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폐염간균에 대한 Quinolone계 약제의 항균작용에 미치는 Rifampin의 영향
류필열,정문태,신부안,정선식,안태휴 대한화학요법학회 1990 대한화학요법학회지 Vol.8 No.2
Antimicrobial activities of nalidixic acid(NA),norfloxacin(NX), oxolinic acid(OA), pefloxacin(PX), pipemidic acid(PA), oxacillin, cefotaxime(CFT), cephaloridine, cefazoline, moxalactam(MX), gentamicin, amikacin(AK) and rifampin(RP) were compared by the agar dilution method against 31 strains of K. pneumoniae isolated from various clinical spectimens. And then combined activities of RP with each of the quinolones (NA, MX, OAA, PX, and PA) against the test strains were measured by checkerboard dilution and time-killing methods. The growth inhibitory activities of PX, NX, OA, MX and AK were exellent, and those of PA, NA, RP and CFT were moderate, while the other's being almost negligible. The bactericidal activity of PX was more active than that of the other quinolones. Increasing concentrations of the quinolones resulted in a parallel increment of killing rate. However, when levels of quinolones were excessive beyond the most effective bactericidal ones, the bactericidal activity was decreased. In the combined growth inhigitory tests of RP with quinolones by checkerboard agar dilution method, synergistic and additive effects were rarely observed, and antagonism was noticed among the combinations in the following order: RP-NA, 22 strains (71%); RP-PA, 21 strains (67.7%); RP-OA, 17 strains (54.8%); RP-PX, 15 strains (48.4%) and RP-NA, 14 strains (45.2%). In the combined bactericidal tests measured by time-killing method, RP was found to reduce the activities of all five quinolones tested. And the gradual increasing of RP dose was revealed to reduce progressively the bactericidal action of the quinolones. But when RP was added to quinolones after 1 hour of incubations, the bactericidal activities were not affected.
Methicillin-내성 황색포도상구균의 각종 항균제에 대한 내성양상과 Plasmid DNA의 특성
정선식,신종희,류필열,안태휴,양동욱,김영일,이준행,김영휴 대한감염학회 1995 감염 Vol.27 No.1
광주지역의 A병원과 B병원에 입원한 환자의 각종 임상가검물로 부터 분리동정한 황색포도상구균 251주를 19종의 항균제에 대한 감수성 검사를 실시하고 내성인자를 조사하여 다음과 같은 결과를 얻었다. Oxacillin에 대한 내성빈도는 A병원에서 74.2%로 B병원의 46.1% 보다 약 30% 정도가 높았다. 또한 cephalosporine계 항균제와 aminoglycoside계 약제에 대한 내성빈도는 A 병원 분리균주에서 높은 경향을 보였으며, ampicillin(Amc), tetracycline(Tc), chloram-phenicol(Chp), ciprofloxacin(Cpfx)등의 항균제에 대한 내성빈도는 A병원와 B병원에서 분리된 균주간에 유사하였다. 그러나 fosfomycin(Fom)에 대한 내성빈도는 오히려 B병원 분리균주에서 높았다. 10가지 이상의 약제에 내성을 갖는 다제내성균의 출현율은 B병원에서 보다 A병원에서 높았다. A병원와 B병원에서 분리된 MRSA 대부분이 cefamandole(Cmdl)을 제외한 cephalosporin계 약제와 aminoglycoside제제에 대해 내성을 나타내었으며, netilmicin(Net) 과 rifampin(Rfp)에 대한 내성빈도는 A병원에서 분리된 균주에서 높았으며 Fom, Tc, Chp에 대한 내성빈도는 오히려 B병원에서 분리된 MRSA 에서 높았다. 다제내성균의 출현율은 두 병원간에 큰차이가 없었다. MRSA 의 다제내성양상은 Fom, Net, Chp 및 Rfp에 대한 내성에 따라 A병원와 B병원에 서 분리된 균주간의 차이가 관찰되었는데, A병원에서 가장 많이 나타난 내성유형은 AmcCtxCzolLmoxGmTobLcmAmkNetTcEmRfp 및 AmcCtxCzolCmdlLmoxFomGmTobLcmAmkNetTcEmRfp에 중복내성을 갖는 균주가 각각 12균주로 가장 많았으며 B병원에서 분리된 균주에서 많이보이는 내성유형은 AmcCtxCzolLmoxFomGmTobLcmAmkChpTcEm에 중복내성은 갖는 균주가 11주로 가장 많았다. 두 병원에서 분리된 균주 모두 β-lactam계 약제와 aminoglycoside계 약제간의 교차내성을 가지고 있었다. MRSA균주에서 분리한 plasmid DNA profile은 A병원와 B병원에서 분리된 균주에서 약제에 대한 다제내성양상에 따라 차이가 있었으며, A병원 분리균주에서는 108kb, B병원 분리균주에서는 2.8kb의 plasmid를 보유하는 차이가 있었다. Background: Increased isolation of methicillin-resistant Straphylococcus aureus has become one of the important problem in treating staphylococcal infections. The aim of the study was to investigate the epidemiological characteristics of antimicrobial resistance of MRSA's isolated in the Kwangju area. Methods: 251 strains of S. aureus were isolated from various specimens from A-hospital and B-hospital and there resistance patterns against 19 antimicrobial agents and plasmid profiles studied. Results: Methicillin resistance was detected in 74.2% and 46.1% of A-hospital and B-hospital isolates, respectively. Resistance to cephalosporins and aminoglycosides was more frequent in the A-hospital isolates than in the B-hospital isolates, whereas fosfomycin resistance was more frequent in the B-hospital isolates than in the A-hospital isolates. Frequency of resistance to ampicillin, tetracycline, chloramphenicol, ciprofloxacin in A-hospital isolates was similar to B-hospital isolates. Strains with multiple resistance to more than 10 drugs were more frequent in the A-hospital isolates than that in the B-hospital isolates. Among MRSA strains, resistance to netilmicin and rifampin was more frequently encountered in A-hospital isolates, while resistance to fosfomycin, tetracyclin, and chloramphenicol was more frequent in B-hospital isolates. No differences in resistance patterns against other cephalosporins and aminoglycosides were observed between the two hospitals. Fosfomycin, netilmicin, chloramphenicol and rifampin resistances were different between the hospitals in strains with multiple resistance. The most frequently observed multiple resistance patterns observed among A-hospital isolates were AmcCtxCzoILmoxGmTobLcmAmkNetTcEmRfp and AmcCtxCzolCmdlLmoxFomGmTobLcmAmkNetTcEmRfp. Among B-hospital isolates, AmcCtxCzolLmoxGmTobLcmAmkChpTcEm pattern was the most frequent. Conclusion: MRSA strains from both hospitals showed cross-resistance to β-lactams and aminoglycosides. Plasmid profiles from MRSA strains were different, according to the multiple resistance patterns. Characteristically, 108 kb plasmid was detected only in A-hospital-MRSA strains, while 2.8 kb plasmid was detected only in B-hospital-MRSA strains.