VRE 감염증의 임상상, 미생물학적 특성 분석 및 유전적 관련성 비교 : 전국 6개 병원에서 분리된 VRE를 중심으로

정희진,박정원,엄중식,하경임,신종희,김정미,이혜수,박영희,김우주,박승철 대한감염학회 2002 감염 Vol.34 No.5

지역사회와 병원에서 페니실린 내성 폐렴구균 감염의 임상적 특징 및 분자유전학적 성상

정희진,황병연,박정원,김우주,김민자,박승철,이영희 대한감염학회 2001 감염 Vol.33 No.2

Background : During the last three decades, the resistance of S. pneumoniae to penicillin has been rapidly increasing in many parts of the world, especially in Korea. To characterize the clinical features and epidemiology of penicillin-resistant S. pneumoniae (PRSP) infections in the community -and hospital, as well as to investigate the possible spread of resistant clone, we performed the antimicrobial susceptibility tests, pulsed filed gel electrophoresis (PFGE) and penicillin-binding protein (PBP) profile analysis of PRSP isolates. Methods : A total 48 PRSP isolates from patients who visited or were admitted to Korea University Guro hospital during the period form July 1998 to June 1999 were studied. Anitimicrobial susceptibility tests for 48 isolates were performed with microbroth dilution method to determine the minimal inhibitory concentration of 11 antibiotics. 39 isolates and 35 isolates were subjected to PFGE and PBP profile analysis, respectively to investigate the genetic relatedness between PRSP isolates. Results : Pneumonia was most common site of infection in the community and the hospital as 50%. There were no significant differences of clinical fentures and prognosis between community and hospital isolates. But, patients with serious underlying diseases had poor prognosis despite of acquisition site. High level penicillin resistance were observed in 69%, multi-drug resistance were 64.6% of isolates. PFGE showed that 13 of 29 community acquired infection were identical PFGE pattern but not that of 23F Spanish clone. There were various PFGE patterns were observed from community and hospital acquired infection isolates. Some of them were existed in both. PBP profiles showed more diverse, even if in isolates of the same PFGE pattern. Conclusion : In our study, high level penicillin resistance and multi-drug resistance were observed in PRSP clinical isolates. No clinical and prognostic differences were observed between community and hospital acquired infections. Molecular epidemiology study were suggest the there were various genotypes of PRSP within our society. Some of them were observed of the hospital and community. Therefore, there was an evidence of communication of PRSP clones between the community and hospital. (Korean J Infect Dis 33:112~122, 2001)

나노크리스탈 약물 전달 기술

황우신,황성주,박정숙,조정원 충남대학교 약학대학 의약품개발연구소 2012 藥學論文集 Vol.27 No.-

Nanotechnology affects on various aspects including medicine and pharmaceutics. This nanocrystal technology which transforms to nano-sized material is able to develop the innovational formulation strategy for poorly water-soluble drugs due to the change of physicochemical properties of drug. Scale-up methods using pearl milling or high pressure homogenizer was described and commercialized products based on nanotechnology were introduced in this manuscript.

전국 10개 종합병원 중환자실 환자의 직장내 Vancomycin-resistant Enterococci(VRE) 보균율, 보균의 위험요인 및 유전적 다양성 조사

정희진,송준영,엄중식,김우주,최선주,최정현,이혁,정문현,이광미,신동현,손보라,최종성,우흥정,권정아,이경원,최강원,박승철 대한감염학회 2002 감염 Vol.34 No.5

임상 검체에서 분리된 vancomycin 내성 장구균에 대한 Quinupristin/dalfopristin(Synercid®)을 포함한 10종 항균제의 시험관내 항균력

정희진,박기호,김동림,김우주,김민자,박승철,신종희 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

목적 : 본 연구에서는 고려대 병원과 전남대 병원에서 임상 검체로부터 분리된 VRE 16균주를 대상으로 하여 장구균 감염의 치료에 흔히 사용되는 항균제인 ampicillin, gentamicin, vancomycin, teicoplanin과 VRE에 대해서도 비교적 항균력이 있는 것으로 알려진 기존의 chloramphenicol, doxycycline, erythromycin, ciprofloxacin, rifampicin, 그리고 다제 내성 그람 양성균의 치료를 위하여 새로이 개발된 quinupristin/dalfopristin을 이용한 시험관내 항균력을 조사하고자 하였다. 방법 : 총 16균주의 VRE faecium을 대상으로 quinupristin/dalfopristin (Synercid^(R))를 포함한 10종 항균제에 대한 최소 발육 억제 농도(MIC)를 한천희석법을 이용하여 측정하였다. 각각의 항균제에 대한 감수성은 NCCLS에서 제시한 기준에 의거하여 해석하였다. 결과 : 1) 5균주의 vanB VRE에 대한 항균제의 MIC_(90)은 ampicillin, erythromycin, gentamicin, cipro- floxacin에서 각각 64㎍/㎖, 512㎍/㎖, 512㎍/㎖, 4㎍/㎖로서 100%에서 내성을 보였고, doxycycline, chloramphenicol의 경우 4㎍/㎖, 4㎍/㎖로서 100%에서 감수성을 보였다. Teicoplanin의 MIC_(90)은 1㎍/㎖로서 모두 감수성을 보였고 quinupristin/dalfopristin에 대해서도 MIC_(90) 0.25㎍/㎖로서 감수성을 보였다. 2) 11균주의 vanA VRE에 대한 항균제들의 MIC 범위는 vanB VRE보다는 다양하였다. MIC_(90)을 보면 amplicillin, erythromycin의 경우 256㎍/㎖, 512㎍/㎖으로 100%에서 내성을 보였응며, gentamicin은 MIC_(90) ≥500㎍/㎖의 고도내성을 보인 경우가 8 균주로서 73%에서 내성을 보였다. Ciprofloxacin은 vanB VRE에서와 마찬가지로 MIC≥32㎍/㎖의 100%의 내성을 보였다. Chloramphenicol의 경우는 MIC_(90)이 16㎍/㎖로서 vanA VRE faecium에 대해서도 감수성이 있는 약제로 남아 있었다. 반면에 doxycycline은 MIC_(90)이 4㎍/㎖로서 시험관내에서는 100% 감수성을 보였고, quinupristin/dalfopristin은 MIC_(90)이 2㎍/㎖로서 내성을 보인 균주는 한 균주도 없었다. 결론 : 국내 임상분리 VRE 16균주는 기존에 사용되어 오던 chloramphenicol, doxycyline등의 항균제에 대하여 시험관내에서 100% 감수성을 보였으며 quinupristin/dalfopristin과 같은 새로운 항균제에 대해서도 중등도 또는 완전 감수성을 보여 향후 VRE에 의한 감염증 치료에 있어 이들 약제의 병합요법등이 고려될 수 있을 것이라 사료된다. Background : Vancomcyin-resistant enterococci (VRE) have become a major nosocomial pathogen in the USA during 1990s. In Korea, VRE have recently emerged as a important nosocomial pathogen and posed therapeutic difficulty. We evaluated the antimicrobial susceptibility of clinical VRE isolates to the antimicrobial agents that are commonly used to treat enterococcal infections and to some alternative drugs and to a newer antibiotic such as quinupristin/dalfopristin(Synercid®). Methods : We evaluated 16 clinical VR-E. faecium (5 vanB VRE, 11 vanA VRE) strains that were isolated from Korea Universtiy and Chonnam University hospital during the last five years (1994-1998). The isolates were identified to the species level by using API 20system. The in vitro susceptibility testing was performed by the agar dilution methods, following the criteria described by the National Committee for Clinical Laboratory Standards (NCCLS). The VRE isolates were tested against antimicrobial agents commonly used to treat enterococcal infections (vancomycin, teicoplanin, ampicillin, gentamicin), potential alternative drugs (chloramphenicol, doxycycline, ciprofloxacin, erythromycin, rifampicin) and a newer antibiotic (quinupristin/dalfopristin). Results : 100% (5/5) of vanB VR-E. faecium were resistant to ampicillin, gentamicin and ciprofloxacm, but 100% (5/5) were susceptible to chloramphenicol, doxycycime, teicoplanin and quinupristin/dalfopristm. 100% (11/11) of vanA VR-E. faecium were resistant to ampicillin, ciprofloxacm, 73% were resistant to gentamicin, and 100% (11/11) were susceptible to chloramphenicol and doxycycline. Quinupristin/dalfopristm showed intermediate or high level susceptibility against all vanA VRE isolates. Rifampin is less susceptible (MIC: 4-16 ㎍/mL) against both vanA and vanB VR-E. faecium. Conclusion : The treatment options for infections caused by VRE seem to be very narrow since a small percentage of those isolates were susceptible to the other antmicrobial agents commonly used to treat these infections. And only a few of the alternative drugs including quinupristin/dalfopristm tested showed good in vitro activity. This study suggested that chloramphenicol, doxycycline and qumuprisitin/dalfopristin would be a good candidate to treat VRE infection, but further studies are necessary to demonstrate the clinical role of these antimicrobial agents.

급성 백혈병 환자에서 감염증의 양상 및 예후인자에 관한 연구 : 1988년∼1995년까지

정희진,김병수,신상원,김열홍,김우주,김민자,김준석,박승철,김권범 대한감염학회 1998 감염 Vol.30 No.3

목적 : 급성 백혈병의 경우 골수기능이 억제되고 항암화학요법에 따른 골수기능 저하로 감염의 위험이 증가하며 감염의 치료가 환자의 생존에 큰 영향을 미치게 된다. 이에 저자들은 1988년부터 1995년까지 고대 구로병원에 급성 백혈병으로 입원했던 환자들 중 입원 기간 내 감염이 있었던 경우를 대상으로 하여 감염의 위험인자 및 감염증의 예후를 후향적으로 분석함으로써 향후 급성 백혈병환자의 감염의 치료에 대한 지침을 얻고자 하였다. 방법 : 급성 백혈병으로 확진된 환자들 중 감염병에 이환된 경우를 대상으로 하여 각각을 미생물학적 확인감염, 임상적 확인감염, 그리고 설명 불가열로 구분하였다. 각각의 경우에서 감염 당시의 호중구 수, 호중구 감소 기간, 항암화학요법과의 연관성, 감염 병소, 배양된 검체 및 원인균, 선택적 소화관 살균법의 사용여부 및 골수회복 여부 등을 조사한 후 환자의 예후와 어떤 관계가 있는 지 조사하였다. 결과 : 연구 대상은 총 113예로 남녀비는 46:67 이었고 평균연령은 34±13세, 진단은 급성 골수성 백혈병 (AML)이 84예, 급성 림프구성 백혈병(ALL)이 29예였으며, 감염시 평균 호중구수는 663±1678/㎣이었고, 호중구 감소 기간은 평균 18±13일이었다. 감염양상은 항암화학요법과 연관된 감염이 84예로 대부분이었고 미생물학적 확인 감염이 40예로서 35%였으며, 폐렴과 원발성 패혈증이 각각 20예와 19예로 가장 많았고, 카테터 연관 감염이 7예로 나타났다. 배양된 균주는 E. coli가 10예(25%)로서 가장 많았으며, 전체적으로 E. coli, P. aeruginosa, K. pneumoniae 등의 그람음성균이 63%로 대부분을 차지하였으나 최근 그람양성구군 및 진균의 분리율이 증가하는 양상을 보였다. 감염증의 예후를 분석한 결과 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으며 그 중에서도 골수 기능이 회복 여부가 환자들의 생존과 통계적으로 유의한 연관이 있었다.(P=0.01). 결론 : 급성 백혈병 환자들에서의 감염은 관해유도화학요법 후 초래되는 호중구 감소와 유의한 관계가 있으며, 폐렴 및 패혈증의 임상양상을 보이는 경우가 흔하고, 원인균별로는 그람 음성균이 주류를 이루나 최근 그람 양성균 감염이 증가하는 추세를 보였다. 감염의 예후 인자로는 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으나 골수 기능의 회복여부가 결정적인 역할을 하는 것으로 나타나, 향후 급성 백혈병 환자의 치료에 있어 감염 빈도의 감소와 감염에서의 조속한 회복을 위해서는 골수 기능의 회복에 중점을 두어야 할 것으로 사료된다. Background : Infection is one of the most important and fatal complications in patients with acute leukemia. The characteristics of infection in acute leukemic patients are different from those in other diseases by the lack of normal inflammatory responses or distinct clinical evidence except fever. To improve the outcome of acute leukemia, it is very important to recognize the risk factors, patterns and prognostic factors of acute leukemia. Methods : We analyzed retrospectively the patterns of infection from 113 febrile patients with acute leukemia from January, 1988 to December, 1995. To determine the prognostic factors and the outcome of infection, the following variables were analyzed: the presence of neutropenia, use of chemotherapeutic agents, type and site of infections, isolated organisms, gastrointestinal decontamination, duration of neutropenia, and bone marrow recovery. Results : Out of 113 febrile patients with acute leukemia, 84 infection episodes(74%) occurred after chemotherapy. The mean duration of neutropenia was 18±13 days. The incidence of microbiologically-documented infection(MDI) was 35%(40/113). Pneumonia was the most common infection(26%), followed by primary sepsis(24%), catheter-related infection(9%). In cases of MDI, 63% were caused by gram-negative bacteria, followed by gram-positive bacteria(28%), and fungi(10%). Escherichia coli(25%) was the most common isolated in MDI. Regarding the prognostic factors in cases with infections, the recovery of bone marrow function was the only statistically significant factor(P=0.01). Conclusion : Infection has been a major cause of morbidity and mortality in acute in acute leukemic patients. To prevent infection and thereby improve the prognosis of acute leukemia, restoration of bone marrow function at early stage is important.

부동산 권원보험의 도입과 향후과제

정우형 한국부동산분석학회 2002 不動産學硏究 Vol.8 No.1

As real estate is a indispensible element in human life and production activity, real property accidents generally can result in serious outcomes socially and economically. This, so as to seek the safety of real estate activities and remove the evil influence to inflict the social economy, above all, it is the best policy to give the public confidence to the registration. But, in considering various given condition of our country, it is difficult to expect this actually, as there are various bottlenecks in the recognition of public confidence of registration. By the way, we cannot neglect eh instability of real estate activities. This study is aimed at reviewing the recognition of public confidence, introducing the title insurance in American real estate system, suggesting implications in our real estate system. It is the function of title insurance to shift or transfer to a responsible insure risks such as those mentioned in the preceding section. Title insurance is a contract to make good a loss arising through defects in title to real estate or encumbrance thereon. The solution on the actual problem that a third party in good faith fail to be protected in real estate activities may be vitalized though title insurance only the public announcement of registration but the public confidence is not being recognized under civil law system of our country to model after the law system of the continental law origin.

Vancomycin-Resistant Enterococci (VRE) 빈도, 검사법 및 감염관리 대책에 관한 전국 병원 설문조사

정희진,김우주,최선주,이경원,최강원,박승철 대한감염학회 2001 감염 Vol.33 No.2

Background : Vancomcyin-resistant enterococci (VRE) have been an important nosocomial pathogen in the 1990s. Recently, VRE have become an emerging nosocomial pathogen in Korea, but there have been no nationwide study about the status of VRE in Korea. This nationwide questionnaire survey was aimed to determine the prevalence of VRE, the appropriateness of detection method fur VRE, and to evaluate the infection control program in hospitals of various size in Korea. Methods : During 4 weeks (September 1 to October 1, 1999), a questionnaire surveillance study was conducted. We had sent the questionnaire to 200 large hospitals in Korea, which were distributed nationwide. Questionnaire included the prevalence of VRE within the hospital, the detection method for VRE, method of enterococci isolation, antibiotics-susceptibility test and infection control method of VRE. Results : The response rate to questionnaire was 42%. The species identification of enterococci was capable in 62.3% but the accurate enterococcal speciation were capable in 18%. Appropriate antibiotic-sus-ceptibility test were produced only in 6.5%. Total 746 VRE were detected in 42 hospitals during 1-year despite of low sensitivity of detection methods. VRE was noted in 54.4% of hospitals at least. The isolation programme of VRE infected patients was presented in 20.3%, regular surveillance of VRE in high-risk pop ulation was produced only in 16.5%. Conclusion : The prevalence of enterococci among microorganisms isolated from clinical specimens were increased up to 27.7% in Korea. VRE has been emerged in many big cities as well as in Seoul. The microbiological methods that include the speciation of enterococcal isolates, antimicrobial susceptibility test, and VRE detection appeared to be inappropriate in many hospitals. And, proper control and prevention methods were presented in a few hospitals. Education and training about accurate detection of VRE as well as proper infection control programs for VRE are urgently needed. (Korean J Infect Dis 33:78~87, 2001)

복합막을 이용한 막수송의 특성연구

정우준,조성우,양원강 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

2종 콜로디온-복합막을 제조하여서 하전막을 통한 물질수송에 대한 조직과 비교적 방법으로 연구하였다. 하나는 퍼풀루로벤조익 산(perfluorobenzoic acid, PFBA)의 여러 가지 양에 콜로디온을 합성시켜 만든 복합막이고, 다른 하나는 이 복합막에다 염소산나트륨(NaClO_4)을 가하여 포아를 갖는 복합막을 합성하였다. 몇가지 막-페러메타는 막전도도와 전기삼투압 계수의 실험값과 기본적인 비교로 열역학적 관점에서 검토하였다. 두 복합막의 차이는 막을 구성하는 골격이 되는 물질의 구조와 또 복합막내에 존재하는 하전밀도와 관련해서 검토하였다. In order to get a better understanding regarding material transport through charged membranes, two kinds of the composite collodion membranes were prepared and investigated by systematic and comparative studies. One of the membranes is a composite collodion membrane incoporating different quantities of perfluobenzoic acid(PEBA) and the other is the same membrane but with pores formed by adding NaClO_4. Several membrane parameters defined by thermodynamics consideration such as membrane conductance and electroosmosis coefficient was estimated from the corresponding experiments and were examined on the basis of frictional consideration. The differences between two membranes were also discussed in relation to the structure of membrane skeleton of charge densities within the composite collodion membrane.

골조구조물의 소성해석을 위한 알고리즘 개발 및 소성붕괴의 고찰

정명채,조우람 전주대학교 공학기술종합연구소 2003 전주대학교 공학기술종합연구소 학술논문집 Vol.9 No.1

Some members of building frame under severe cyclic loads may be experienced inelastic behavior. In seismic design of building frames elasto-plastic analysis of flame structures are needed to understand the inelastic behavior. In this study, simple and clearer elasto-plastic analysis algorithm is used to investigate the collapse mechanism of a building frame. This algorithm is simple and clear to understand the inelastic behavior of the frame. Two-bay frame is used as a model. The analysis results are very reasonable to describe the collapse of the frame.