의학강좌 : 경구 항생제요법

김의석 ( Eu Suk Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.5

혈액투석 환자에서 발생한 뇌 아스페르길루스증 1예

김순애 ( Soon Ae Kim ),신성준 ( Sung Joon Shin ),김의석 ( Eu Suk Kim ),박석원 ( Seok Won Park ),이정호 ( Jeong Ho Lee ),김경수 ( Kyung Soo Kim ),이정상 ( Jung Sang Lee ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

그람양성균으로 인한 감염 척추염에서 Linezolid의 효과와 안전성

정종탁 ( Jongtak Jung ),이은영 ( Eunyoung Lee ),송경호 ( Kyoung-ho Song ),최평균 ( Pyoeng Gyun Choe ),박완범 ( Wan Beom Park ),방지환 ( Ji Hwan Bang ),김의석 ( Eu Suk Kim ),김홍빈 ( Hong Bin Kim ),박상원 ( Sang Won Park ),김남중 ( 대한내과학회 2018 대한내과학회지 Vol.93 No.5

Background/Aims: Infectious spondylitis requires long-term antibiotic treatment; however, the use of intravenous antibiotics during this period has high social and monetary costs due to hospitalization. Linezolid has high oral bioavailability and is not affected by changes in renal or hepatic function. We investigated the clinical and microbiological effects of linezolid in infectious spondylitis caused by beta-lactam resistant gram-positive bacteria. Methods: Clinical data from patients who were treated with linezolid for at least four weeks were collected retrospectively from electronic medical records at the Seoul National University Hospital, Seoul National University Bundang Hospital, and Boramae Medical Center from 2006 to 2016. Results: Twenty Korean patients were treated with linezolid for at least four weeks during the study period. Of these, 14 patients were cured, four failed, and two cases of mortality occurred due to other causes than infectious spondylitis. Ten of 13 patients who had previously been assessed as vancomycin treatment failure were cured by linezolid. Bacteremia occurred in 14 patients, and 10 of these showed persistent bacteremia at the time of linezolid administration. Eight of these cases of persistent bacteremia were cured by linezolid. Median duration of linezolid treatment was 40.5 days (28-90 days). Severe cytopenia (grade II or more of National Cancer Institute criteria) was the most common adverse event, with incidences of 11.11% for neutropenia, 12.96% for anemia, and 20.37% for thrombocytopenia. Conclusions: Linezolid can be used as an effective antibiotic agent in patients with infectious spondylitis, especially when treatment failure of the first-line treatment is expected. (Korean J Med 2018;93:464-472)

국내 Epstein-Barr 바이러스 일차감염의 임상적 특성

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

In this study, the clinical features of 264 patients of primary Epstein-Barr virus (EBV) infection between the years of 2002-2006 were evaluated retrospectively. The median age of the patients was 6 years old (0-69), and the hospitalization rate was 78.0%. Fever (83.3%) and sore throat (50.4%) were the most common symptoms. Cervical lymphadenopathy (71.2%), tonsillitis (51.1%), splenomegaly (26.1 %), hepatomegaly (25.8%), rash (10.2%) and jaundice (1.5%) were observed. Cervical lymphadenopathy was less frequent in older age groups. The annual number of primary EBV infections according to the age group during the study period did not change significantly in this study.

수술부위감염 예방을 위한 항생제 요법

김의석 동국대학교 의학연구소 2009 東國醫學 Vol.15 No.2

수술부위감염은 흔한 병원감염 중 하나로 이환율과 사망률의 증가와 의료비의 상승을 초래한다. 수술 전후에 적절하게 예방적 항생제를 투여하는 것이 수술부위감염을 낮출 수 있는 것으로 알려져 있다. 그러나 항생제의 선택과 투여방범이 적절하지 못한 경우 수술부위감염을 예방하는 효과는 떨어지고 오히려 내성, 부작용, 추가적인 의료비 상승 등의 문제가 발생하게 된다. 본 글에서 기존에 알려진 예방적 항생제 투여지침을 토대로 하여 효과적인 항생제의 종류, 투여시간, 투여기간에 대한 일반적인 권고사항을 정리하였다. Surgical site infections (SSIs) remain one of the most common causes of nosocomial infections. Morbidity and mortality for patients who develop SSIs increase and healthcare costs increase substantially. While preoperative administration of proper antibiotics reduces SSIs, inappropriate use of prophylactic antibiotics would cause bacterial resistance, adverse reactions, and increase in medical costs rather than reduce SSIs effectively. Based on the previously published guidelines for surgical prophylaxis in the literature, selection of proper antibiotics and effective administration methods, including proper timing and duration of prophylaxis, were discussed in this article.

쯔쯔가무시병에서 가피의 위치와 복장과의 관계

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 쯔쯔가무시병의 예방을 위하여 위험지역에서 긴소매 윗옷을 입고 바지 끝을 양말 속에 넣는 것이 권장되고 있다. 이러한 예방조치의 효용성을 알아보기 위하여 우리는 쯔쯔가무시병에서 가피의 위치와 신발과 복장과의 관계를 살펴보았다. 재료 및 방법 : 2005년 10-12월 사이 6개 병원에서 전형적인 임상양상, 가피의 존재, 혈청검사 결과로 쯔쯔가무시병이 의심되거나 확진된 159명의 성인을 대상으로 가피의 위치, 추정 감염일, 야외활동, 당시 착용한 신발과 복장 등 을 조사하였다. 결과 : 혈청검사는 5명에서 시행되지 않았고 99명이 양성이었으며, 가피는 142명에서 발견되었다. 몸의 두 군데에서 발견된 6명을 제외한 136명 중 82명(60.3%)에서 가피는 하반신(아랫배, 엉덩이, 서혜부, 생식기, 넓적다리, 종아리)에 있었다. 감염일이 추정가능하고 가피가 1개만 있는 44명을 대상으로 하였을 때, 가피가 하반신에서 발견된 17명에서 슬리퍼를 신거나 맨발인 경우는 5명이었으나 상반신에 있는 27명 중에는 아무도 없었다(P=0.006). 바지아랫단을 양말 속에 집어 넣은 4명 중 1명은 하반신에서 3명은 상반신에서 가피가 발견되었다. 42명이 긴 소매 윗옷을 입었는데, 이중 16명은 하반신에서 26명은 상반신에서 가피가 발견되었다(P=1.00). 결론 : 쯔쯔가무시병 환자에서 신발을 신지 않거나 발이 잘 보호되지 않았을 때 가피는 하반신에 더 잘 생겼다. 바지 아랫단의 처리방법이나 긴 소매 윗옷의 착용은 가피의 위치와 통계적으로 유의한 연관관계는 발견되지는 않았다. 그러나 표본수가 적고 유충의 침범경로에 영향을 줄수 있는 다른 요인이 있기 때문에 가피의 위치와 연관관계가 없다고 이 연구에서 단정할 수는 없다. 따라서 쯔쯔가무시병의 예방을 위한 실용적인 권고를 위해서는 더 많은 연구가 필요하다. Background:Wearing a long-sleeved shirt and tucking the pants legs into the socks is recommended to prevent scrub typhus. This study investigated associations between the location of eschar and the type of clothes and shoes to evaluate the efficacy of these protective measures. Materials and Methods:One-hundred and fifty nine patients in whom scrub typhus was confirmed or suspected based on the typical clinical manifestations, presence of eschar, or positive results of serologic tests at 6 Korean hospitals from October to December 2005 were included in this study. We collected the information on the location of eschar, presumed exposure date to chiggers, and the clothes and shoes which they had worn. Results:Serologic tests were positive in 99 patients. Eschars were observed in 142 patients and 6 of them exhibited more than 2 eschars. Eighty-two (60.3%) of 136 patients with a single eschar had an eschar on the lower half of the body. Of the 44 patients whose exposure date could be estimated, and who had only a single eschar, 5 of the 17 patients with eschars in the lower half of their bodies, and none of the 27 patients with eschars in the upper half of their bodies went barefoot or wore open footware (P=0.006). Only 4 patients tucked the pants into their socks, and an eschar was found in the lower half in one patient, and in the upper half of the body in the other 3 patients. Of 42 patients who wore long-sleeved shirts, eschars were found in their lower bodies in 16, and on their upper bodies in 26 (P=1.00). Conclusion:When the feet were not protected properly with shoes, eschars were found more frequently on the lower half of the body than on the upper half. Wearing a long-sleeved shirt or tucking the pants legs into the socks was not found to be significantly correlated to the location of eschars. Further studies involving larger samples are necessary for the development of practical guidelines of protective measures to prevent scrub typhus.

발작과 쇼크를 동반한 토착형 삼일열 말라리아 1예

윤상구,김민환,정은숙,한금현,곽이경,조종래,엄태현,김의석 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

삼일열 말라리아는 일반적으로 경미한 임상경과를 거치며, 열대열 말라리아와 달리 뇌형말라리아, 폐부종, 신부전등의 치명적인 합병증을 일으키지 않는 것으로 알려져 있다. 저자들은 특이한 과거력이 없던 건강하던 성인이 국내에서 삼일열 말라리아에 걸린 후 발작과 쇼크가 발생하여, 항말라리아 약제와 대증치료로 치료된 증례를 경험하였다. Vivax malaria reemerged in the Republic of Korea in 1993. Vivax malaria is generally a benign disease with few severe complications. Even in the worldwide literature, there is only a small number of case reports on severe complications in vivax malaria. We report a unique case of P. vivax infection complicated by seizure and shock. A 58 year-old male showed generalized tonic-clonic seizure and shock after P. vivax infection. The species of malarial parasite was identified using peripheral blood film examination and polymerase chain reaction (PCR). He successfully recovered after treatment with hydroxychloroquine.

국내 다기관에서 조사한 지역사회획득 메티실린내성 황색포도알균의 빈도와 임상적 특성

송진수,최평균,송경호,조재현,김성한,방지환,이창섭,박경화,박경운,신수,최희정,김의석,김동민,이미숙,박완범,김남중,오명돈,김의종,김홍빈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 최근 전세계적으로 지역사회획득 메티실린내성 황색포도알균(community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA)의 보고가 증가하고 있다. 하지만, 우리나라에서는 CA-MRSA 감염증에 대한 증례보고만 있을 뿐 아직까지 체계적인 연구결과가 없는 실정이다. 저자들은 국내에서 CA-MRSA의 빈도, 감염증의 임상적 양상, 분리된 균주의 항균제내성 양상을 조사하였다. 재료 및 방법 : 2005년 1월부터 2005년 6월까지 7개 병원에서 MRSA가 분리된 환자의 명단을 파악한 후 의무기록지와 건강보험심사평가원의 자료를 검토하였다. 외래나 응급실에서 혹은 입원 후 72시간 이내에 균주가 분리되고 MRSA 획득과 관련된 위험인자가 없는 경우 CA-MRSA로 정의하였으며, 분리된 균주의 임상적 의미에 따라 원인병원체(pathogen), 집락화(colonizer), 미결정(undetermined)으로 분류하였다. Penicillin과 oxacillin을 제외하고 3개 이상의 다른 계열 항균제에 내성이면 다제내성으로 정의하였다. 결과 : 연구기간동안 총 3,251주의 황색포도알균이 분리되었으며, 이 중 MRSA는 1,900주(58.4%)였다. MRSA 가운데 CA-MRSA는 114주(6.0%) 였으며, 이들이 분리된 부위는 귀(62주), 비뇨기계(14주), 피부 및 연부조직(11주), 호흡기계(10주), 혈액(3주) 등이었다. CA-MRSA 균주 가운데 집락균은 22주, 원인병원체는 22주였으며, 나머지 균주에 대해서는 그 임상적 의미를 결정할 수 없었다. 항균제 감수성 검사를 시행한 73균주 중 47주(64.4%)는 다제내성이었다. CA-MRSA 감염증 22예 중 피부 및 연부조직 감염(9예)과 중이염/외이도염(9예)이 가장 흔하였다. 침습적 감염증(invasive infection)은 4명(원발성 균혈증 3예, 감염성 관절염 1예)에서 확인되었지만, CA-MRSA 감염증으로 사망한 환자는 없었다. 결론 : 병원내 감염증에서는 MRSA가 심각한 문제이지만, 아직까지 지역사회 감염증에서 CA-MRSA는 흔하지 않았다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). Material and Methods : Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. Results : Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides β-lactams. Conclusion : Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.

한 병원 의료종사자의 A형 간염 혈청역학과 예방접종

김민수,김의석,장윤정,허희진,채석래,이진호 대한감염학회 2009 감염과 화학요법 Vol.41 No.5

Background : Recently, the incidence of hepatitis A has increased in Korea and an outbreak among healthcare workers (HCWs) has also been reported. This study was performed to evaluate the seroepidemiology of hepatitis A among HCWs and their response to vaccination recommendation at a Korean hospital. Materials and Methods :HCWs aged 20-39 years were tested for IgG antibodies against hepatitis A virus (HAV) using ARCHITECT HAVAb-IgG (Abbott Diagnostics Division, Wiesbaden, Germany) during July, 2008. Vaccination was recommended for the seronegative HCWs. Data on age, sex, place of birth, number of siblings, number of children, travel history to endemic areas, occupations, and vaccination history were collected. Statistical analyses were conducted to identify variables related to HAV seropositivity. Results : Among a total of 391 HCWs enrolled, 75 (19%) were males and 316 (81%) were females. The percentages of HCWs aged 20 to 24 years, 25 to 29 years, 30 to 34 years, and 35 to 39 years were 23%, 48%, 17%, and 12%, respectively. The study population comprised of physicians (11%), nurses (62%), nurse aides (5%), paramedical technicians (13%), and administrative staff (9%). Seropositivity for HAV significantly increased with age (P<0.05):1.1% for 20.24, 8.6% for 25-29, 35.8% for 30-34, and 60.9% for 35-39 years-of-age. Multivariate analysis revealed that HAV seroprevalence correlated significantly with age, HCWs born in the non-metropolitan areas, and having ≥ 3 children (P<0.05). The types of work the HCWs do at the hospital were not significantly associated with HAV seropositivity in multivariate analyses. Of a total of 322 seronegative HCWs, 121 (38%) were not vaccinated in spite of recommendation. The reasons for non-compliance were lack of understanding on the necessity of vaccination (39%), lack of time (26%), expensive costs (16%), fear of injection (15%), and some other reasons including pregnancy (4%). Conclusions : Since the seropositivity for HAV is low, vaccination against Hepatitis A should be considered for all HCWs aged 20-39 years in Korea. Education on the necessity of vaccination is warranted to increase compliance.

2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.