관해유도 항암요법을 받는 백혈병 환자에서 진균 감염증의 예방 : 무작위 배정법과 이중 눈가림법에 의한 Fluconazole과 Nystain의 효과에 관한 다기관 공동연구 A Randomized, Double-blind, Multicenter Trial to Compare Fluconazole with Nystatin

최강원,오명돈,배현주,백경란,박선양,김병국,신완식,강문원,진종률,박종원,김춘추,김동집,한지숙,민유홍,이선주,고윤웅 대한화학요법학회 1993 대한화학요법학회지 Vol.11 No.2

Fluconazole의 진균 감염증 예방 효과와 안전성에 관하여 3개 대학병원에서 관해유도화학요법을 받는 급성 백혈병환자를 대상으로 무작위 배정법과 너도나도 누가림법에 의하여 연구하였다. 모두 62명의 환자에게 fluconazole(100㎎ bid) 또는 nystatin(1,000,000IU/day)을 무작위로 투여하였다. 투약은 관해유도화학요법과 같은 날짜에 시작하여 호중구수가 1,000㎣이상으로 회복되거나 진균 감염증이 확인되거나 의심되어 Amphotericin-B를 시작하거나, 약과 관련된 부작용이 나타날 때까지 계속하였다. 진균 colonization은 fluconazole군에서 감소하였으나 nystqatin군에서는 증가하였다, 표재성 진균감염증으로 nystatin군에서 C. albicans 진균혈증 1례와 C.parasilosis 진균혈중 1례가 발생하였다. 경험적 항진균요법으로 Amphotericin-B를 투여한 경우는 fluconazolerns 34명중 7례(21%), nystatinrns 28명중 10례(36%)였다(p<0.05). Fluconazole군과 nystatin군 사이에 부작용이나 사망률에 차이는 없었다. 결론적으로, fluconazole은 관해유도화학요법을 받는 급성 백혈병환자에서 진균의 colonization을 줄이는데 효과적이고 안전한 항진균제이다. We made a randomized, double-blind, multicenter trial to compare the efficacy and safety of fluconazole with nystatin for prevention of fungal infections in patients with acute leukemia. Sixty-two adult undergoing remission induction chemotherapy for cute leukemia were enrolled. Patients were randomly assigned to receive either fluconazole (100㎎ bid) or nystatin(1,000,000IU×6/day) with corresponding placebo. The study drug was started in initiation of chemotherapy and continued until recovery of neutrophil counts(>1,000/㎣), development of proven or suspected invasive fungal infection, or the occurrence of drug-related toxicity. Fungal colonization decreased in fluconazole(F) group, however increased in nystain(n) group. Superficial fungal infection occurred in 1 of 34 F group, whereas invasive fungal infection developed in 3 of 28 N group. Empirical amphotericin-B therapy was given in 7 of 34(21%) F group and 10 of 28(36%) N group(p>0.05). The incidence of drug-related side effects and overall moratlity were similar in both study groups.

광범위 베타 락탐계 항생제 분해 효소를 생성하는 폐렴간균에 의한 균혈증이 발생한 환자에서 감영의 위험 인자 및 치료 결과

강철인,김성한,방지환,김홍빈,박상원,최영주,오명돈,김의종,최강원 대한감염학회 2003 감염과 화학요법 Vol.35 No.2

목적 : 본 연구는 ESBL을 생성하는 K. pneumoniae에 의한 균혈증 환자에서 감염의 위험 인자 및 치료 결과를 알아보고자 시행하였다. 방법 : 1998년 1월부터 2002년 4월까지 혈액 배양 검사에서 동정된 K. pneumoniae를 대상으로 NCCLS guidelines과 이중 디스크 확산법(double-disk diffusion test)을 이용하여 ESBL 생성 여부를 확인하였다. ESBL 생성 균주에 의한 균혈증 환자 60명(환자군)에 대해 ESBL을 생성하지 않는 균주에 의한 균혈증 환자들(대조군)을 연령, 성별, 균혈증 발생 시점을 고려하여 1:2 또는 1:3으로 배정하였다. 총 159명의 대조군을 선정하였고 후향적인 환자-대조군 연구를 시행하였다. 결과 : 환자군과 대조군 사이에 연령, 성별, APACHE Ⅱ score, 주된 감염 부위의 유의한 차이는 없었다. ESBL을 생성하는 K. pneumoniae에 의한 균혈증이 발생할 독립적인 위험 인자에는 요관 삽입, 균혈증 발생 이전 72시간 동안 침습적인 시술을 받은 경우, 균혈증 발생 이전 30일 동안 투여받은 항생제 개수가 있었다. 초기 항생제 치료 72시간 후의 반응을 평가하였을 때, 완전 반응(complete response)은 대조군에서 더 많았고(13.3% vs. 40.3%, P<0.001), 치료 실패(treatment failure)는 환자군에서 더 많았다(33.3% vs. 11.9%, P<0.001). 7일 사망률은 환자군에서 20% (12/60), 대조군에서 15.6% (25/159)이었고(P=0.451), 30일 사망률은 환자군에서 30% (18/60), 대조군에서 24.5% (39/159)이었다(P=0.410). ESBL 생성 균주에 의한 균혈증이 있는 환자들에서 최종 항생제 치료가 부적절했던 환자들을 제외하고 30일 사망률을 분석하였을 때 효과적인 항생제 치료의 지연은 사망률을 높이지 않았다(11.1% vs. 9.1%, P=1.000). 결론 : ESBL을 생성하는 K. pneumoniae에 의한 균혈증이 있는 환자에서 초기 항균제 치료 72시간 후의 치료 반응률은 낮지만 사망률은 유의하게 증가하지 않았다. 원인균이 동정된 후 최종 치료 항생제의 선정이 적절하다면 초기에 효과적인 항생제 투여의 지연은 사망률을 유의하게 증가시키지는 않았다. Background : This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum β-lactamases(ESBL)-producing K. pneumoniae. Methods: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. Results : There were no significant differences in age, sex, APACHE Ⅱ score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7-day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P=0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. Conclusion : In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.

Impact of Interferon-Based Treatment on Quality of Life and Work Related Productivity from the Korean Cohort in the MOSAIC Study

( Sang Hoon Ahn ),( Won Hyeok Choe ),( Yoon Jun Kim ),( Jeong Heo ),( Dorota Latarska-smuga ),( Jiho Kang ),( Seung Woon Paik ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Chronic Hepatitis C Virus (HCV) infection increases the risk for progressive liver disease, hepatocellular carcinoma and negatively impacts the patient’s quality of life. HCV treatment is evolving with direct acting antivirals but IFN based therapy has been the standard of care for many years and remains available in some countries. The MOSAIC study aims to characterize patients with chronic HCV infection and assess the impact of IFN-containing treatment on health-related quality of life, work related productivity and health care utilization. Methods: MOSAIC is an international prospective multicenter observational study that has been conducted in 20 countries. Consecutive patients with chronic HCV infection were enrolled and those who initiated an IFN based regimen were prospectively followed for 48 weeks. We report results from the Korean cohort Results: 100 patients were enrolled: 86 were treatment naïve and 14 were treatment experienced. 33 patients initiated an IFN based regimen: 6 patients started IFN + RBV, 26 patients started Peg-IFN + RBV, none started Peg-IFN + RBV + DAA and 1 patient received other treatment. Among the treated cohort, demographic and disease characteristics were the following: the mean age was 54.5 years; 14 patients were male. 14 had minimal or no fibrosis, 2 portal fibrosis, 3 bridging fibrosis and 6 patients suffered from cirrhosis. HCV Genotype distribution was as follows: genotype 1: 11; genotype 2: 19 and genotype 3: 3. Table 1 describes the results at baseline and changes over 4, 12 and 48 weeks and end-of-treatment (EOT) for the quality of life and work productivity outcome measures (EQ-5D-5L, HCV-PRO and WPAI). Conclusions: Results from the Korean cohort of the MOSAIC study show a moderate trend for deterioration of health-related quality of life and work productivity associated with IFN based treatment for patients with chronic HCV infection during treatment period. Acknowledgements: The design, study conduct, analysis, and financial support of MOSAIC study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the content of the abstract. All authors had access to all relevant data and participated in writing, review, and approval of this abstract. Medical writing support was provided by Olivier Van de Steen of Medeor-consulting, funded by AbbVie. Disclosures: Sang Hoon Ahn: served as an advisor and lecturer for Bristol-Myers Squibb, Gilead Sciences, F.Hoffmann-La Roche, Merck, AbbVie, and has received unrestricted grants from Bristol-Myers Squibb, Gilead Sciences, and F. Hoffmann-La Roche for investigator- initiated trials Won Hyeok Choe: Nothing to disclosure Yoon Jun Kim: Nothing to disclosure Jeong Heo: received a grant from GSK; Research support from BMS, and Roche; Advisor for Abbvie, BMS, Gilead Sciences, Pharma Essentia, SillaJen, and Johnson & Johnson. Dorota Latarska-Smuga, Jiho Kang: are employees of AbbVie, Inc. and may hold stock or stock options. Seung Woon Paik: received grant and research support from AbbVie, BMS, Gilead, GSK, Merck, Novartis, and Roche

황색포도구균의 균혈증에서 초기 항생제 치료가 예후에 미치는 영향

김성한,박완범,이기덕,강철인,최영주,김홍빈,박상원,김의석,오명돈,김의종,최강원 대한감염학회 2002 감염 Vol.34 No.5

성인의 예방접종

崔康元 대한의학협회 1993 대한의학협회지 Vol.36 No.2

Cryptococcosis의 임상적 고찰

최강원,오명돈,고경혁 대한감염학회 1986 감염 Vol.18 No.2

The clinical aspect of 11 patients with cryptococcosis were studied. Eleven patients were admitted to the internal medicine service at SNUH between Jan. 1979 and Jun. 1986. The following result were obtained: 1) The age was distributed between 15 and 61 years.(mean 38) Male to female ratio was 7 : 4. 2) In 8 cases, underlying conditions were liver cirrhosis 2, pulmonary tuberculosis 2, renal transplant 1, systemic lupus 1, Cushing disease 1, and malignant lymphoma 1. 3) The involved organs were CNS 10, lung 3, skin 2, lymph node 2, kidney 1, liver 1, bone marrow 1. 4) Three out of 6 patients with meningitis were diagnosed as tuberculous meningitis at initial presentation. 5) With amphotericin and 5-flucytosine treatment, 4 cases were improved. Those 5 patients with serious underlying condition were fatal. Two patients discharged with neurologic sequelas.

종합병원에서의 항생제 사용

최강원 대한감염학회 1989 감염 Vol.21 No.4

항균제의 출현은 현대의학에 있어서 획기적 사건으로써, 그것이 치료의학에서 차지하는 비중으로 볼 때 가장 중요한 치료제의 하나라는 것은 부인할 수 없는 사실이다. 그러나 이런 중요한 공헌에도 불구하고, 이들 약제가 과연 적절하게 사용되고 있는가 하는 의문, 다시 말해서 남용 내지 오용의 가능성에 대한 심각한 의문이 초기부터 제기되었다. 특이 이들 항균제들이 특수한 종류의 감염 병원체에 대해 치료 혹은 예방 목적으로 합리적으로 사용되고 있는가 하는 문제와 점증하는 내성균의 발현과 그 전파, 부작용, 생태학적 영향, 상승하는 의료비 부담등이 이제는 더욱 현실적인 문제로 등장하고 있다. 항생제의 남·오용의 문제는 비단 우리나라만의 문제가 아니라 전 세계적인 범위에 걸쳐 심각한 문제로 되어 있으나, 이들 약제에 대한 규제와 안전성에 대한 법적, 제도적 장치와 사회적 관심이 부족한 개발도상국에서 특히 심각하다고 할 수 있다. 예컨데 중남미와(우리나라를 포함한) 아시아 여러나라에서는 각종 항생제가 처방없이 자유로이 판매, 사용되고 있으며, 심지어 자국에서는 안전성 문제등으로 사용이 금지된 항균제가 제3세계에서는 아무 제한없이 광고, 판매하는 예도 있다. 축산에 사용되는 항생제의 생태학적 영향도 막대할 것으로 추정되고 있다. 그러나 무엇보다도 항균제 사용과 그에 따른 문제가 가장 심대하고, 직접적인 분야는 말할 것도 없이 병의원이며, 그 중에서도 복합적인 문제를 가진 중증환자가 많이 몰려드는 종합병원이 항균제사용의 여러 문제점들을 대표적으로 보여주고 있다고 해도 과언이 아닐 것이다. 저자가 여기서 다루고자 하는 것은 이러한 종합병원에서의 항생제 사용실태와 문제점, 그 개선방안 등에 대한 것이 될 것이며, 그 중에서도 본인이 소속되어 일하는 서울대학교 병원의 경험이 주가 될 것이다. 따라서 비교적 규모가 큰 종합병원, 특히 교육을 맡고 있는 대학부속병원의 경험으로써 이해되기를 바라며, 모든 우리나라의 종합병원 혹은 대학병원을 대표하는 것으로 추단되지 않기를 바란다.

Ceftazidime의 임상적 연구 : 과립구 감소환자에서의 감염증에서 Piperacillin-Tobramycin 병합요법과의 비교연구 Ceftazidime or Piperacillin plus Tobramycin and the Possible Modifications Required for a Successful Outcome

최강원,배현주,김양수,김성민,박선양,김병국,김노경,우준희 대한화학요법학회 1990 대한화학요법학회지 Vol.8 No.1

In a randomized, prospective study, ceftazidime monotherapy was compared with a combination of piperacillin and tobramycin for the treatment of infection in febrile granulocyto penic cancer patients. The subjects consisted of 40 patients with acute leukemia or solid tumor who developed fever and other signs of infections after induction chemotherapy or bone marrow transplantation. 21 patients were randomized to the piperacillin plus tobramycin combination, while 19 patients were allocated to ceftazidime monotherapy. Initial granulocyte count, duratation of granulocytopenia, infection days and granulocyte count on therapeutic responsewere all comparable in both treatment groups. On 72 hour assessment, success (with or with-out modification) rate according to NCI criteria was 100% in ceftazidime and 95% in combination group. Success according to EORTC criteria was 26% and 48% respectively. On posttreatment assessment, success rate according to MCI criteria was 91% in ceftazidime group and 70% in combination group, while one according to EORTC was 33% and 40% respectively. There was no statistical significance between the two success rates. The superinfection was more commonly seen in the combination group, esp. by resistant E. coli, even though the difference was not significant.

백혈병과 과립구 감소증에서의 감시배양(surveillance culture) : 예방적항균제 사용에 따른 균총의 변화

최강원,김성민,오명돈,김병국,김의종 대한화학요법학회 1991 대한화학요법학회지 Vol.9 No.1

A surveillance culture was to monitor the changes in flora during prophylactic antibiotics(PA) in patients whith granulocytopenia. Twenty patients with granulocytopenia were included: divided into 3 PA groups. Terimthoprim-sulfamethoxazole(TS) group consisted of 7 patients who underwent induction chemotherapy, Cipprofloxacin plus nystatin(CN) group consisting of 7 patients and Gentamicin plus Nystain(GN) group consisting of 7 patients. All of the latter 2 group underwent bone marrow transplantation and were put in protected environment (laminar air flow, sterile food) in addition to PA. Normal flora and other colonizing microorganisms were replaced with antibiotic resistant bacteria and fungus : MRSA, methicillin resistant CNS, P. aeruginosa, Enterobacter spp. and candida spp. and truolopsis. Entreobacteriaceae were diminished markedly, expecially with CN. Two episodes of bacteremia were preceded by the colonization with the same organisms in the skin, throat, and stool. Surveillance culture seems useful in the helping to design prdventive measures, select antibiotics n selected cases.

Ciprofloxacin을 이용한 장티프스의 항균요법 : chloramphenicol 요법과의 비교 및 ciprofloxacin 단기 요법

최강원,김성민,오명돈 대한화학요법학회 1991 대한화학요법학회지 Vol.9 No.1

Ciprofloxacin was evaluated with regard to its clinical eddicacy by randomized controlled study. Ciprofloxacin was given to 32 patients, and chloramphenicol was given to 34 patients with typhoid fever. In chloramphenicol group, there were 1 clinical failure, 4 relapse 1 carrier while in ciprofloxacin group there was none of clinical failure, relapse or carrier. Number of days to become afebrile after institution of antibiotic therapy was 5.7 days for chloramphenicol, and 3.6 days for ciprofloxacin. Another group of 18 subjects were given 7day-course of ciprofloxacin. There was no clinical failure, relapse of carrier state in this short-term therapy group.