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신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성
김탁,성흥섭,박관태,김송철,김성한,최상호,김양수,우준희,박수길,한덕종,이상오 대한감염학회 2009 감염과 화학요법 Vol.41 No.2
Background : This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients. Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection. Results : A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, Positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively. Conclusions : The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.
대동맥 판막 치환술 후 반복되는 Acinetobacter baumannii 균혈증의 원인이 된 대동맥염 1예
정용필,김성철,송은희,장은영,김은경,김윤지,성흥섭,김미나,최상호,우준희,김양수 대한감염학회 2007 감염과 화학요법 Vol.39 No.3
감염성 대동맥염은 흔하지 않지만 매우 위중한 질병으로 Salmonella so.와 S. aureus가 주된 원인균이다. 아직까지 병원내 감염의 주요 원인균인 Acinetobacter baumannii에 의한 감염성 대동맥염은 보고된 바가 없었다. 저자들은 대동맥 판막 치환술을 시행받은 76세 남자 환자에서 적절한 항생제 투여에도 반복되는 A. baumannii 균혈증의 원인이 감염성 대동맥염으로 진단되었던 1예를 경험하였기에 보고하는 바이다. Infectious aortitis is an uncommon yet, life threatening disease. Early surgical treatment and prolonged antibiotic therapy is crucial to survival. Salmonella sp. and Staphylococcus aureus are the most common organisms isolated. There is no case report of infectious aortitis caused by Acinetobacter baumannii, which has recently emerged as a major cause of health care-associated infections. Here, we describe a 76-year-old male with infectious aortitis who experienced recurrent bacteremia due to A. baumannii in spite of adequate antimicrobial therapy after aortic valve replacement.
Mycobacterium intracellulare에 의한 요추부 척추염 1예
장은영,김미영,김정욱,송은희,백관미,정용필,성흥섭,김미나,김양수,우준희,이상호 대한감염학회 2007 감염과 화학요법 Vol.39 No.3
비결핵성 미코박테리아에 의한 척추염에 대한 증례 보고가 국내에서는 아직 없었다. 저자들은 기저질환이 없는 환자에서 M. intracellulare에 의한 척추염을 rpoB 유전자에 대한 PCR-RFLP 방법을 통해 진단하였고 수술적 치료와 3제 병합 항균 요법으로 성공적인 임상 경과를 보인 1예를 경험하였기에 보고하는 바이다. We report a case of vertebral osteomyelitis due to Mycobacterium intracellulare in a 60-year-old man without predisposing conditions. He was successfully treated with surgical excision of the inflamed tissue and combined antimycobacterial therapy consisting of clarithromycin, ethambutol, and rifampin. In this case, polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) based on the rpo B gene of cultured isolates allowed rapid identification of M. intracellulare. Although very rare, nontuberculous mycobacteria (NTM) should be suspected as a causative pathogen of vertebral osteomyelitis. To the best of our knowledge, this is the first case of vertebral osteomyelitis caused by NTM reported in the Korean literature.
Heungsup Sung,Kyoung Ho Roh,Ki Ho Hong,성문우,Namhee Ryoo,Hyun Soo Kim,Jaehyeon Lee,So Yeon Kim,Sookwon Yoo,Mi-Na Kim,Myung-Guk Han,Sang Won Lee,Hyukmin Lee,Cheon Kwon Yoo 대한진단검사의학회 2020 Annals of Laboratory Medicine Vol.40 No.6
Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Early detection of COVID-19 and immediate isolation of infected patients from the naive population are important to prevent further pandemic spread of the infection. Real-time reverse transcription (RT)-PCR to detect SARS-CoV-2 RNA is currently the most reliable diagnostic method for confirming COVID-19 worldwide. Guidelines for clinical laboratories on the COVID-19 diagnosis have been recently published by Korean Society for Laboratory Medicine and the Korea Centers for Disease Control and Prevention. However, these formal guidelines do not address common practical laboratory issues related to COVID-19 real-time RT-PCR testing and their solutions. Therefore, this guideline is intended as a practical and technical supplement to the “Guidelines for Laboratory Diagnosis of COVID-19 in Korea”.
( Sung-han Kim ),( Ho-su Lee ),( Hyun-jung Lee ),( Sun-mi Kim ),( Sung Shin ),( Sang-hyoung Park ),( Kyung-jo Kim ),( Young-hoon Kim ),( Heungsup Sung ),( Sang-oh Lee ),( Sang-ho Choi ),( Suk-kyun Yan 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.5
Background/Aims: We evaluated the proposed clinical application of the com-bined interpretation of host factors and viral factors in two different cytomegalo-virus (CMV) co-infection models. Methods: We prospectively enrolled all human immunodeficiency virus non-in-fected patients with confirmed Pneumocystitis jirovecii pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypoth-esized that cases falling in the left upper quadrant (high viral load and low CMV- specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians. Results: Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gas-trointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV dis-ease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model. Conclusions: Cases yielding low CMV IGRA results and high CMV viral repli-cation appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.
( Tark Kim ),( Yu-mi Lee ),( Sang-oh Lee ),( Sang-ho Choi ),( Yang Soo Kim ),( Jun Hee Woo ),( Heungsup Sung ),( Joo Hee Jung ),( Sung Shin ),( Young Hoon Kim ),( Young-ah Kang ),( Young-shin Lee ),( 대한내과학회 2016 The Korean Journal of Internal Medicine Vol.31 No.5
Background/Aims: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy. Methods: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period. Results: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001). Conclusions: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.
Yoo, Soo Jin,Kim, Hyo-Bin,Choi, Sang-Ho,Lee, Sang-Oh,Kim, Sung-Han,Hong, Sang-Bum,Sung, Heungsup,Kim, Mi-Na American Society for Microbiology 2012 Antimicrobial Agents and Chemotherapy Vol.56 No.12
<B>ABSTRACT</B><P>We investigated the frequency and clinical significance of macrolide resistance in adult and pediatric patients with community-acquired pneumonia from aMycoplasma pneumoniaeinfection. The frequency of the A2063G mutation in the 23S rRNA gene was significantly higher in children than in adults (61.3% [19/31] and 13.3% [8/60], respectively;<I>P</I>< 0.001). Patients with macrolide-resistantM. pneumoniaeinfections showed a longer duration of fever (<I>P</I>= 0.021) and required a longer duration of antibiotic treatment (<I>P</I>= 0.007).</P>
Moon, Song Mi,Kim, Tark,Sung, Heungsup,Kim, Mi-Na,Kim, Sung-Han,Choi, Sang-Ho,Jeong, Jin-Yong,Woo, Jun Hee,Kim, Yang Soo,Lee, Sang-Oh American Society for Microbiology 2011 Antimicrobial agents and chemotherapy Vol.55 No.10
<B>ABSTRACT</B><P>While it is well-known that adjunctive corticosteroid use improves the outcome of moderate-to-severePneumocystis jiroveciipneumonia (PcP) in patients with human immunodeficiency virus (HIV), there are limited data on its efficacy in non-HIV-infected patients with PcP. Patients undergoing fiber-optic bronchoscopy with bronchoalveolar lavage for suspected PcP from January 2007 through December 2010 were reviewed retrospectively. We compared demographics, clinical characteristics, and outcomes in 88 non-HIV-infected patients with moderate-to-severe PcP with (<I>n</I>= 59) and without (<I>n</I>= 29) adjunctive corticosteroid use. Outcomes of PcP were assessed by respiratory failure and 30-day and 90-day all-cause mortality. Survival curves were analyzed by the Kaplan-Meier method and estimated by the log rank test. All-cause mortality of moderate-to-severe PcP at 90 days was lower in the solid-organ transplant recipients than in all other patients (6/26 [23%] versus 34/62 [55%], respectively;<I>P</I>= 0.006), and mortality at 30 days was lower in patients with hematologic malignancies than in all other patients (4/26 [15%] versus 24/62 [39%], respectively;<I>P</I>= 0.03). The outcomes of PcP were not significantly different in moderate-to-severe PcP patients with and without adjunctive corticosteroid use, regardless of recent corticosteroid use. Survival analysis of PcP patients with and without corticosteroid use by the Kaplan-Meier method also did not reveal any difference (log rank test;<I>P</I>= 0.81). There again was no difference within the subgroup of PcP patients with solid-organ transplants. Adjunctive corticosteroid use may not improve the outcome of moderate-to-severe PcP in non-HIV-infected patients.</P>
Bae, Seongman,Kim, Min-Chul,Park, Su-Jin,Kim, Hee Sueng,Sung, Heungsup,Kim, Mi-Na,Kim, Sung-Han,Lee, Sang-Oh,Choi, Sang-Ho,Woo, Jun Hee,Kim, Yang Soo,Chong, Yong Pil American Society for Microbiology 2016 Antimicrobial agents and chemotherapy Vol.60 No.11
<P>Emerging resistance to colistin in clinical Acinetobacter baumannii isolates is of growing concern. Since current treatment options for these strains are extremely limited, we investigated the <I>in vitro</I> activities of various antimicrobial combinations against colistin-resistant A. baumannii. Nine clinical isolates (8 from bacteremia cases and 1 from a pneumonia case) of colistin-resistant A. baumannii were collected in Asan Medical Center, Seoul, South Korea, between January 2010 and December 2012. To screen for potential synergistic effects, multiple combinations of two antimicrobials among 12 commercially available agents were tested using the multiple-combination bactericidal test (MCBT). Checkerboard tests were performed to validate these results. Among the 9 colistin-resistant strains, 6 were pandrug resistant and 3 were extensively drug resistant. With MCBT, the most effective combinations were colistin-rifampin and colistin-teicoplanin; both combinations showed synergistic effect against 8 of 9 strains. Colistin-aztreonam, colistin-meropenem, and colistin-vancomycin combinations showed synergy against seven strains. Colistin was the most common constituent of antimicrobial combinations that were active against colistin-resistant A. baumannii. Checkerboard tests were then conducted in colistin-based combinations. Notably, colistin-rifampin showed synergism against all nine strains (100%). Both colistin-vancomycin and colistin-teicoplanin showed either synergy or partial synergy. Colistin combined with another β-lactam agent (aztreonam, ceftazidime, or meropenem) showed a relatively moderate effect. Colistin combined with ampicillin-sulbactam, tigecycline, amikacin, azithromycin, or trimethoprim-sulfamethoxazole demonstrated limited synergism. Using MCBT and checkerboard tests, we found that only colistin-based combinations, particularly those with rifampin, glycopeptides, or β-lactams, may confer therapeutic benefits against colistin-resistant A. baumannii.</P>