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카테터 집락화가 없는 지속성 캔디다혈증의 위험인자와 예후
채윤태,정수진,구남수,백지현,김혜원,김선빈,윤지현,진성준,한상훈,송영구,김준명,최준용 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.1
Background: Candidemia is one of the most common causes of nosocomial bloodstream infection, and increases the morbidity and mortality rate of seriously ill patients. We evaluated the risk factors and outcomes associated with persistent candidemia without catheter colonization (non-catheter related candidemia) and compared them with those of non-persistent candidemia. Materials and Methods: A retrospective case-control study was performed to identify risk factors for, and outcomes of, persistent candidemia. All adults who experienced candidemia in a university-affiliated hospital in Korea between January 2005 and December 2009 were included. Patients with catheter colonization were excluded. Persistent candidemia was defined as the occurrence of candidemia in a patient receiving at least 3 days of systemic antifungal agents prior to the second positive blood culture. Results: Of 605 adult patients with candidemia, 104 (17.2%) patients had persistent candidemia and 23 (3.8%) patients were free of catheter colonization. There were no statistically significant differences in baseline characteristics between patients with persistent and non-persistent candidemia. In univariate analysis, less use of metronidazole, glycopeptide, fluoroquinolone, and aminoglycoside, and presence of Candida parapsilosis were significantly associated with persistent candidemia. In multivariate analysis, less use of metronidazole was an independent factor associated with persistent candidemia. The candidemia related mortality was insignificantly (P =0.094) higher in persistent candidemia than non-persistent candidemia. Conclusions: Persistent candidemia can occur without catheterization. Patterns of antibiotic use could be associated with the occurrence of persistent candidemia, and prognosis of persistent candidemia seems to be worse than non-persistent candidemia. Further studies for persistent candidemia should be performed.
카테터 집락화가 없는 지속성 캔디다혈증의 위험인자와 예후
채윤태,정수진,구남수,백지현,김혜원,김선빈,윤지현,진성준,한상훈,송영구,김준명,최준용 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.4
Background: Candidemia is one of the most common causes of nosocomial bloodstream infection, and increases the morbidity and mortality rate of seriously ill patients. We evaluated the risk factors and outcomes associated with persistent candidemia without catheter colonization (non-catheter related candidemia) and compared them with those of non-persistent candidemia. Materials and Methods: A retrospective case-control study was performed to identify risk factors for, and outcomes of, persistent candidemia. All adults who experienced candidemia in a university-affiliated hospital in Korea between January 2005 and December 2009 were included. Patients with catheter colonization were excluded. Persistent candidemia was defined as the occurrence of candidemia in a patient receiving at least 3 days of systemic antifungal agents prior to the second positive blood culture. Results: Of 605 adult patients with candidemia, 104 (17.2%) patients had persistent candidemia and 23 (3.8%) patients were free of catheter colonization. There were no statistically significant differences in baseline characteristics between patients with persistent and non-persistent candidemia. In univariate analysis, less use of metronidazole, glycopeptide, fluoroquinolone, and aminoglycoside, and presence of Candida parapsilosis were significantly associated with persistent candidemia. In multivariate analysis, less use of metronidazole was an independent factor associated with persistent candidemia. The candidemia related mortality was insignificantly (P =0.094) higher in persistent candidemia than non-persistent candidemia. Conclusions: Persistent candidemia can occur without catheterization. Patterns of antibiotic use could be associated with the occurrence of persistent candidemia,and prognosis of persistent candidemia seems to be worse than non-persistent candidemia. Further studies for persistent candidemia should be performed.
채윤태,황일준,류경희,고은향,류정임,김수경,박석원,김유리,조용욱,최영길,이상종 대한내분비학회 2006 Endocrinology and metabolism Vol.21 No.1
Mesenchymal tumors including hemangiopericytomas, hepatocellular tumors, adrenal carcinomas, and a variety of other large tumors have been reported to produce excessive amounts of insulin-like growth factor (IGF) type II precursor, which binds weakly to insulin receptors and strongly to IGF-I receptors, leading to insulin like actions. In addition to increased IGF-II production, IGF-II bioavailability is increased due to complex alterations in circulating binding proteins.The authors of this article diagnosed non-islet cell tumor hypoglycemia from an 81-year-old male patient suffering from repetitive fasting hypoglycemia while he has not received any treatment for pulmonary hemangiopericytoma diagnosed in the past. Moreover, this topic is getting reported as the authors have experienced a significant improvement of catamnesis by a treatment with glucocorticoid (J Kor Soc Endocrinol 21:74~78, 2006). 비소도세포 종양에 의한 저혈당은 big IGF-II의 생성 증가로 인해 유리형 IGF-II가 증가하고, 정상적인 150 kDa의 삼중복합체 생산감소와 함께 big IGF-II와 IGFBP-3가 결합하여 주로 이중 복합체를 형성하여 생물학적 활성도가 증가됨으로써 야기된다. 저자들은 폐 혈관주위세포종을 진단받은 후 치료 없이 지내던 중 반복적인 공복저혈당이 발생한 81세 남자환자에서 비소도세포 종양에 의한 저혈당을 진단하고, 경구 당질코르티코이드 투여로 경과가 호전된 예를 경험하였기에 보고하는 바이다.
크립토코쿠스 수막염 : 일개 대학병원에서 최근 12년간의 경험
정수진,채윤태,진성준,백지현,진범식,한상훈,김창오,최준용,송영구,김준명 대한감염학회 2010 Infection and Chemotherapy Vol.42 No.5
Background: Cryptococcal infections are frequent in human immunodeficiency virus (HIV)-infected patients. This infection may occur in other immunocompromised patients, and the diagnosis is often delayed in these cases. There are a few reports on cryptococcal meningitis in non-HIV-infected patients in Korea. We reviewed the clinical features and efficacy of antifungal therapy in 33 patients who were treated at a single tertiary health care center of Korea. Materials and Methods: The medical records of 33 consecutive patients who were admitted to one tertiary hospital for cryptococcal meningitis between 1995 and 2008 were reviewed retrospectively. Cryptococcal meningitis was confirmed by positive cerebral spinal fluid (CSF) cultures or compatible clinical features plus a positive cryptococcal antigen test of CSF. Results: Of the 33 patients analyzed, 30 cases were non-HIV patients. The outcomes were complete cure in 23 cases, relapse after initial treatment in four cases, and death due to treatment failure in six cases. The main initial manifestations were headache (84.8%), fever (54.5%), and seizure (33.3%). Factors significantly associated with unfavorable outcomes, including mortality and relapse, were afebrile condition, mental change, hearing impairment, initial high opening pressure of CSF (>250 mmH2O), and low initial absolute neutrophil count. On multivariate analysis,afebrile condition was an independent predictor of an unfavorable outcome (odds ratio 17.3; 95% confidence interval 1.0-28.3; P=0.045). Conclusions: It is necessary to observe closely cryptococcal meningitis patients without fever on admission.