorized 11.8%isolates as susceptible-dose dependent (SDD) for cefepime. Among 183 isolates with extended-spectrum ß-lactamase (ESBL)phenotype, implementation of the new criteria reduced the rates of susceptibility to cefotaxime, ceftazidime, and cefepime by2.8%, 14.8%, and 53.6%, respectively. The proportion of ESBL phenotype among BSC-susceptible isolates was low (0.9% forcefotaxime, 3.0% for ceftazidime, and 3.3% for cefepime). In summary, implementation of new CLSI criteria led to little changein susceptibility to cefotaxime and ceftazidime but a substantial change in susceptibility to cefepime. The recognition of revisedCLSI criteria for BSC and SDD will help clinicians to select the optimal antibiotic and dosing regimen.