CTX-M형 ESBL 생성 비장티푸스성 살모넬라의 특성

박순호,서일혜,안정열,박필환,김경희,송영희,김정은 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Background: Extended-spectrum ß-lactamase (ESBL)-producing Salmonella have been increasingly reported worldwide. ESBL-producing Salmonella is of particular concern since children cannot be treated with quinolones. This study was conducted to determine the phenotypic and genetic characteristics of ESBL-producing Salmonella in a tertiary hospital. Materials and Methods: Four clinical ESBL-producing isolates of non-typhoidal Salmonella were collected during 2001 to 2009. Antimicrobial susceptibility was determined by disk diffusion test and VITEK-II system. ESBL production was tested by ESBL phenotypic confirmatory test. TEM, SHV, CTX-M1, CTX-M2, CTX-M8, and CTX-M9 type ESBL genes were detected by PCR amplification, and PCR products were subjected to direct sequencing Results: Phenotypic confirmatory test showed that 4 of the 300 non-typhoidal Salmonella isolates were ESBL-producing: 3 S. Enteritidis and 1 S. Typhimurium. All 4 isolates were recovered during the past 1 year period. All 3 S. Enteritidis harbored CTX-M-15, while the S. Typhimurium harbored CTX-M-14. All CTX-M-15-producing S. Enteritidis isolates showed resistance both to cefotaxime and ceftazidime, while the CTX-M-14-producing S. Enteritidis were resistant only to cefotaxime. Conclusions: ESBL-producing nontyphoidal Salmonella has emerged recently and the type of ESBL has switched from TEM and SHV to CTX-M.

수술중 기계적 환기시 HME (Heat and Moisture Exchanger)가 기도저항에 미치는 영향

윤석화,김일문,이상묵,유재현 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

To compare the airway resistance effects of two heat and moisture exchangers(HME) during short-term intraoperative volume controlled mechanical ventilation. Following a randomized order, the patients were ventilated during 3hrs with two HMEs(Pall conserve and Humi-vent filter). In each patient and for each 5 min, lhr, 2hrs and 3 hrs period, body temperature and airway resistance were measured. The hydrophobic HME (Pall conserve) had a good theraml conservation capacity, but increase airway resistance(11.7±2.9cm H_2O/1/s to 15 4±3.4 after lhr, to 17.3±2.5 after 2hrs, to 17.5±3.3cm H_2O/l/s after 3hrs). The hygroscopic filter(Humi-vent filter) had a good thermal conservation capacity, and less increase airway restance than Pall conserve(13.0±2.3 to 15. 4±3.4. after 1hr, 15.9±2.5 after 2hrs, 15.0±3.3 cmH2O/I/s after 3hrs). The hygroscopic HME had a thermal and humidification capacity and less increase the airway resistance.

Flavimonas oryzihabitans에 의한 지역사회 획득 감염성 심내막염 1예

장욱순,김수연,박윤수,서일혜,김민주,조용균 대한감염학회 2005 감염과 화학요법 Vol.37 No.5

Flavimonal oryzihabitans는 인체에 감염을 일으키는 드문 원인균의 그람음성 간균으로 주로 인공 삽입물이 있는 경우, 수술 등의 침습적 시술을 한 경우, 면역억제상태의 환자 등에서 잘 발생하며 1세대 및 2세대 cephalosporin에 내성을 보이고 3세대 cephalosporin, antipseudomonal penicillin, aminoglycoside에 감수성을 보이는 것으로 알려져 있다. 저자들은 입원, 수술 등의 기왕력이 없는 평소 건강하였던 23세 남자환자가 발열과 오한을 주소로 내원하여 혈액배양검사와 심초음파 검사를 통해 F. oryzihabitans 지역사회 획득성 심내막염으로 진단하였고 ceftazidime과 gentamicin 투여 및 승모판 성형술 후 치유된 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하는 바이다. Flavimonas oryzihabitans is a yellow-pigmented, non-spore forming, gram-negative bacillus mainly found in damp environments such as soil and stagnant water. F. oryzihabitans is an uncommon cause of clinically significant human infection. This organism has been mainly reported to cause infection related to indwelling intravenous catheters, continuous ambulatory peritoneal dialysis catheters or surgical procedures in immune compromised hosts or cancer patients. We report a case of community-acquired infective endocarditis caused by F. oryzihabitans in a 24-year-old man who had no significant past medical history. He was successfully treated by antimicrobial therapy and mitral valvuloplasty.

Erythromycin 내성 포도알균의 유도형 Macrolide-Lincosamide-Streptogramin B (MLS_(B)) 내성 표현형 빈도

김경희,박순호,박필환,안정열,서일혜 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Inducible MLS_(B) (macrolide-lincosamide-streptogramin B) resistance in staphylococci is not detected by standard susceptibility test methods. Failure to identify inducible MLS_(B) resistance may lead to clinical failure during clindamycin therapy. We determined the prevalence of inducible MLS_(B) resistance in erythromycin-resistant staphylococcal isolates. Materials and Methods: We evaluated all 2,792 non-duplicate staphylococcal strains: 1,402 Staphylococcus aureus and 1,390 coagulase-negative staphylococci (CoNS) isolated from May 2008-June 2009 at one-unoversity hospital. Testing for inducible MLS_(B) was accomplished by the disk approximation test (D-test) in accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI). Results: Of the 2,792 staphylococcal isolates, 892 S. aureus isolates and 740 CoNS isolates were resistant to erythromycin. Among the 892 erythromycin-resistant S. aureus isolates, the overall prevalence of inducible MLS_(B) was 21.3% (16.2% of MRSA and 76.3% of methicillin-susceptible S. aureus). Among the 740 erythromycinresistant CoNS isolates, the overall prevalence of inducible MLS_(B) was 16.5% (16.0% of methicillin-resistant CoNS and 18.7% of methicillin-susceptible CoNS). The D-test was positive in 88.8% of S. aureus and 28.4% of CoNS isolates, which were erythromycin-resistant and clindamycin-susceptible. Conclusions: There are some variations in the prevalence of inducible MLS_(B) resistance in clinical staphylococcal isolates. It is important that clinical laboratories report inducible MLS_(B) resistance for erythromycin-resistant and clindamycinsusceptible staphylococcal isolates.

16S rRNA 유전자 염기서열 분석에 의해 확인된 Acinetobacter spp. 가성요로감염 유행

김수연,김진용,강지혜,박신영,이희승,박윤수,서일혜,조용균 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

목적 : 본 연구는 일개 대학병원의 한 병동에서 16SrRNA 유전자 염기서열 분석을 통해 확인된 Acinetobacter spp. 가성요로감염 집단 발생에 대한 조사이다. 재료 및 방법 : 일개 대학병원의 일반병동에서 2005년 9월 23일부터 26일까지 5명의 환자에서 Bordetelta bronchiseptica 세균뇨가 동시에 분리되었다. 해당 환자들에 대한 입원 진료 기록을 확인하고, 이학적 검사를 시행하였고, 의료진 면담 등의 역학적 조사와 의심되는 전파원의 환경 감시배양을 시행하였다. 또한 다섯 균주들의 상동성 확인을 위해 pulsed field gel electrophoresis (PFGE)를 하였고, 정확한 균 동정을 위해 16S rRNA 유전자 염기서열 분석을 하였다. 결과 : VITEK system에 의해 B. bronchiseptica로 보고된 다섯 균주들은 거의 유사한 항생제 감수성을 가지고 있었다. 유행조사에서 요로감염의 증상이나 균혈증을 보인 환자는 없었고, 환경 감시배양에서 공통의 전파원은 증명되지 않았다. 또한 PFGE와 16S rRNA 유전자 염기서열분석에서 상동성을 가진 동일 Acinetobacter spp.로 확인되어 이에 의한 가성요로감염의 유행으로 결론지었다. 결론 : 역학적 조사와 함께 PFGE와 16s rRNA 유전자염기서열 분석과 같은 분자생물학적인 조사를 시행하는 것은 희귀한 균에 의한 병원감염 유행조사에 도움이 될 것이다. Background : Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. Materials and Methods : Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. Results : All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. Conclusion : This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms.

Candida albicans에 의한 허리근 농양 1예

정승기,김수연,봉정민,백은기,이규훈,이상오,서일혜,조용균 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

칸디다는 우리 몸의 여러 곳에서 발견되는 상재 진균으로 Candida albicans가 가장 흔히 질병을 일으킨다. 대부분 표재성 감염을 일으키며 칸디다에 의한 심부 감염은 드물다. 심부 감염은 주로 면역약화 환자에서 혈류를 따라 여러 장기에 퍼지는 파종성 칸디다증으로 발생하며, 한 곳의 심부 장기에만 농양을 형성하는 경우는 상대적으로 덜 흔하다. 저자들은 당뇨병과 알코올성 간경변을 가진 환자에서 혈액 및 농 배양 검사에서 C. albicans가 동정된 허리근 농양 1예를 경험하였고 배농과 amphotercin-B, fluconazole로 성공적으로 치료하였기에 문헌고찰과 함께 보고하는 바이다. Candida species are ubiquitous human commensals, of which Candida albicans is most commonly associated with human disease. Candida infections usually involve superficial tissues, but the infections of deep tissues are relatively uncommon. Among the Candida infections of deep organs, disseminated candidiasis is the most common presentation particularly in immunosuppressed patients, however, a single abscess formation in deep organ is rare. We experienced a case of psoasabscess by C. albicans in a patient who had diabetes and alcoholic liver cirrhosis, which was treated successfully by drainage of the abscess and administration of amphotericin-B, followed by fluconazole. We report this case with review of the pertinent literatures.

성인에서 발생한 폐렴을 동반한 출혈성 수두 1예

김현옥,김진용,고광일,김영생,김수연,박윤수,서일혜,조용균 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

출혈성 수두는 심각한 합병증을 초래 할 수 있으며 사망률이 높은 질환으로 국내에서는 소아에서 발생한 2예 이외에는 성인에서 발생이 보고된 바가 없다. 본 증례에서와 같이 면역이 억제된 성인에서 출혈성 수포가 전신적으로 발생하면서 폐렴이 동반된 경우 치명적이므로 조기에 acyclovir 지속 정주요법 등의 적극적인 치료를 고려해야 한다. 저자들은 면역이 저하된 성인에서 폐렴이 동반된 출혈성 수두가 발생하여 조기에 acyclovir 지속적 정맥 주입요법 시행 후 치명적인 합병증 없이 호전을 보인 예를 경험했기 에 보고하는 바이다. Chickenpox is a common benign childhood disease caused by varicella-zoster virus, typically associated with fever and a characteristic exanthematous vesicular rash. The clinical manifestations in adults are more severe and more commonly complicated with varicella pneumonia. Hemorrhagic varicella, also called malignant chickenpox, is very rare and potentially fatal. Bleeding can occur in the form of hemorrhages within the rash and surrounding skin or within the mucous membrane. We report a case of hemorrhagic varicella complicated with pneumonia in a immunocompromised host. We emphasize on the successful treatment with continuous acyclovir infusion.

Streptococcus constellatus에 의한 경막 외 농양이 동반된 화농성 척추염 1예

안홍대,박재찬,서종구,김진용,김수연,박윤수,서일혜,조용균 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomveltis with epidural abscess to be reported in Korea.

지역사회획득 메티실린 내성 황색포도알균에 의한 급성 신우신염 1예

김수연,김진용,이희승,박철민,박윤수,서일혜,조용균 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

전세계적으로 지역사회획득 메티실린 내성 황색포도알균에 의한 감염 질환이 증가하고 있으나 아직까지 국내외에서 이로 인한 요로감염의 보고는 없었다. 저자들은 지역사회획득 메티실린 내성 황색포도알균에 의한 신우신염을 진단하고 ciprofloxacin 투여로 성공적으로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. In the past decade, methicillin-resistant staphylococcus aureus (MRSA) have emerged in the community, causing serious infection in young and healthy persons without established risk factors for MRSA acquisition. This community acquired methicillin- resistant S. aureus (CA-MRSA) has been usually reported to cause the skin and soft tissue infection and necrotizing pneumonia. We have experienced a case of acute pyelonephritis caused by CA-MRSA without health care-associated risk factors. The staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST) revealed the ST5- MRSA-IV clone, which showed SCCmec type IV and MLST allelic profile of ST5 (1-4-1-4-12-1-10).

메티실린 내성 황색포도알균 주사부위 감염 후 발생한 척추추간판염 1예

김진용,김현옥,고광일,김영생,김길현,김수연,박윤수,서일혜,조용균 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

본 증례는 약물남용자가 아닌 환자에서 MRSA에 의한 말초주사부위 감염 후 발생한 화농성 척추추간판염의 첫 보고이다. 최근 MRSA에 의한 원내감염이 증가하고 있는 현실에 비추어 볼 때 말초주사부위 감염 후 MRSA에 의한 화농성 척추추간판염의 발생을 고려하여야 한다. Infections of the intervertebral disc and adjacent vertebrae may present with spondylitis, discitis and spondylodiscitis and are hematogenous origin in most cases. Potential sources of hematogenous infection are skin and soft tissue infection, genitourinary tract infection, infective endocarditis, intravenous drug abuse, respiratory tract infection and infected intravenous injection site. We have experienced a case of pyogenic spondylitis caused by methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with peripheral injection site infection. He was successfully treated with surgical debridement and antibiotics.