신생아 발열 환자에서 중증 감염의 예측 인자

최의윤,이정수,이정현 대한신생아학회 2008 Neonatal medicine Vol.15 No.1

Purpose : The purpose of this study was to describe the epidemiologic features of febrile illnesses in newborns and to predict the risk of serious infections in this population. Methods : A retrospective study was conducted on 123 full-term infants <30 days of age with an axillary temperature >38℃ who were hospitalized between 2000 and 2006. Neonates with prenatal risk factors, congenital anomalies, antibiotic administration prior to admission to the hospital, or suspected hospital-acquired infections were excluded. We evaluated the symptoms, physical examination findings, laboratory data, and clinical course between the high- and low-risk groups for serious infections. Results : The high-risk group included 30 infants with the following diagnoses in order of frequency: aseptic meningitis, urinary tract infection, bacterial meningitis, infectious enteritis, sepsis concomitant with disseminated intravascular coagulopathy, bacteremia, pneumonia, cellulitis, and omphalitis. Leukocytosis and thrombocytopenia were statistically different between the two groups. Factors, such as moaning signs, seizures, body temperature, and pulse rate were statistically significant. Conclusion : Unlike previous studies, we included newborns with clinical bacterial infections and aseptic meningitis as the high-risk group. Leukocytosis, thrombocytopenia, moaning signs, seizures, and changes in vital signs were considered useful predictors for identifying febrile neonates at high-risk for serious infections in spite of a difference in the definition of serious infection.

국내 DTaP 백신 1차 및 2차 추가 접종 후 면역원성과 안전성 평가

최의윤,이수영,곽가영,마상혁,박준수,김황민,강진한 대한의사협회 2011 대한의사협회지 Vol.54 No.9

Diphtheria-tetanus-acellular pertussis (DTaP) vaccination must currently be administered three times starting at 2 months of age, at intervals of two months, with the first and second boosters administered at 15 to 8 months and 4 to 6 years of age. A high rate of vaccination is maintained, but studies of the efficiency and safety of booster vaccination are lacking. This study evaluated the immunogenicity and safety of the DTaP booster vaccine. Seventy-two infants who had been vaccinated with the first booster and 78 children who had been vaccinated with the second booster were enrolled in this study. Local and systemic adverse reactions after vaccination were recorded. Sera obtained before and 1 month after booster vaccination were analyzed for antibodies to diphtheria and tetanus toxoid, and anti-pertussis toxin. Diphtheria: The GMT was increased. Tetanus: The geometric mean antibody titer (GMT) was increased. Pertussis: The GMT was increased by 13.72 times and 14.37 times after the first and the second additional vaccination, respectively. Although the seroconversion rate was low prior to the first booster, the average amount of anti-pertussis toxin antibodies before the first additional vaccination was 143.37 EU/mL, which rose to 261.88 EU/mL after the vaccination. The seroconversion rate also increased to 100%. Adverse reactions showed spontaneous resolution within a few days after vaccination. After the second additional vaccination, there was a statistically significant increase in the manifestation of myalgia compared to after the first additional vaccination. In conclusion, DTaP booster vaccination was effective in Korean children, demonstrating that modifications to the current regimen would be unnecessary.

코로나19 감염관리와 예방을 위한 감염관리감시단 활동

최의윤,권영미,최정현,이제훈 대한의사협회 2020 대한의사협회지 Vol.63 No.9

The coronavirus disease 2019 (COVID-19) pandemic is unlikely to end soon, and hospitals face a high risk of exposure to COVID-19 and nosocomial infections. Therefore, strengthened infection control and prevention (ICP) strategies are crucial. Here, we share our experience of activities implemented by an infection control surveillanceworking group (ICS-WG) and the introduction of a hospital emergency code for patients requiring screening for COVID-19, which were established at a university-affiliated hospital. This hospital applies multi-step processes to identify patients who must visit the outdoor screening clinic for COVID-19 testing, instead of entering the hospital building. However, some of these patients inevitably end up inside the hospital building. To solve this issue, we implemented a process to announce the emergency code (“code apple”) and have the medical personnel escort such patients to the outdoor screening clinic. This process was useful in protecting the hospital from unnecessary exposure to COVID-19. The ICS-WG was assigned to conduct the surveillance of ICP practices, patrol the hospital, and recommend improvements for any practices that did not adhere to the guidelines. The ICS-WG also developed a checklist as a monitoring tool for ICP practices. The checklists were distributed to the infection control coordinators who were assigned to monitor their team’s ICP practices and report to the ICS-WG. Overall, we believe that code apple and the ICS-WG are effective strategies in improving ICP practices of COVID-19 at hospitals.

다발성 기형을 동반한 1형 치사성 이형성증

최의윤 ( Ui Yoon Choi ),이정현 ( Jung Hyun Lee ),이정수 ( Jung Soo Lee ) 대한주산의학회 2008 Perinatology Vol.19 No.1

Thanatophoric dysplasia (TD) is a lethal inherited skeletal disorder characterized by extremely short limbs, narrow chest, skull deformity and underdeveloped lungs. TD is divided into two types, depending primarily upon whether the bone in the upper leg (the femur) is curved or straight. We experienced two case of TO type I that were confirmed by clinical and radiological features after birth. Unlike previously reported cases of TD in our country, the multiple anomalies of CNS, kidney and cardiovascular system were identified in one of these cases.

백일해에 대한 연령별 면역혈청학적 연구

이수영,최의윤,김주상,안중현,최정현,마상혁,박준수,김황민,강진한,Lee, Soo Young,Choi, Ui Yoon,Kim, Ju Sang,Ahn, Joong Hyun,Choi, Jung Hyun,Ma, Sang Hyuk,Park, Joon Soo,Kim, Hwang Min,Kang, Jin Han 대한소아감염학회 2012 Pediatric Infection and Vaccine Vol.19 No.2

목적: 우리나라의 백일해에 대한 연령별 방어면역 상태를 평가하고자 면역혈청학적 연구를 시행하였다. 방법: 국내 4개 대학병원에 방문한 건강한 소아, 청소년 및 성인을 대상으로 하였다. 대상을 연령에 따라 7개 연령군으로 구분하였고 ELISA 방법을 이용하여 백일해의 항체가를 측정하였다. 연령군별 기하 평균항체가와 각 연령군별 양성 항체가를 보이는 피험자의 비율을 조사하였다. 제조사의 지침대로, 항체가가 24.0 EU/mL 이상인 경우를 양성으로 판정하였다. 결과: 전체 1,605명의 피험자가 연구에 참여하였고, 기하 평균항체가는 $56.16{\pm}50.54EU/mL$였다. 연령군별로는 11세 미만 소아 연령군($64.78{\pm}53.24EU/mL$)이 가장 높은 기하 평균항체가를 보였다(P<0.001). 양성 항체가를 보인 피험자의 비율은 전체 대상의 68.2%였고, 11세 미만 소아 연령군(76.5%)이 가장 높은 비율을 보였다(P<0.001). 결론: 소아 연령군과 비교하여, 청소년과 성인 연령군에서 백일해에 대한 낮은 기하 평균항체가를 나타냈으며 양성 항체가를 갖는 피험자의 비율이 낮다는 것을 확인하였다. Purpose: We conducted the immunoassay of pertussis according to ages, in order to evaluate protective immunity against pertussis in Korean populations. Methods: Healthy subjects were enrolled at four university hospitals in Korea. The subjects were grouped as seven age groups (every 10 years). Antibodies against pertussis toxin (PT) in sera were measured by enzyme linked immunosorbent assay (ELISA) kits. Geometric mean concentrations (GMC) of antibodies and the ratios of the subjects with seroprotective antibody levels were determined. The subjects with antibody titers ${\geq}24.0EU/mL$ were considered to seroprotective as the manufacturer's protocol. Results: Total 1,605 subjects (age: 2 months-65 years) participated in this study, and their GMC was $56.16{\pm}50.54EU/mL$. Among seven age groups, age group <11 year showed the highest GMC ($64.78{\pm}53.24EU/mL$) (P<0.001). In the analysis of the ratios of the subjects with seroprotective antibody titers, 68.2% of the subjects were proven to seroprotective, and age group <11 year also showed the highest ratio (76.5%) (P<0.001). Conclusions: We found that adolescences or adults (age group ${\geq}11$ year) showed lower levels of antibody against pertussis and lower ratio of the subjects with seroprotective antibody titers than children (age group <11 year).

소아 관찰병실 운영에 대한 분석

이지영,최의윤,이수영,이병찬,황희승,목혜린,정대철,정승연,강진한 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.7

Purpose : While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. Methods : All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. Results : There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/ bed). Conclusion : Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea. 목 적 : 소아 관찰병실(pediatric observation unit: POU)의 운영내역을 분석하여 국내에서도 그 적용이 가능한지를 평가하기 위함이다. 방 법 : 2006년 3월부터 2007년 2월까지 1년간 가톨릭대학교 성모자애병원 소아과 POU에 입원한 환아들을 대상으로 하여 의무기록을 분석하였고 평균재원일수와 병상회전율을 평가하기 위하여 연구기간 1년 전 자료와 비교하였다. 결 과 : 총 1,076명이 POU에 입원하였으며 환아들의 중앙 연령은 2.4세이었고 중앙 재원시간은 14시간 00분이었다. 질환별로는 장염(42.7%)이 가장 많았고 그 외 급성인후염(19.1%), 모세기관지염(7.8%), 폐렴(5.5%), 열성경련(5.2%) 순이었다. 전체 환아 중 7.5%(81/1,076명)는 일반입원으로 전환되어 입원이 연장되었다. 전환율이 낮은 질환들은 변비와 장염, 중이염과 인후염을 포함한 상기도 감염성 질환, 경련성 질환, 후두염이었고 전환율이 높은 질환들은 폐렴, 발열이 조절되지 않은 열성경련, 천식이었다. POU 시행 1년전 자료와 비교할 때, 전체 입원환자의 평균 재원일수는 4.69일에서 3.75일로 감소하였고 병상회전율은 1병상 당 78.8명에서 98.2명으로 증가하였다. 결 론 : POU는 국내에서도 효율적으로 운영될 수 있음을 확인하였다. 향후 POU는 외래와 응급실 진료의 제한점을 보완하며 불필요한 입원기간을 줄일 수 있는 소아과 영역의 새로운 진료 형태로 자리잡을 수 있을 것이라고 기대한다.

농뇨 동반 가와사키병의 임상적 특징

김효진,이주영,최의윤,이수영 대한소아감염학회 2017 Pediatric Infection and Vaccine Vol.24 No.3

목적: 농뇨가 동반된 가와사키병(Kawasaki disease [KD]) 환아와 농뇨 동반이 없는 KD 환아의 임상및 검사실 지표들을 비교하여 농뇨 동반 KD의 임상적 특징을 파악하고자 하였다. 방법: 2015년 1월부터 2016년 12월까지 KD로 입원한 140명(남아 86명, 여아 54명) 환아의 의무기록을 후향적으로 조사하였다. 결과: 48명의 KD 환아(34.3%)에서 농뇨가 관찰되었다. 농뇨 KD군은 비농뇨 KD군보다 높은 C-반응단백(C-reactive protein [CRP]) 값을 보였고 간 효소치가 증가한 환아의 비율이 높았다. 두 군 간의면역글로불린(intravenous immunoglobulin) 치료 저항성과 관상동맥병변(coronary artery lesion) 발생률에 대한 차이점은 없었다. 농뇨 KD군 중 6명(12.5%)은 요로감염(urinary tract infection)을 감별하기 위해 신장 영상검사를 받았고, 농뇨 KD군의 2/3(66.7%)는 KD 표준치료에 추가로 항생제 치료를 받았다. 결론: 농뇨가 동반된 KD 환아들은 농뇨 동반이 없는 KD 환아들보다 더 높은 CRP 값과 더 많은 경우의 간 효소치 증가를 보였다. 이는 농뇨가 동반된 KD 환아가 농뇨 동반이 없는 KD 환아보다 더 심한전신염증반응을 보인다는 점을 시사한다. Purpose: Clinical and laboratory features of two Kawasaki disease (KD) groups were evaluated; the patient with pyuria and those without pyuria. Methods: From January 2015 to December 2016, the medical records of 140 (86 males and 54 females) inpatients with KD were retrospectively analyzed. Results: Forty-eight KD patients (34.3%) presented with pyuria. KD patients with pyuria showed a higher level of C-reactive protein (CRP) and a higher proportion of elevated liver enzymes than those without pyuria. There were no differences in the proportions of unresponsiveness to intravenous immunoglobulin and coronary artery lesions between the two groups. Six KD patients (12.5%) with pyuria underwent a renal imaging study to rule out the possibility of a urinary tract infections. Thirty-two KD patients (66.7%) with pyuria received treatment with antibiotics in addition to the standard treatment for KD. Conclusions: KD patients with pyuria showed a higher level of CRP and elevated levels of liver enzymes than those without pyuria. These findings suggest that KD patients with pyuria have more severe systemic inflammation than those without pyuria.

A Case of Epiploic Appendagitis with Acute Gastroenteritis

조민선,황보석,최의윤,김환수,한승훈 대한소아소화기영양학회 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.4

Epiploic appendagitis is an inflammation of the epiploic appendage in which the small sacs projecting from the serosal layer of the colon are positioned longitudinally from the caecum to the rectosigmoid area. Epiploic appendagitis is rare and self-limiting; however, it can cause sudden abdominal pain in children. Epiploic appendagitis does not typi-cally accompany other gastrointestinal diseases. Here, we report on a healthy eight-year-old girl who presented with abdominal pain, fever, vomiting, and diarrhea. Based on these symptoms, she was diagnosed with acute gastro-enteritis, but epiploic appendagitis in the ascending colon was revealed in contrast computed tomography (CT). The patient was treated successfully with conservative management. CT is beneficial in diagnosis and further assess-ment of epiploic appendagitis. Pediatricians need to be aware of this self-limiting disease and consider it as a possible alternate diagnosis in cases of acute abdominal pain.

A Case of Pyogenic Liver Abscess Caused by Staphylococcus epidermidis in a Healthy Child

곽지혜,임연주,최의윤,강진한,Gwak, Ji Hye,Eem, Yeun Joo,Choi, Ui Yoon,Kang, Jin Han The Korean Society of Pediatric Infectious Disease 2013 Pediatric Infection and Vaccine Vol.20 No.1

Staphylococcus epidermidis is a normal inhabitant of skin, throat, mouth, vagina, and urethra. It is not usually pathogenic, particularly in immunocompetent hosts. This report describes a case of a pyogenic liver abscess caused by Staphylococcus epidermidis in a healthy 12-year-old boy. He was admitted to Seoul St. Mary's Hospital with intermittent fever for 6 days. Findings on abdominal computed tomography (CT) showed a mass measuring $7.0{\times}6.5$ cm in the right hepatic lobe. Culture of the abscess resulted in growth of Staphylococcus epidermidis as a causative organism. The patient was successfully treated with intravenous administration of antibiotics and percutaneous drainage of the abscess. 간농양은 선진국과 개발도상국에서 발생빈도에 차이가 있는 질환으로 국내에서는 드물다. 면역결핍, 간, 담도계기형, 천공성 충수염, 외상, 단백질 결핍 등의 선행요인이 있을 때 발생하기 쉬우며 Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus, Bacteroides와 Entamoeba histolytica 등에 의해 유발된다. 저자들은 발열을 주소로 내원한 건강한 12세 남아에서 컴퓨터 단층촬영을 시행하여 간농양을 발견하였으며 경피배액술 흡인물 배양 검사에서 Staphylococcus epidermidis가 검출되어 항생제를 투여하여 합병증 없이 치료하였기에 보고한다.

치료불응 가와사끼병의 임상양상을 보인 대식세포활성 증후군

박현진,조윤정,배이영,최의윤,정대철,이경일,강진한,이수영 대한소아감염학회 2010 Pediatric Infection and Vaccine Vol.17 No.2

Few cases of macrophage activation syndrome (MAS) or reactive hemophagocytic lymphohistiocytosis (HLH) during the acute febrile phase of Kawasaki disease (KD) have been reported. We report on a case of a 19 month-old girl with MAS or reactive HLH during the course of KD. Despite immunoglobulin and steroid therapy, she showed persistent fever with hepatosplenomegaly and evidence of hemophagocytosis in the bone marrow. A high index of suspicion for clinical features associated with MAS is necessary for KD patients in order to provide appropriate treatment. KD의 급성 열성기에 드물지만 MAS가 발생할 수 있다. 저자들은 19개월 여아의 KD 치료 중에 발생된 MAS 를 경험하였다. 환아는 IVIG과 steroid 치료를 받았지만,발열과 간비종대는 지속되었고 골수생검에서 혈구탐식구증이 관찰되었다. KD에 동반된 MAS를 인지하여 적기에 치료하기 위해서는 임상양상과 치료반응을 토대로,MAS의 가능성을 고려하는 것이 필요하다.