폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예

이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.

Spontaneous Bacterial Peritonitis due to Ochrobactrum anthropi: A

Yu Mi Wi,손경목,이지영,오원섭,백경란,Nam Young Lee,송재훈 대한의학회 2007 Journal of Korean medical science Vol.22 No.2

We report a case of spontaneous bacterial peritonitis from Ochrobactrum anthropi. O. anthropi is recognized as an emerging pathogen in immunocompromised patients. In contrast to most previously described cases, the patient reported here had no indwelling catheter. To our knowledge, no case of O. anthropi spontaneous bacterial peritonitis has been reported in the medical literature until now.

Antimicrobial Effects of β-Lactams on Imipenem-Resistant Ceftazidime-Susceptible <i>Pseudomonas aeruginosa</i>

Wi, Yu Mi,Choi, Ji-Young,Lee, Ji-Young,Kang, Cheol-In,Chung, Doo Ryeon,Peck, Kyong Ran,Song, Jae-Hoon,Ko, Kwan Soo American Society for Microbiology 2017 Antimicrobial agents and chemotherapy Vol.61 No.6

<P>We studied the resistance mechanism and antimicrobial effects of beta-lactams on imipenem-resistant Pseudomonas aeruginosa isolates that were susceptible to ceftazidime as detected by time-kill curve methods. Among 215 P. aeruginosa isolates from hospitalized patients in eight hospitals in the Republic of Korea, 18 isolates (23.4% of 77 imipenem-resistant isolates) were imipenem resistant and ceftazidime susceptible. Multilocus sequence typing revealed diverse genotypes, which indicated independent emergence. These 18 isolates were negative for carbapenemase genes. All 18 imipenem-resistant ceftazidime-susceptible isolates showed decreased mRNA expression of oprD, and overexpression of mexB was observed in 13 isolates. In contrast, overexpression of ampC, mexD, mexF, or mexY was rarely found. Time-kill curve methods were applied to three selected imipenem-resistant ceftazidime-susceptible isolates at a standard inoculum (5 X 10(5) CFU/ml) or at a high inoculum (5 X 10(7) CFU/ml) to evaluate the antimicrobial effects of beta-lactams. Inoculum effects were detected for all three beta-lactam antibiotics, ceftazidime, cefepime, and piperacillin-tazobactam, against all three isolates. The antibiotics had significant killing effects in the standard inoculum, but no effects in the high inoculum were observed. Our results suggest that beta-lactam antibiotics should be used with caution in patients with imipenem-resistant ceftazidime-susceptible P. aeruginosa infection, especially in high-inoculum infections such as endocarditis and osteomyelitis.</P>

An Outbreak of Breakthrough Infections by the SARS-CoV-2 Delta Variant in a Psychiatric Closed Ward

Yu Mi Wi,Si-Ho Kim,백경란 대한의학회 2022 Journal of Korean medical science Vol.37 No.4

Background: A rapid decline in immunity and low neutralizing activity against the delta variant in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinees has been observed. This study describes an outbreak of coronavirus disease 2019 (COVID-19) breakthrough infections caused by the SARS-CoV-2 delta variant in a psychiatric closed ward. Methods: Data from epidemic intelligence service officers were utilized to obtain information regarding demographic, vaccination history, and clinical data along with SARSCoV-2 PCR test results for a COVID-19 outbreak that occurred in a closed psychiatric ward. Results: Among the 164 residents, 144 (87.8%) received two doses of vaccines and 137 (95.1%) of them received ChAdOx1 nCoV-19 vaccine. The mean interval between the second vaccination and COVID-19 diagnosis was 132.77 ± 40.68 days. At the time of detection of the index case, SARS-CoV-2 had spread throughout the ward, infecting 162 of 164 residents. The case-fatality ratio was lower than that in the previously reported outbreak before the vaccination (1.2%, 2/162 vs. 6.9%, P = 0.030). Prolonged hospitalization occurred in 17 patients (11.1%) and was less prevalent in the vaccinated group than in the unvaccinated group (8.5% vs. 25.0%, P = 0.040). Conclusion: The findings of this study highlight that while vaccination can reduce mortality and the duration of hospitalization, it is not sufficient to prevent an outbreak of the SARSCoV-2 delta variant in the present psychiatric hospital setting.

카바페넴 내성 그람음성균 감염의 항생제 치료

위유미 ( Yu Mi Wi ),강철인 ( Cheol-in Kang ) 대한내과학회 2018 대한내과학회지 Vol.93 No.5

Carbapenem-resistance emerging in Gram-negative pathogens, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii, has become a major human health problem globally. The therapeutic options available for carbapenem- resistant pathogens are very limited. Antibiotics such as colistin, tigecycline, fosfomycin, and aminoglycosides are often the only ones that can be used to treat carbapenem-resistant pathogens. Carbapenem may still be an option in certain circumstances. The administration of combination therapy for carbapenem-resistant pathogens is controversial. This review presents the current knowledge of available antimicrobial therapeutic options for infections due to carbapenem-resistant pathogens in Korea. (Korean J Med 2018;93:439-446)

카바페넴 내성 그람 음성균 감염의 항생제 치료

위유미 ( Yu Mi Wi ),강철인 ( Cheol-in Kang ) 대한내과학회 2019 대한내과학회지 Vol.94 No.2

Detection of colistin-resistant populations prior to antibiotic exposure in KPC-2-producing Klebsiella pneumoniae clinical isolates

Seo Jungyu,Wi Yu Mi,Kim Jong Min,Kim Yae-Jean,Ko Kwan Soo 한국미생물학회 2021 The journal of microbiology Vol.59 No.6

Although colistin is frequently regarded as the antibiotic of last resort in treating carbapenem-resistant Klebsiella pneumoniae, colistin heteroresistance may in part be associated with antibiotic treatment failure. However, we do not know how widespread the colistin heteroresistance is in carbapenem- resistant K. pneumoniae isolates. In this study, we performed colistin disc diffusion assays, E-tests, and population analysis profiling for KPC-2-producing K. pneumoniae isolates to identify colistin heteroresistance. Although no colistin- resistant colonies were detected by the disc diffusion test and E-test, a colistin-resistant subpopulation was identified in population analysis profiling in all colistin-susceptible, KPC-2-producing K. pneumoniae isolates. Colistin-resistant subpopulations were also identified even when isolates had no colistin exposure. The ratio of colistin-resistant subpopulations to the total population increased as the exposure concentration of colistin increased. In in vitro time-kill assays, regrowth was observed in all isolates after 2 h upon exposure to colistin. We identified common amino acid alterations in PhoQ, PhoP, and PmrB in colistin-resistant subpopulations from some isolates, but no substitutions were found in most resistant subpopulations from other isolates. In all colistin-resistant subpopulations, overexpression of PhoQ and PbgP was observed. In this study, we demonstrated that colistin heteroresistance may be common in KPC-2-producing K. pneumoniae isolates, which could not be detected in the disc diffusion method and E-test. Colistin heteroresistance may cause colistin treatment failure in part and may evolve into resistance. Thus, development of more reliable diagnostic methods is required to detect colistin heteroresistance.

골전도성 삽입물을 이용한 안와골절 정복술

위재민(Jae Min Wi),김유정(Yu Jeong Kim),지미정(Mi Jung Chi) 대한안과학회 2016 대한안과학회지 Vol.57 No.4

목적: 흡수성 골전도성 안와 삽입물인 unsintered hydroxyapatite/poly L-lactide를 이용한 안와골절 정복술의 효과를 안와전산화단층촬영을 통한 안와용적 분석을 이용해 알아보고자 하였다. 대상과 방법: Unsintered hydroxyapatite/poly L-lactide를 이용한 안와골절 정복술 후 6개월 이상 추적관찰된 24명의 환자를 대상으로 후향적 의무기록 분석을 통해 임상소견, 합병증을 확인하였고, 수술 전, 수술 직후, 최종 경과 관찰 시 안와전산화단층촬영 영상을 The Eclipse Treatment Planning System (ver.13.0, Varian Medical System Inc., Palo Alto, CA, USA)을 이용하여 안와용적을 측정하였다. 결과: 수술 전 14명(58.3%)의 환자에서 복시 및 외안근 운동 장애가 있었으나 복시는 모든 환자에서 최종 경과 관찰 시, 안구운동장애는 수술 후 6개월째 모두 개선되었다. 수술 전 골절안의 평균 안와 용적은 23.62 ± 0.45 ㎤, 정상안은 21.95 ± 1.01 ㎤였고 (p=0.003), 수술 직후 골절안의 평균 안와 용적은 21.65 ± 0.91 ㎤, 정상안은 21.78 ± 0.83 ㎤였으며(p=0.542), 최종 경과 관찰 시 골절안의 평균 안와 용적은 21.84 ± 0.93 ㎤, 정상안은 21.81 ± 0.91 ㎤였다(p=0.889). 결론: 안와골절 정복술 시 흡수성 골전도성 기능을 가진 unsintered hydroxyapatite/poly L-lactide는 안와재건 효과가 우수함을 임상소견의 호전 및 안와용적분석을 통해 확인할 수 있었으며, 뚜렷한 합병증 없이 사용할 수 있는 삽입물이다. Purpose: To evaluate the effect of orbital wall reconstruction with absorbable osteoconductive unsintered hydroxyapatite/poly L-lactide by assessment of the orbital volume via orbital computed tomography. Methods: 24 patients who followed up at least 6 months after orbital wall reconstruction with unsintered hydroxyapatite/poly L-lactide were included. Retrospective clinical chart reviews for clinical manifestations and complications were performed, and orbital volume measurements were taken using the Eclipse Treatment Planning System (ver.13.0, Varian Medical System Inc., Palo Alto, CA, USA) through orbital computed tomography, which were taken before operation, right after operation, and at last follow up. Results: Fourteen patients (58.3%) showed diplopia and extraocular muscle movement limitation preoperatively. Diplopia was resolved at last follow up and extraocular muscle movement limitation was improved at postoperative 6 months for all cases. The mean volumes of the fractured orbit and the unaffected orbit before operation were 23.62 ± 0.45 ㎤ and 21.95 ± 1.01 ㎤, respectively (p = 0.003). The mean volumes of the fractured orbit and the unaffected orbit right after operation were 21.65 ± 0.91 ㎤ and 21.78 ± 0.83 ㎤, respectively (p = 0.542). The mean volumes of the fractured orbit and the unaffected orbit at last follow up were 21.84 ± 0.93 ㎤ and 21.81 ± 0.91 ㎤, respectively (p = 0.889). Conclusions: Absorbable osteoconductive unsintered hydroxyapatite/poly L-lactide was effective for clinical improvement and orbital volume assessment in cases of orbital wall reconstruction and it can be used safely without definite implant related complications.

Clinical Effectiveness of Tetracycline-Class Agents Based Regimens in Patients With Carbapenem-Resistant Acinetobacter baumannii Bacteremia: A Single-Center Retrospective Cohort Study

Kim Si-Ho,Wi Yu Mi,Peck Kyong Ran 대한의학회 2023 Journal of Korean medical science Vol.38 No.34

This study evaluated the clinical outcome of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and the clinical effectiveness of tetracyclines-based therapy. In a retrospective cohort study over 5 years period, 108 patients were included in the study. The overall 30-day mortality rate was 71.4%. Pitt’s bacteremia score (PBS) (adjusted hazard ratio [aHR], 1.32; 95% confidence interval [CI], 1.22–1.42 per 1-point), colistin-single regimens (aHR, 0.34; 95% CI, 0.17–0.69), and tetracyclines single/tetracyclines-colistin combination regimens (aHR, 0.18; 95% CI, 0.07–0.48) were independently associated with 30-day mortality. Among patients with a PBS < 6, only tetracycline-containing regimens were associated with decreased mortality. Among patients receiving appropriate definite antimicrobials, the tetracyclines-colistin combination (7 of 7, 100%) tended to a higher 30- day survival rate compared to a tetracycline (7 of 12, 57.1%) or colistin single regimen (10 of 22, 41.6%, P = 0.073). Our findings suggest tetracyclines might be effective for treating CRAB infections when combined with colistin.

Adverse Events in Healthcare Workers after the First Dose of ChAdOx1 nCoV-19 or BNT162b2 mRNA COVID-19 Vaccination: a Single Center Experience

Kim Si-Ho,Wi Yu Mi,Yun Su Yeon,Ryu Jeong Seon,Shin Jung Min,Lee Eun Hui,Seo Kyung Hwa,Lee Sung Hee,Peck Kyong Ran 대한의학회 2021 Journal of Korean medical science Vol.36 No.14

Coronavirus disease 2019 vaccinations for healthcare workers (HCWs) have begun in South Korea. To investigate adverse events (AEs) of the first dose of each vaccine, any symptom was collected daily for seven days after vaccination in a tertiary hospital. We found that 1,301 of 1,403 ChAdOx1 nCoV-19 recipients and 38 of 80 BNT162b2 recipients reported AEs respectively (90.9% vs. 52.5%): injection-site pain (77.7% vs. 51.2%), myalgia (60.5% vs. 11.2%), fatigue (50.7% vs. 7.5%), headache (47.4% vs. 7.5%), and fever (36.1% vs. 5%; P < 0.001 for all). Young HCWs reported more AEs with ChAdOx1 nCoV-19 than with BNT162b2. No incidences of anaphylaxis were observed. Only one serious AE required hospitalization for serious vomiting, and completely recovered. In conclusion, reported AEs were more common in recipients with ChAdOx1 nCoV-19 than in those with BNT162b2. However, most of the reported AEs were mild to moderate in severity. Sufficient explanation and preparation for expected AEs required to promote widespread vaccination.