Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals

Son, Jun Seong,Song, Jae-Hoon,Ko, Kwan Soo,Yeom, Joon Sup,Ki, Hyun Kyun,Kim, Shin-Woo,Chang, Hyun-Ha,Ryu, Seong Yeol,Kim, Yeon-Sook,Jung, Sook-In,Shin, Sang Yop,Oh, Hee Bok,Lee, Yeong Seon,Chung, Doo The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.7

<P>Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. <I>Escherichia coli</I> was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, <I>Staphylococcus aureus</I> (15.2%), coagulase-negative <I>Staphylococcus</I> (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment.</P>

폐렴구균의 용혈능 변화와 pneumolysin 유전자의 변이 양상

오원섭,장현하,정숙인,김연숙,이혁,김신우,김성민,백경란,이남용,송재훈 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.3

목적 : 폐렴구균은 인체에서 폐렴, 수막염 및 패혈증 등을 일으키는 중요한 병원균으로 현재 전 세계적으로 항균제 내성이 큰 문제가 되고 있다. 하지만 폐렴구균의 항균제 내성에 따라 병독성이 어떻게 변화하는지에 대해서는 구체적으로 알려져 있지 않다. 이에 기능적 및 구조적 분석을 통하여 폐렴구균의 주요 병독성 인자인 pneumolysin의 병인론적 역할을 규명하고자 하였다. 방법 : 임상 검체에서 분리된 페니실링 감수성 균주 20주와 내성 균주 20주를 대상으로 하였다. Pneumolysin의 세포 독성의 변화를 관찰하기 위하여 각각의 균주들의 용혈능을 측정하였고, pneumolysin 유전자를 중합효소 연쇄반응으로 증폭한 후 증폭 산물의 유전자 구조를 분석하였다. 결과 : 페니실린 감수성 균주와 내성 균주간의 용혈능은 유의한 차이를 보이지 않았으나, 일부 용혈능이 매우 낮은 균주에서 Lys152→Thr, Thr-172→Ile, Lys-224→Arg와 같은 변이가 관찰되었다. 결론: pneumolysin의 세포 독성의 변화는 항균제 내성 정도와는 무관하였으나, 일부 용혈능이 저하된 균주에서 발견된 pneumolysin 유전자의 변이가 pneumolysin의 세포 독성에 영향을 주는 것으로 보인다. Background : Pnumolysin (Ply) is one of the most important virulence factors of Streptococcus pneumoniae. To investigate the functional and structural variation of Ply, hemolytic activity (HA) and gene sequences of pneumolvsin were determined. Methods : A total of 40 invasive pneumococcal isolated (20 penicillin-susceptible & 20-resistant strains) were analyzed. HA of each isolate was measured in crude extracts (1×10^8 CFU/mL) hourly from the time of inoculation to 9h. Crude extracts (50㎕) and DTT buffer (100㎕) were serially diluted in 96-well plate and mixed with 1% sheep blood (50㎕). HA was represented as the reciprocal of the greatest dilution, which resulted in the complete lysis. Two sets of oligonucleotide primers were used to amplify a 1,474-bp fragment containing the coding region and a 578-bp fragment of upstream region of ply gene, respectively. Amplified products were directly sequenced. Results : HA showed a wide variation from 0 to 87,480 regardiess of penicillin MICs, serotypes or specimen sources. Two bacteremic strains showed completely no hemolytic activity. No significant differences in HA between penicillin-susceptible (Mean± SE : 15,468± 4,693) and penicillin-resistant strains (21,384± 4,087) were found (p > 0.05).Sequencing of the coding region showed unique alterations in amino acids in strains with markedly reduced hemolytic activity (≤ 40): Thr-172-Ile and Lys-224-Arg. However, upstream region of ply gene was highly conserved. Conclusions : Ply activity was not related with antibiotic resistance. Absence of HA in some strains was associated with unique alterations in amino acid sequences in ply gene. Relationnship between genomic alteration and functional changes in pneumolysin should be further investigated.

국내에서 발생하고 있는 사람 브루셀라증의 임상적 특성

김연숙,최영실,오원섭,권기태,이혁,이선희,손준성,김신우,장현하,정숙인,고관수,박미연,백경란,송재훈 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

배경 : 2002년 내국인에서의 첫 사람 브루셀라증의 증례 보고 이후 국내에서 사람 브루셀라증이 빠른 증가를 보이고 있다. 이에 연구자들은 국내에서 발생하는 브루셀라증의 임상적 특성을 연구하고자 하였다. 방법 : 2003년부터 2006년 7월까지 7개 대학병원에 내원한 환자들을 대상으로 WHO의 진단기준에 의하여 확진된 브루셀라증 환자들의 의무기록을 후향적으로 조사분석 하였다. 배양된 균은 삼성서울병원에 의뢰하여 16S rRNA 유전자 분석방법을 이용하여 종을 확인하였고, 표준시험관응집검사는 국립보건원에 의뢰하여 시행하였다. 결과 : 34예의 환자들이 브루셀라증으로 확진되었고, 31명이 남자였다. 혈액에서 B. abortus가 증명된 경우가 8예, 표준시험관 응집검사상 의미 있는 항체가 상승을 보인경우가 26예이었다. 환자들은 대부분 축산업관련 종사자였고, 추후 브루셀라증으로 확진된 소와의 직접 접촉을 통해 감염된 것으로 여겨진다. 국내 사람 브루셀라증의 가장 흔한 증상은 발열이었고, 위장관계 합병증이 가장 흔히 동반되었다. 치료로는 doxycycline/rifampicin이 24예의 환자에서 doxycycline/aminoglycoside (streptomycin 혹은 gentamicin)이 10예의 환자에서 6주 이상의 기간 동안 투여되었다. 치료에 반응을 보이지 않는 환자는 없었고, 재발이 1예 있었다. 결론 : 국내에서 발생하는 사람 브루셀라증의 원인균으로 현재까지 분리 동정된 것은 B. abortus이며, 소 브루셀라증의 증가로 인해 인체감염사례가 함께 증가하는 것으로 사료된다. 위험 직업군 종사자들에서 감염된 소와의 직접 접촉을 통해 주로 발생하고 있는 브루셀라증의 임상종상은 국외에서 발생하는 경우와 유사한 양상을 보이고 있으며 치료에 대한 반응은 비교적 좋은 편이긴 하나, 추후 보다 많은 환자들을 대상으로 한 연구가 필요하리라 사료된다. 사람 브루셀라증의 조절을 위해서는 소 브루셀라증의 조절이 필수적이며, 브루셀라증의 조절에 성공한 선진국의 사례를 적극적으로 도입해야 할 것으로 생각된다. Background : Since the first Korean case of human brucellosis was reported in 2002, the incidence of human brucellosis has been rapidly increasing. We performed this study to evaluate the clinical characteristics of human brucellosis occurring in South Korea. Materials and Methods : Demographic features, clinical manifestations, and therapeutic outcomes of cases confirmed as brucellosis according to WHO diagnostic criteria were evaluated. Species of Brucella isolates were identified with 16S rRNA gene sequencing method. Serologic diagnosis was performed with standard tube agglutination test (STA). Results : A total of 34 cases were enrolled from 2003 to 2006 in six hospitals. Eight cases were confirmed with the isolation of Brucella from blood and 26 cases were confirmed with titer of antibodies ≥1:160 by STA. Male (31) was predominant and most of the patients were cattle farmers. The most common transmission route was direct contact with infected or their cattle byproducts. Fever was the most prominent symptom and fatigue followed. Gastrointestinal and musculoskeletal systems were commonly complicated. Patients were treated with doxycycline and rifampin or aminoglycosides for more than 6 weeks. All patients responded well to the therapeutic regimens, but one patient relapsed 10 months after treatment. Conclusion : Brucellosis occurring in Korea has been caused by B. abortus, whose preferred natural host animals are cattle. Korean patients were infected through direct contact with bovine brucellosis. Clinical manifestations of brucellosis were similar to those occurring worldwide. Therapeutic outcomes were good among patients with brucellosis in Korea. In order to prevent human brucellosis, measures to eradicate bovine brucellosis should precede.

The Comparisional Analysis of Colostrum Protein between the First and Third Days after Calving using Proteomic Analysis

Woo Tae Ha1,Hyun Jung Park,Won-Young Lee,Ha Yeon Jeong,Hyuk Song 한국동물생명공학회(구 한국동물번식학회) 2017 Reproductive & Developmental Biology(Supplement) Vol.41 No.2

The colostrum proteins are an important energy source for newborns and improves their innate immune system. Recently, there are many interest about beneficial factors in colostrum to health and many products using colostrum are attentive into dietary supplements in global industry. The aim of this study was to compare the enriched proteins between the colostrum from the first and the third day after calving using proteomic analysis and to analyze which enriched protein will be useful to industry of dietary supplements. In this study, cows in the experimental group were fed a standard composition of feed for 12 months, after which we collected the colostrum on the first and the third day after calving. By comparison between the first and the third day colostrum, several factors, including beta-lactoglobulin, fibrinogen gamma-B chain, complement C3, zinc-alpha-2 glycoprotein, bP47 protein, beta casein, and alpha-S2 casein were enriched in the third day colostrum, whereas immunoglobulin gamma 1 and beta- casein A2 were enriched in the first day colostrum. The results suggest that the colostrum composition depends on time and the first day colostrum is important to establish the primary specific immune system, whereas the third day colostrum might regulate the non-specific immune system and increase nutrition using casein and the third day colostrum might be useful dietary products for supporting the immune system.

Regeneration of Bovine Mammary Gland in Immunodeficient Mice by Transplantation of Bovine Mammary Epithelial Cells mixed with Matrigel

Woo Tae Ha1,Hyun Jung Park,Won-Young Lee,Ha Yeon Jeong,Hyuk Song 한국동물생명공학회(구 한국동물번식학회) 2017 Reproductive & Developmental Biology(Supplement) Vol.41 No.2

With the global demand for dairy protein for consumption growing annually, there has been increasing activity in the research field of dairy protein synthesis and production. From a manipulation perspective, it is more difficult to use live cattle for laboratory studies on the production of milk as well as of dairy protein such as casein, as compared with using laboratory animals like rodents. Therefore, we aimed to develop a mouse model of bovine mammary alveolar ducts for laboratory-scale studies. We studied the formation of the bovine mammary gland ductal structure by transplanting the MAC-T bovine alveolar cell line into mice. MAC-T cells (1×107) were suspended in Matrigel and injected into the dorsal tissue of 8-week-old male BALB/C nude mice. Histological analysis of tissue dissected from the MAC-T cell-transplanted mice after 6 weeks showed the typical morphology of the tubuloalveolar female gland, as well as glands made up of branching ducts that were surrounded by smooth muscle with small alveoli budding off the ducts. In addition, the epithelial markers CK14 and CK18 were expressed within the duct-like structure. Prolactin was detected in the duct interior in these CK14+ and CK18+ cells but not in the non-transplanted MAC-T cells. These results showed that duct-like tissue had been successfully formed after 6 weeks of transplantation of the CK14+ and CK18+ MAC-T cells into mice dorsal tissue. This mouse model will be a useful tool for further research on the bovine mammary gland.

다도해 해상국립공원 常綠闊葉樹林의 群落形成에 미치는 環境要因

임병선,박연우,김하송 木浦大學校 沿岸環境硏究所 1992 沿岸環境硏究 Vol.9 No.1

본 연구는 서남해 다도해 해상국립공원내의 대표적인 5개 상록활엽수군락인 후박나무, 동백나무, 구실잣밤나무, 붉가시나무 및 가시나무군락에서 생육지의 지형적 특징 토양환경 및 산림지역지수(FSQI)를 측정하였다. 군락분포는 동백나무와 후박나무군락이 10。이하의 완만한 경사지로써 북사면의 계곡에, 가시나무와 붉가시나무군락이 15。이상의 급한 경사지로써 남동사면에, 구실잣밤나무군락이 이들 사이에 주로 형성되었다. 식생구조는 일부 보존림을 제외하고는 대부분의 군락에서 DBH가 10㎝이하, 수고 8m미만인 맹아림이었다. 토양요인중 전기전도도, 질소함량 및 인함량 등은 후박나무군락에서 가장 높았고, 그 다음으로 동백나무, 붉가시나무 및 구실잣밤나무 순으로 낮았다. 삼림지역지수(FSQI)의 평균값은 후박나무, 동백나무, 구실잣밤나무, 붉가시나무, 가시나무가 각각 16.42, 15.72, 13.28, 9.36 및 11.80이었다. 이상의 결과에서 상록활엽수림의 분포는 지형적 특성을 나타내는 FSQI와 밀접한 관련이 있는 것으로 나타났다. To elucidate main factor affecting species distrubuttion, the five representative evergreen broad-leaved communities of camellia japonica, Machilus thunbergii Castanopsis cuspidata var. sieboldii, Quercus acuta and Quercus myrsinaeforlia were copared to topographic position, soil properties and Forest Site Quality Index(FSQI) in Dadohae National Marine Park. Camellia japonica and Machilus thunbergii are abundant on northern slopes in valley position whereas Quercus myrsinaeforlia and Quercus acuta were most abundant on southestern slopes in high elevation. Castanopsis cuspidata var. sieboldii was occured between intermediate position of those. Dominant species of vegetation were mainly a sprout forest whose DBH and height were within 10 cm and 8 m respectively. Soil properties did not enfluence on community distribution but electric conductivity, total nitrogen and phosphorus contents of soil decreased in the order of Machilus thunbergii, Camellia japonica, Quercus acuta and castanopsis cuspidata var. sieboldii community. Mean values of FSQI in the communities of Machilus thunbergii, Camellia japonica, Castanopsis cuspidata var. sieboldii, Quercus acuta and quercus myrsinaeforlia were 16.42, 15.72, 13.28, 9.36 and 11.80 respectively. These results indicate that distribution of evergreen broad leaved communities were highly associated with FSQI of site quality.

비만을 동반한 위암 환자에서 두 병을 같이 수술 치료한 경험(증례)

최경현,윤기영,문형환,신연명,서경원,안수미,송윤미,석정희,정경연,이은하 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Obesity is growing problem in Korea. We had a case of bariatric surgery during gastric cancer operation. Patient was 29 year old Korean lady with early gastric cancer located in the lesser curvature side of the middle 1/3 of the stomach. Her body weight was 89 kg, height 163 cm, and thus body mass index was 33.5 kg/m2. Preoperative blood pressure was 130/90 mmHg, hemoglobin 12.9 g/dL, total lymphocyte count 3,280/mL, serum albumin 4.3 g/dL, CEA 1.1 ng/mL, CA 19-9 9.1 ng/mL, and alpha fetoprotein 2 ng/mL. Another associated disease was right thyroid follicular neoplasm. The chest X-ray was normal. After IM injection of 2,500 units of heparin 30 minutes before the induction of general anesthesia, she received curative subtotal gastrectomy and Roux en Y gastrojejunostomy when a malabsorption loop of 120 cm jejunum was incorporated between the Treitz ligament and the end to side jejuno-jejunostmy site at May 29th 2006. Her postoperative course was uneventful except a minor wound seroma and the elevations of serum amylase(up to 4 folds) and lipase(up to 2 folds). She lost her body weight 9 kg in 5th, 21 kg in 7th, and 27 kg in 10th postoperative months to became 61.5 kg. On follow up exams in July 2008, she gained 4 kg to overcome her weakness and fatigue. From the above result, the incorporation of a malabsorption loop during reconstruction phase of gastric cancer operation was a good option for obese gastric cancer patients especially in cases of early gastric cancer.

분포형 토양침식지도를 이용한 한강상류지역 토양유실 위험성 평가

박찬원(Chan-Won Park),손연규(Yeon-Kyu Sonn),장용선(Yong-Seon Zhang),홍석영(S. Young Hong),현병근(Byung-Keun Hyun),송관철(Kwan-Cheol Song),하상건(Sang-Keun Ha),문용희(Young-Hee Moon) 한국토양비료학회 2010 한국토양비료학회지 Vol.43 No.6

본 연구에서는 1:25,000 정밀토양도 등 가용한 공간자료를 이용하여 작성된 토양유실도를 이용하여 한강 상류지역 10개 중권역 108 소유역에 대하여 토양유실량 평가하고 토지이용별 토양유실 위험지역을 분석하였다. 대상유역 총 토양유실량은 895만 Mg yr<SUP>-1</SUP>으로 예측되었으며, 면적당 평균 토양유실량은 6.1 Mg ha<SUP>-1</SUP>yr<SUP>-1</SUP>이었다. 중소유역 단위로 살펴보면 남한강지역이 북한강지역의 유실량 뿐만 아니라 면적당 유실량이 더 많았다. 이는 북한강 권역의 경우 화강암 및 화강편마암이 주요 모재인 반면에 남한강 권역의 경우 토양모재가 퇴적암지대를 많이 포함있어 토양침식성 인자 (K factor)와 경사 인자 (LS factor)가 상대적으로 높고, 남한강 지역의 경우 농경지 토양이 상대적으로 많이 분포하고 있기 때문으로 판단된다. 대상유역의 토지이용별 연평균 토양유실량을 분석한 결과 산림/초지 > 밭 >> 도심/대지 >> 논 > 과수의 순로 분석 대상유역 중 10.7%를 차지하고 있는 농경지에서 유실되는 토양의 추정량은 41.3%이였으며, 이중 6.2%면적을 차지하는 밭이 40.6%으로 44.2%의 산림/초지와 비슷한 수준이었다. 한강상류지역 토양유실 위험성 평가시 분포형 토양침식지도와 항공사진을 비교한 결과 토양유실에 대한 공간인 정보를 확실하게 보여주고 있으며, 토양침식위험성은 남한강권역의 남한강 상류 (1001), 평창강 (1002), 충주댐 (1003) 권역에서 각각 토양침식위험성이 “보통”이상으로 높은 지역이 각각 8.7%, 7.9%, 7.8%로 평균인 5.9%보다 높았으며, 이에 대한 보전방안이 강구될 필요가 있고 판단된다. This study was conducted to evaluate soil erosion risk with a standard unit watershed in the upper Han river basin using the spatial soil erosion map according to the change of landuse. The study area is 14,577 ㎢, which consists of 10 subbasins, 107 standard unit watersheds. Total annual soil loss and soil loss per area estimated were 895 × 10<SUP>4</SUP> Mg yr<SUP>-1</SUP> and 6.1 Mg ha<SUP>-1</SUP> yr<SUP>-1</SUP>, respectively. A result of analysis with a subbasin as a unit showed that annual soil losses and soil loss per area in Namhan river basins was more than in Bukhan river ones. Predicted annual soil loss according to the landuse ranked as Forest & Grassland > Upland >> Urban & Fallow area > Paddy field > Orchard. Upland area covered 6.2% of the study area, but the contribution of total annul soil loss was 40.6% and that of Forest & Grassland was 44.2%. As a evaluation of soil erosion risk using the spatial soil erosion map, we could precisely conformed the potential hazardous region of soil erosion in each unit watersheds. The ratio of regions, graded as higher “Moderate” for annual soil loss, were respectively 8.7%, 7.9% and 7.8% in 1001, 1002 and 1003 subbasins in Namhan river basin. Most landuse of these area was upland, and these area is necessary to establish soil conservation practices to reduce soil erosion based on the field observation.

아시아 지역 폐렴 구균의 항균제 내성 현황 및 변화 양상 : Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study

정숙인,김나영,손준성,기현균,고관수,서지연,장현하,김연숙,오원섭,백경란,이남용,송재훈,항생제 내성 감시를 위한 아시아 연합 (ANSORP) 대한감염학회 2004 감염과 화학요법 Vol.36 No.1

목적 : 1980년대부터 페니실린을 비롯한 β-lactam 계열과 비 β-lactam 계열 항균제에 대한 폐렴구균의 항생제 내성이 급격하게 증가하여 국내 뿐 아니라 세계적인 문제로 대두되고 있다. ANSORP 에서는 아시아 지역에서 폐렴구균의 항균제 내성과 그 변화 추이, 내성의 기전 및 위험인자를 분석하고자 본 국제 공동 연구를 시행하였다. 재료 및 방법 : 1999년 11월부터 2001년 8월까지 아시아 지역 12개국의 14개 기관에서 폐렴구균 감염증 환자의 임상 검체로 분리된 침습성 폐렴구균을 대상으로 액체배지 미량희석법을 이용하여 16개 항생제의 MIC를 구하였다. 위험인자의 분석을 위하여 폐렴구균 감염증 환자를 대상으로 의무기록지를 조사하였다. Quellung 반응을 통해 혈청형을 결정하였다. 결과 : 총 685균주 중 52.4%가 페니실린에 대하여 비감수성(중등도 내성 22.9%, 내성 29.5%)을 보였고, 그 빈도는 베트남(92.1%), 스리랑카(85.7%), 홍콩(67.9%), 한국(64.5%)의 순이었다. Erythromycin에 대한 비감수성 비율은 베트남(92.1%), 대만(87.7%), 한국(80.6%), 홍콩(76.8%) 등에서 높게 나타났고, 베트남, 대만, 한국, 홍콩 등의 erythromycin의 MIC_(90)이 32㎍/mL를 넘는 고도내성을 보였다. 홍콩, 싱가포르, 대만, 인도에서는 fluoroquinolone에 대한 내성 균주가 출현하였다. 전체 균주 중 다제내성 균주의 비율은 47.7%였다. 혈청형은 19형과 23형이 가장 많았고, 그 외 6형, 14형 등이 있었다. 페니실린 비감수성 감염증의 위험인자로는 5세 미만(OR=1.7; 95%, CI, 1.2-2.4; P=0.002), 기관지폐질환(OR=2.0; 95%, CI, 1.3-3.1; P=0.003), 악성종양(OR=2.3; 95%, CI, 1.2-4.6; P=0.015), 스테로이드의 사용(OR=2.8; 95%, CI, 1.1-7.4; P=0.032)이 확인되었다. 결론 : 침습성 폐렴구균 균주를 대상으로 한 본 연구의 결과 아시아 국가들에서 페니실린, β-lactam 및 macrolide에 대한 폐렴구균의 내성률 및 내성 정도가 급증하고 있음을 확인하였다. Background : Emergence of pneumococcal resistance became a global issue since 1990s. According to the ANSORP studies with clinical isolates and carriage isolates between 1996 and 1999, some Asian countries showed alarmingly high prevalence of resistance to penicillin and other antimicrobial agents. To investigate the changing trends of pneumococcal resistance, ANSORP study group has performed a multinational surveillance study with invasive pneumococcal isolates from Asian countries. Methods : All isolates from various invasive pneumococcal diseases were prospectively collected from 14 centers in 12 countries between November 1999 to August 2001. Broth microdilution tests with 16 antimicrobial agents were performed according to the NCCLS procedures. Serotyping was performed by means of Quelling reaction with use of group-specific antisera. Results : A total of 685 isolates were collected. Overall, 52.4% of invasive isolates from Asian countries were not susceptible to penicillin (intermediate (1), 22.9%, Resistant (R), 29.5%). Vietnam showed the highest prevalence of penicillin non-susceptibility (1 20.6%, R 71.4%) followed by Sri Lanka (1 71.4%, R 14.3%), Hong Kong (1 24.1%, R 76%) and Korea (1 9.7%, R 54.8%). China (I 19.8%, R 23.4%) and Malaysia (1 9.1%, R 29.5%) also showed remarkable increase in penicillin resistance compared with previous ANSORP data, which were less than 10%. Vietnam (92.1%), Taiwan (87.7%), Korea (80.6%), and Hong Kong (76.8%) showed high prevalence of erythromycin resistance. MIG_(90)S for ciprofloxacin were 4 ㎍/mL (Hong Kong) and 2 ㎍/mL (11 Asian countries except Hong Kong), respectively. Conclusion : Compared with previous data from ANSORP studies, antimicrobial resistance among invasive pneumococcal isolates has markedly increased in Vietnam, Sri Lanka, Taiwan, China, and Malaysia. Continuous surveillance of pneumococcal resistance in Asia is strongly warranted.

폐렴구균 감염증에서 항생제 내성의 임상적 의미 : Asian Network for Surveillance of Resistant Pathogens(ANSORP) Study

정숙인,기현균,손준성,고관수,김나영,장현하,오원섭,백경란,이남용,김신우,이혁,--,송재훈 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

목적 : 전 세계적으로 폐렴구균의 페니실린을 포함한 β-lactam과 마크로라이드 및 퀴놀론 계열의 항생제에 대한 내성이 급격히 증가하여 임상적으로 문제가 되고 있으나, 시험관내 내성이 실제 임상적 예후에 미치는 영향에 대해서는 아직까지 논란이 되고 있다. 본 연구는 폐렴구균의 항생제 내성률이 높은 아시아 지역에서 항생제 내성이 폐렴구균 감염증의 임상경과에 미치는 영향을 평가하기 위하여 시행되었다. 방법 : ANSORP에서 주관한 전향적 임상 연구로서 1999년 11월부터 2001년 8월까지 아시아 지역 11개국의 14개 기관에서 진단된 침습성 폐럼구균 감염증 환자를 대상으로 내성 균주 감염의 위험요인, 임상양상, 예후 등의 임상적 분석을 시행하였다. 결과 : 총 646명 환자의 평균연령은 30.1세(6일-89세)였고, 이전 3개월 내에 항생제 사용력이 있는 환자는 159명(32.4%)이었다. 질환별로는 폐렴이 377예(58.4%)로 가장 많았고, 중이염 67예, 뇌수막염 66예(10.2%), 일차성 균혈증 65예(10.1%)였다. 총 646균주 중 347균주(53.7%)가 페니실린 비감수성(중등도 내성 23.1%, 고도 내성 23.1%)이었고, 페니실린에 대한 MIC_(90)은 0.03㎍/mL에서 4㎍/mL까지의 분포를 보였다. 페니실린 비감수성 균주에 의한 감염증과 차이가 없었다. 페니실린 내성 폐렴구균 폐렴에 의한 사망률은 페니실린 감수성 폐렴구균 폐렴에 의한 사망률과 차이가 없었다(p=0.846). Erythromycin에 대한 고도 내성을 보이는 균주의 비율이 매우 높았으나, 실제 임상상이나 치사율에는 영향을 미치지 않았다(p=0.092). 페니실린 비감수성 폐렴구균에 의한 뇌수막염의 치사률도 감수성 균주에 의한 사망률과 차이가 없었다(p=0.059). 결론 : 본 연구의 결과 페니실린 및 베타 락탐 제제에 대한 시험관 내성은 폐렴구균 폐렴이나 뇌수막염의 임상상이나 치사율에 영향을 미치지 않는 것으로 확인되었다. 이는 내성의 정도와 연관될 것으로 생각되므로, 향후 고도 내성 균주가 증가할 때 추가 검증을 요한다. 아울러 macrolide 및 퀴놀론계 항생제 내성의 임상적 의미에 대한 후속 연구가 필요할 것으로 사료된다. Background : Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. Methods : In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. Results : A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIG_(90)s for penicillin ranged from 0.03 (India) to 4.0 ㎍/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. Conclusion : Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.