VRE 감염증의 임상상, 미생물학적 특성 분석 및 유전적 관련성 비교 : 전국 6개 병원에서 분리된 VRE를 중심으로

정희진,박정원,엄중식,하경임,신종희,김정미,이혜수,박영희,김우주,박승철 대한감염학회 2002 감염 Vol.34 No.5

지역사회와 병원에서 페니실린 내성 폐렴구균 감염의 임상적 특징 및 분자유전학적 성상

정희진,황병연,박정원,김우주,김민자,박승철,이영희 대한감염학회 2001 감염 Vol.33 No.2

Background : During the last three decades, the resistance of S. pneumoniae to penicillin has been rapidly increasing in many parts of the world, especially in Korea. To characterize the clinical features and epidemiology of penicillin-resistant S. pneumoniae (PRSP) infections in the community -and hospital, as well as to investigate the possible spread of resistant clone, we performed the antimicrobial susceptibility tests, pulsed filed gel electrophoresis (PFGE) and penicillin-binding protein (PBP) profile analysis of PRSP isolates. Methods : A total 48 PRSP isolates from patients who visited or were admitted to Korea University Guro hospital during the period form July 1998 to June 1999 were studied. Anitimicrobial susceptibility tests for 48 isolates were performed with microbroth dilution method to determine the minimal inhibitory concentration of 11 antibiotics. 39 isolates and 35 isolates were subjected to PFGE and PBP profile analysis, respectively to investigate the genetic relatedness between PRSP isolates. Results : Pneumonia was most common site of infection in the community and the hospital as 50%. There were no significant differences of clinical fentures and prognosis between community and hospital isolates. But, patients with serious underlying diseases had poor prognosis despite of acquisition site. High level penicillin resistance were observed in 69%, multi-drug resistance were 64.6% of isolates. PFGE showed that 13 of 29 community acquired infection were identical PFGE pattern but not that of 23F Spanish clone. There were various PFGE patterns were observed from community and hospital acquired infection isolates. Some of them were existed in both. PBP profiles showed more diverse, even if in isolates of the same PFGE pattern. Conclusion : In our study, high level penicillin resistance and multi-drug resistance were observed in PRSP clinical isolates. No clinical and prognostic differences were observed between community and hospital acquired infections. Molecular epidemiology study were suggest the there were various genotypes of PRSP within our society. Some of them were observed of the hospital and community. Therefore, there was an evidence of communication of PRSP clones between the community and hospital. (Korean J Infect Dis 33:112~122, 2001)

Fluctuations in Abundance and Species Composition of Fishes that appear in the set net fishery in the Dadohae Marine National Park

Cheong, Hyun-Ho,Park, Kyung-Hee national science museum of korea 2009 Journal of Korean nature Vol.2 No.1

In a joint research of the Korean Biodiversity Information Facility (KBIF), the study analyzed species composition and fluctuations in abundance of fishes caught by the set net fishery installed in the offing of Impo, Dolsando in Yeosu-si, Jeollanamdo in June and September 2008. During the study period, there were 11,180 individuals of 54 species of 39 families in 8 orders that appeared in the set net fishery in the offing of the Dadohae Marine National Park. The numbers of individuals that appeared in June and September were shown in Table 2. Among the fishes caught, the Perciformes was the dominant species with 29 species of 22 families followed by the Tetraodontiformes with 6 species of 2 families and the Pleuronectiforme with 5 species of 4 families. There appeared 3 species of 3 families of the Anguilliformes and the Beloniformes, respectively. There were 4 species of 2 families of the Clupeiformes and 3 species of 2 families of the Scorpaeniformes. There was 1 species of 1 family of the Aulopiformes. During the study period, Scomber japonicus was the dominant species with 9005 individuals followed by Trichiurus lepturus with 1500 individuals and Panpus argenteus with 184 individuals. In June, Trichiurus lepturus was dominant with 1200 individuals followed by Panpus argenteus with 150 individuals and Scomberomorus koreanus with 58 individuals. In October, Scomber japonicus was the dominant species with 9000 individuals followed by Trichiurus lepturus with 300 individuals and Scomberomorus koreanus with 45 individuals. It indicates that the dominance of a species has close relationship with water temperature because fishes migrate to feed in this season. Given the frequency of appearance, Scomber japonicus and Trichiurus lepturus most frequently appeared because they were in the middle of growing into adult fishes while the frequent appearance of Scomberomorus koreanus and Panpus argenteus, which were major species of the fishing industry, contributed to the income of fishermen. There appeared rarely seen species in the offing of Yeosu like Pelamis platurus, Rachycentron canadum (Linnaeus), Lobotes surinamensis, Kyphosus vaigiensis, Abudefduf vaigiensis and Siganus fuscescens (Houttuyn). They are subtropical fishes and seem to move here due to the warmer water affected by the global warming. Additional studies on species composition and fluctuations in abundance of fishes that appear in the set net fishery in the Dadohae Marine National Park will be continuously conducted. So, they will contribute to the increase of fishermen's income by transferring the new fish species to fishermen when newly developed rare fish species are fostered in the lab and evaluated for adaptability and growth potential. The research result will be used as basic data to secure national biological resources, and create/manage biodiversity data by building a biodiversity database network.

임상 검체에서 분리된 vancomycin 내성 장구균에 대한 Quinupristin/dalfopristin(Synercid®)을 포함한 10종 항균제의 시험관내 항균력

정희진,박기호,김동림,김우주,김민자,박승철,신종희 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

목적 : 본 연구에서는 고려대 병원과 전남대 병원에서 임상 검체로부터 분리된 VRE 16균주를 대상으로 하여 장구균 감염의 치료에 흔히 사용되는 항균제인 ampicillin, gentamicin, vancomycin, teicoplanin과 VRE에 대해서도 비교적 항균력이 있는 것으로 알려진 기존의 chloramphenicol, doxycycline, erythromycin, ciprofloxacin, rifampicin, 그리고 다제 내성 그람 양성균의 치료를 위하여 새로이 개발된 quinupristin/dalfopristin을 이용한 시험관내 항균력을 조사하고자 하였다. 방법 : 총 16균주의 VRE faecium을 대상으로 quinupristin/dalfopristin (Synercid^(R))를 포함한 10종 항균제에 대한 최소 발육 억제 농도(MIC)를 한천희석법을 이용하여 측정하였다. 각각의 항균제에 대한 감수성은 NCCLS에서 제시한 기준에 의거하여 해석하였다. 결과 : 1) 5균주의 vanB VRE에 대한 항균제의 MIC_(90)은 ampicillin, erythromycin, gentamicin, cipro- floxacin에서 각각 64㎍/㎖, 512㎍/㎖, 512㎍/㎖, 4㎍/㎖로서 100%에서 내성을 보였고, doxycycline, chloramphenicol의 경우 4㎍/㎖, 4㎍/㎖로서 100%에서 감수성을 보였다. Teicoplanin의 MIC_(90)은 1㎍/㎖로서 모두 감수성을 보였고 quinupristin/dalfopristin에 대해서도 MIC_(90) 0.25㎍/㎖로서 감수성을 보였다. 2) 11균주의 vanA VRE에 대한 항균제들의 MIC 범위는 vanB VRE보다는 다양하였다. MIC_(90)을 보면 amplicillin, erythromycin의 경우 256㎍/㎖, 512㎍/㎖으로 100%에서 내성을 보였응며, gentamicin은 MIC_(90) ≥500㎍/㎖의 고도내성을 보인 경우가 8 균주로서 73%에서 내성을 보였다. Ciprofloxacin은 vanB VRE에서와 마찬가지로 MIC≥32㎍/㎖의 100%의 내성을 보였다. Chloramphenicol의 경우는 MIC_(90)이 16㎍/㎖로서 vanA VRE faecium에 대해서도 감수성이 있는 약제로 남아 있었다. 반면에 doxycycline은 MIC_(90)이 4㎍/㎖로서 시험관내에서는 100% 감수성을 보였고, quinupristin/dalfopristin은 MIC_(90)이 2㎍/㎖로서 내성을 보인 균주는 한 균주도 없었다. 결론 : 국내 임상분리 VRE 16균주는 기존에 사용되어 오던 chloramphenicol, doxycyline등의 항균제에 대하여 시험관내에서 100% 감수성을 보였으며 quinupristin/dalfopristin과 같은 새로운 항균제에 대해서도 중등도 또는 완전 감수성을 보여 향후 VRE에 의한 감염증 치료에 있어 이들 약제의 병합요법등이 고려될 수 있을 것이라 사료된다. Background : Vancomcyin-resistant enterococci (VRE) have become a major nosocomial pathogen in the USA during 1990s. In Korea, VRE have recently emerged as a important nosocomial pathogen and posed therapeutic difficulty. We evaluated the antimicrobial susceptibility of clinical VRE isolates to the antimicrobial agents that are commonly used to treat enterococcal infections and to some alternative drugs and to a newer antibiotic such as quinupristin/dalfopristin(Synercid®). Methods : We evaluated 16 clinical VR-E. faecium (5 vanB VRE, 11 vanA VRE) strains that were isolated from Korea Universtiy and Chonnam University hospital during the last five years (1994-1998). The isolates were identified to the species level by using API 20system. The in vitro susceptibility testing was performed by the agar dilution methods, following the criteria described by the National Committee for Clinical Laboratory Standards (NCCLS). The VRE isolates were tested against antimicrobial agents commonly used to treat enterococcal infections (vancomycin, teicoplanin, ampicillin, gentamicin), potential alternative drugs (chloramphenicol, doxycycline, ciprofloxacin, erythromycin, rifampicin) and a newer antibiotic (quinupristin/dalfopristin). Results : 100% (5/5) of vanB VR-E. faecium were resistant to ampicillin, gentamicin and ciprofloxacm, but 100% (5/5) were susceptible to chloramphenicol, doxycycime, teicoplanin and quinupristin/dalfopristm. 100% (11/11) of vanA VR-E. faecium were resistant to ampicillin, ciprofloxacm, 73% were resistant to gentamicin, and 100% (11/11) were susceptible to chloramphenicol and doxycycline. Quinupristin/dalfopristm showed intermediate or high level susceptibility against all vanA VRE isolates. Rifampin is less susceptible (MIC: 4-16 ㎍/mL) against both vanA and vanB VR-E. faecium. Conclusion : The treatment options for infections caused by VRE seem to be very narrow since a small percentage of those isolates were susceptible to the other antmicrobial agents commonly used to treat these infections. And only a few of the alternative drugs including quinupristin/dalfopristm tested showed good in vitro activity. This study suggested that chloramphenicol, doxycycline and qumuprisitin/dalfopristin would be a good candidate to treat VRE infection, but further studies are necessary to demonstrate the clinical role of these antimicrobial agents.

신 손상환자에서 혈관조영술의 역할

박청희,송창준,김종철 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.2

We analyzed angiographic findings of 18 patients with renal injury, and also excretory urography. Angiography is advocated for better definition of previously identified urographic abnormality and for assessment of active bleeding in patients with suspected damage to renal vessels. It also can be therapeutic as transcatheter embolization for control of hemorrhage.

Pristinamycin(Pyostacine®)의 methicillin-resistant Staphylococcus aureus,Penicillin-resistant Streptococcus pneumoniae, Haemophilus influenzae 임상균주에 대한 시험관내 항균력

박정원,송준영,김철현,정희진,김우주,김민자,박승철 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.4

목적 : 국내 및 전세계적으로 methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant Streptococcus pneumoniae(PRSP), β-lactamase 생성 H. influenzae 등의 항균제 내성 감염증이 증가되고, 이에 대한 효과적인 항생제 요법에 대한 필요성이 증가되고 있다. Streptogramin 계열의 경구 항생제인 pristinamycin의 임상검체에서 분리된 균주에 대한 시험관내 항균력을 검사함으로서 이러한 감염증에 대한 임상적 사용의 유용성여부를 알아보고자 하였다. 방법 : 1999년 8월1일부터 2000년 1월 1일까지 호흡기 감염, 피부 및 연조직 감염환자로부터 분리된 MRSA 60주, PRSP 50주, H. influenzae 40주를 대상으로 pristinamycin을 비롯한 8-9종 항생제의 시험관내 항균제 감수성을 측정하였다. 결과 : Pristinamycin은 MRSA에 대한 MIC 범위가 0.125-1㎎/L로서 100%의 감수성을, PRSP에 대한 MIC 범위가 0.125-1㎎/L로서 100%의 감수성을, β-lactamase를 생성하는 H. influenzae에 대해서도 MIC 범위가 0.25-2㎎/L, 96% 감수성으로서 다른 항생제들에 비하여 우수한 시험관내 항균력을 나타내었다. 결론 : 국내에서 문제가 되고 있는 MRSA, PRSP, β-lactamase 생성 H. influenzae에 대하여 pristinamycin은 우수한 시험관내 항균력을 나타내어, 이들 항생제 내성균들에 의한 감염증의 치료에 효과적으로 사용될 수 있을 것으로 생각된다. Background: Pristinamycin(Pyostacine®) is a natural antibacterial combination of compounds Produced by Streptomyces pristinaespiralis. It has been marketed in European countries over 30 years as an oral anti-stphyhcoocal agent. Because of the increasing prevalence microorganisms that are resistant to multiple antimicrobial agents in Korea. there are demand of noble antibiotics like pristinamycin against these resistant organissms. Methods The one-hundred and fifity bacterial strains which were collected from Korea University Guro hospital included sixty methicillin-resistant S. aurous (MRSA) , fifty penicillin-resistant S. pneumoniae (PRSP) and forty H. infuenzae clinical isolates. Using an microbroth dilution or agar dilution technique, we compared the antimicrobial activities of pristinamycin and other usual antibiotics against the studmicroorganisms. Results: All sixty MRSA strains were multiply resistant to other antimicrobial agents, but 100% of MRSA strains were susceptible to pristinamycin (MIC range: 0.125-1㎎/L). All of fifty PRSP strains were multiple resistant to other antimicrobial agents but 100% PRSP strains were susceptible to pristinamycin (MIC range: 0.125-1㎎/L). Twenty-seven strains of forty H. influenzae strains were β-lactamase positive, and 95% (38/40) of H. influenzae strains were susceptible to prisitinamycin (MICrange : 0.015-4㎎/L) . Conclusion : Pristinamycin demonstrated the highly active. in vitro antimicrobial activities against MRSA. PRSP. and H.influenzae isolated so it might be an effective oral therapeutic agent for treating patients with mild infection due to those organisms or on the outpatient setting.

정신분열증 환자 가족의 부담감에 대한 구조모형

박청자,이경희 대한보건협회 2003 대한보건연구 Vol.29 No.2

This study was designed to develop and test a structural model for the burden in families with the prolonged schizophrenia. The model included 6 theoretical concepts and llpaths. The data were collected from May to July, 2002. The subjects of this study were Mx) families with the prolonged schizophrenia registered in four community mental health centers at Daegu city. An SPSS PC+ and PC-Lisrel 8.30 computer programs were used for descriptive an covariance structure analysis. The results of the study were as follows: 1) The hypothetical model showed itself a good fit to the empirical data. Goodness of Fit Index = .980 Ajusted Goodness of Fit Index = .908 GFI=.980, AGFI=.908 NFI=0.913 2) The results of hypthesis testing indicated that five paths were significant.

Debrun 라텍스분리풍선을 이용한 외상성 경동맥해면동루의 치료

박청희 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.2

The occlusion of fistula was done using detachable balloons in six cases of traumatic carotid-cavernous fistulas(CCF) and the results of the experience are reported. Transarterial approach was tried in all 6 cases using manually-tied Debrun latex balloons, one in four cases and two in two cases. Balloon embolization improved visual acuity in 3 cases among 4 cases of decreased visual acuity, and light reflex in 3 cases among 4 cases of decreased or abscent light reflex. Stenosis of ICA at the fistular orifice was made in 2 cases(case 3;20%, case 4;70%) without clinical symptoms. Ten-month follow-up angiogram of case 4 showed complete shrinkage of the balloon and change of the stenotic ICA to normal diameter. Minor complication such as nausea, vomiting, and ocular pain were present in all cases which completely disappeared in one week. Balloon embolization is the definitely effective treatment of post-traumatic CCF, which should be done by experienced radiologists. Early diagnosis and early treatment should be made to improve the reversible visual loss and cranial nerve palsy before the irreversible complication may occur.

병원과 지역사회에서 메티실린 내성 황색 포도상구균(methicillin-resistant Staphylococcus aureus) 감염의 임상 분자역학 연구

박정원,이종섭,송준영,김철현,엄중식,정희진,김우주,박승철 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.2

목적 : 국내에서 1990년대 이후 중요한 병원균으로 대두되고 있는 methicillin-resistant S. ureus(MRSA)는 주로 입원환자에서만 분리되는 것으로 알려져 있으나, 최근들어 지역사회에서도 퍼져있는 것으로 알려지기 시작하였다. 이에 병원획득 및 지역사회획득 MRSA의 임상역학 및 분자역학적 연구를 통하여 획득요인, 병원과 지역사회 획득 균주간의 교류 양상등을 규명하고자 하였다. 방법 : 1998년 1월부터 12월까지 고려대 부속 구로병원에서 임상검체로부터 분리된 S. aureus 균주중에서 MRSA 균주의 빈도를 구하였고, 이중 1998년 10월 1개월 동안 분리되었던 42균주에 대하여 지역사회획득 균주와 병원획득 균주로 나누고, 임상역학적 조사를 하였다. 지역사회 획득 18주와 병원획득 22주에 대하여 PCR 방법으로 mecA 유전자를 확인하였고, PFGE를 시행하여 균주의 클론형(clonal type)을 결정하고 이 결과에 준하여 덴드로그램 분석을 시행하여 분자적 친밀도를 결정하였다. 결과 : 1998년 1년간 분리된 총 1,587주의 S. aeureus 균주중 73.8%(1,163주)가 MRSA 였다. 1998년 10월 1개월 동안 임상자료의 고찰이 가능하였던 MRSA 감염환자 42명 중 20명이 지역사회획득 환자였고, 병원획득 환자가 지역사회획득 환자보다 항생제사용 과거력(17 vs 5, p=0.001), 기저질환의 존재(18 vs 8, p=0.002) 등이 통계적으로 의미있게 높았다. 지역사회획득환자가 이루(7/20[35.0%] vs 2/22[9.1%] ; p=0.041)와 밀접한 관계가 있음도 확인하였다. 분자생물학적연구가 진행된 40주의 MRSA 균주는 모두 mecA 유전자 양성이었고, 18주의 지역사회획득 균주에서 총 8가지의 PFGE 클론형이 존재하였으며 A형이 가장 많았다(7/18, 38.8%). 22주의 병원획득균주에서는 6가지의 클론형이 존재하고 A형이 가장 많았으며(15/22, 68%), 15주의 지역사회획득 균주(83.3%)가 21주의 병원획득균주와 공통적인 클론형을 공유하고 있었다. 결론 : 지역사회 획득 MRSA는 주로 이루나 창상부위에서 많이 분리되는 반면 병원획득 MRSA는 객담에서 많이 분리되고 또한 당뇨병을 가진 환자에서 감염을 잘 일으키는 것으로 밝혀졌다. PFGE 분석 결과 원내감염은 단일균주에 의한 유행양상을 보였고, 지역사회에서도 같은 형의 균주에 의한 감염빈도가 가장 높음을 보여 MRSA 균주가 지역사회로 유입되어 지역사회내 MRSA 감염의 발생에 기여했을 것으로 사료된다. Background : Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infection has been acquired primarily in hospital settings. During the late 1990s, the incidence of community-acquired MRSA infections has been increased in this university hospital. This retrospective study evaluated the clinical features and risk factors for community-acquired MRSA infection compared with hospital-acquired MRSA infection; and molecular relatedness of MRSA strains determined by pulsed-field gel electrophoresis(PFGE). Method: MRSA isolates collected from patients during October of 1998 were classified as community-acquired("community') or hospital-acquired("hospital") cases. MRSA infections were defined as hospital-acquired if organisms were isolated > 48 hours after admission to the hospital or isolated from patients with a history of admission to a hospital within the last 3 months. A comparative analysis of risk factors for community MRSA compared with hospital MRSA was performed. mecA gene PCR and PFGE of MRSA isolated was used as a tool of strain identification and molecular typing. Result : During one month, there were 42 patients with MRSA infection or colonization. Of 42 patients with MRSA isolates, 22(52%) were hospital cases and 20(48%) were community cases. Previous exposure to antibiotics(17 vs 5, p = 0.001) and presence of underlying diseases (18 vs 8, p = 0.002) were more common in hospital cases than in community cases. MRSA were more frequently isolated in otorrhea specimens from patients with otitis media in community cases compared with hospital cases. Of the 40 MRSA isolates subjected for PFGE typing, 18 were community isolates and 22 were hospital isolates. There were 8 distinct PFGE types among the 18 community isolates and type A was the most common clonal type (7/18, 38.8%). 22 hospital isolates were of 6 distinct PFGE types, and type A was dominant clonal type (15/22, 68%). PGFE subtyping indicated that 15(83.3%) of 18 community MRSA strains were clonally related with that of 21 hospital MRSA strains. Conclusion : Our results suggest that hospital MRSA strains may have disseminated in the community setting. PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in the regional community.

척추결핵의 전산화단층촬영술

박청희 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.2

Computed tomography (CT) of 15 patients with spinal tuberculosis were retrospectively analized in comparison with conventional radiography, which were examined from June 1983 to October 1985 at Department of Radiology, Chungnam National University Hospital. The loss of intervertebral disc height was shown as well by plain film as by CT imaging. However, CT was more effective in demonstrating erosion of the vertebral endplate, multifocal destruction of the vertebral body, and the full exetnt of combined paraspinal abscess(13/15, 87%). CT showed a soft tissue mass, epidural abscess, and bony fragment in spinal canal which caused cord compression (8/15, 53%) CT is useful both in diagnosis and in the adequate therapy, especially for the advanced cases of spinal tuberculosis with localized neurologic signs.