그람양성구균에 대한 Teicoplanin과 Vancomycin의 시험관내 항균력

최태열,김경숙,전용관,서일혜,김정욱,이웅수,안정열,김홍석,정재용,최효선,김덕언,유진우 대한감염학회 1994 감염 Vol.26 No.1

An increasing frequency of methicillin resistant S. aureus(MRSA), methicillin resistant coagulase negative staphylococci(MRCNS) and Enterococcal infection have been observed in recent years. Teicoplanin is a new glycopeptide antibiotic obstained from the Actinoplanes teicomycetius. The molecular structure and spectrum of antimicrobial activity of teicoplanin is simillar to those of vancomycin, and has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. Therefore, we evaluated the in vitor susceptibility of gram positive cocci, such as, S. aureus, coagulase negative Staphylococci(CNS), and Enterococci to teicoplanin and vancomycin. The total 253 strains consisted of MSSA(40), MRSA(53), MSCNS(47), MRCNS(48), and Enterococci(65). They were assayed by disc diffusion and agar dilution. During the study, 57% of S. aureus and 49% of CNS showed resistance to methicillin. The inhibitory diameter of teicoplanin was 15-20mm in MSSA, 12-19mm in MRSA, 13-24mm in MSCNS, 11-23mm in MRCNS, and 15-22mm in Enterococci respectively, and showed sensitivity in all but 8 strains(3.2%). The range of the minimum inhibitory concentration (MIC) of teicoplanin to MSSA, MRSA, MSCNS, MRCNS and Enterococci were 9.12-2.0㎍/ml, 0.25-2.0㎍/ml, & 0.25-32㎍/ml, 0.12-1.0㎍/ml respectively. One case of S. haemolyticus was resistant to teicoplanin (32㎍/ml) by the agar dilution method. Eight minor (3.2%) and one major(0.4%) error was observed when the MIC and disk diffusion data were correlated with teicoplanin. As for vancomycin the inhibitory diameter was 17-21mm in MSSA, 15-21mm in MRSA, 18-26mm in MSCNS, 18-25mm in MRCNS, and 16-22mm in Enterococci respectively. The range of the MIC of vancomycin to MSSA, MRSA, MSCNS, MRCNS, and Enterococci were 0.25-1.0㎍/ml, 0.25-4.0㎍/ml, 0.5-2.0㎍/ml and 0.5-2.0㎍/ml respectively. One minor error (0.4%) was seen with the vancomycin disk. The MIC90 of MSSA and MRSA exhibited the same results in teicoplanin (1.0㎍/ml, 1.0㎍/ml), and vancomycin(2.0㎍/ml, 2.0㎍/ml). MSCNS and MRCNS exhibited greater MIC90 with teicoplanin(4.0㎍/ml, 8.0㎍/ml) than vancomycin(2.0㎍/ml, 2.0㎍/ml). Incontrase Enterococci were more susceptible to teicoplanin(0.5㎍/ml) than to vancomucin (2.0㎍/ml). Results from this analysis indicated that both teicoplanin and vancomycin were very excellent for gram positive infections, especially those resistant to methicillin.

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.

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.

급성골수성백혈병에서 Cytarabine과 Idarubicin 관해유도요법

이정선,방수미,주기탁,안정열,조용균,조은경,신동복,이재훈 大韓血液學會 2001 大韓血液學會誌 Vol.36 No.2

과다 호산구 증다증을 동반한 분선충 감염 1예

엄정인,최태열,채정돈,류재숙,안명희 대한임상병리학회 2000 대한임상병리학회지 Vol.20 No.4

급성 진행성 사구체신염을 동반한 eosinophilic granulomatosis with polyangiitis 1예

김소정 ( So Jeong Kim ),이상민 ( Sang Min Lee ),심영섭 ( Young Sup Shim ),안정열 ( Jeong Yeal Ahn ),이상호 ( Sangho Lee ),하승연 ( Seung Heon Ha ),이상표 ( Sang Pyo Lee ) 대한천식알레르기학회 2016 Allergy Asthma & Respiratory Disease Vol.4 No.1

Eosinophilic granulomatos is with polyangitis (EGPA) should be considered in asthmatic patients who present with severe systemic symptoms and eosinophilia. Progressive renal insufficiency can occur during the acute phase of EGPA accompanied by renovascular involvement. A 58-year-old man visited local clinic with complaints of malaise, weight loss, fever, and dyspnea. Eosinophilia was revealed in peripheral blood. Pulmonary function tests were carried out, which yielded decreased lung function with positive bronchodilator response. Kidney and skin biopsies were performed, and histological examination showed acute necrotizing crescentic glomerulonephritis and leukoclastic vasculitis in the skin, which led to a diagnosis of EGPA (Churg-Strauss syndrome) associated with rapidly progressive glomerulonephritis. The patient received pulse steroid therapy with parenteral methylprednisolone, followed by oral prednisolone. Clinical and laboratory findings improved dramatically, and remission was attained rapidly. The patient continued to be in remission for 5 months. Prompt and aggressive treatment with systemic corticosteroids is mandatory to control disease activity and to achieve remission. (Allergy Asthma Respir Dis 2016;4:70-73)

Chlamydia Pneumoniae 에 대한 단클론 항체 생산

최태열,강정옥,김덕언,안정열,최효선 대한감염학회 1997 감염 Vol.29 No.2

목적:Chlamydia pneumoniae는 성인 폐염, 기관지염 및 인후염 등 급성 호흡기 지로한을 일으키는 중요한 병원체이다. 그러나 아직까지 실용적인 진단방법이 없었기에 연구자들은 C.pneumoniae에 대한 단클론 항테를 생산하여 진단에 사용코져 하였다. 방법:C.pneumoniae는 HeLa-229세로에 배양하였고, linear gradient(renograffin)을 이용하여 균체ㄹ를 순수 분리하였다. BALB/c마우스에 C.pneumoniae(TW-183)균체를 면역하여, 그 비장세포와 SP 2/0골수종세포와 융합아혀 단클론항체를 생산하였다. 생산된 단클론항테는 SDS-PAGE 및 Western-blot법으로 C.pneumoniae의 단백을 분석하였다. 결과:C.pneumoniae에 특이하게 반응하는 단클론항체 HYMD10 및 HYMG12을 생산하였다. HYMD10은 C.pneumoniae의 75- 및 39-KDa protein과 반응하였고, HYMG12는 98- 및 39-KDa의 막단백과 반응하였다. 결론:상기 단클론항테들(HYMD10, 및 HYMG12)은 C.pneumoniae에 특이한 단클론 항체로 C.pneumoniae 세포배양 후 진단시약으로 사용하면 유용하리라 생각된다. Background: Chlamydia pneumoniae is a recently recognized species consisting of the strains commonly referred to as TWAR. These strains are associated with acute respiratory infections in humans, especially atypical pneumonia. So we tried to make a monoclonal antibody to Chlamydia pneumoniae. Methods: C. pneumoniae were adapted to grow in HeLa-229 cells. The organisms were harvested and purified in a linear gradient of renograffin. BALB/c mice (female, 10 weeks) were intravenously immunized with purified C. pneumoniae(TW-183). The spleen cells and SP 2/0 myeloma cells were fused with 40% polyethylene glycol(Mol.Wt.:1,450). Antibodies against C. pneumoniaee were screened by an enzymelinked immunosorbent assay(ELISA). The proteins of purified chlamydial elementary bodies were separated by discontinuous sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE), and Western blots were performed with these monoclonal antibodies. Result: Two monoclonal antibodies(HYMD10, HYMG12) reacted specifically with C. pneumoniae, as measured by an ELISA and indirect immunofluorecent stain. One of the monoclonal antibody (HYMD10) reacted with 75- and 39-KDa proteins in Western blot. The other monoclonal antibody(HYMG12) reacted with 98- and 39- KDa proteins of C. pneumoniae. Conclusions: These species-specific monoclonal antibodies (HYMD10, HYMG12) to C. pneumoniae could be used for diagnosis of C. pneumoniae infections.

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

정지훈,Yiel Hea Seo,Jeong Yeal Ahn,Kyung Hee Kim,Ja Young Seo,Ka Yeong Chun,Yong Su Lim,Pil Whan Park 대한진단검사의학회 2020 Annals of Laboratory Medicine Vol.40 No.1

Background: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). Methods: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. Results: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P =0.022, ≤1 hour; STEMI: P =0.017, ≤1 hour and P =0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. Conclusions: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

Effects of Hormone Replacement Therapy on Nitric Oxide Bioactivity and Markers of Inflammation in Hypertensive or Overweight Postmenopausal Women

Koh, Kwang Kon,Ahn, Jeong Yeal,Son, Ji Won,Sohn, Min Soo,Choi, In Suck,Shin, Eak Kyun Yonsei cardiovascular center 2001 Korean journal of cardiovascular diseases Vol.2 No.2

말기신질환을 동반한 다발성 골수종 1예에서 시행된 자가말초혈액 조혈모세포이식

유승민,박정우,이규훈,방수미,안정열,박필환,조은경,신동복,이종호,이재훈 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.2

본 환자는 혈액투석이 요구되는 말기신질환을 동반한 다발성골수종으로 진단받고 VAD 유도요법으로 초기 치료 후 부분관해를 보였으며, melphalan 투여 후 자가말초 조혈모세포이식을 시행하여 심각한 부작용 없이 완전관해를 보이고 그 효과가 1년간 유지되어 이를 보고하는 바이다. Multiple myeloma with monoclonal gammopathy of the lambda light chain, which initially manifested as end-stage renal disease, was diagnosed in a 50-year-old man. Induction chemothery with VAD (vincristine, adriamycin, and dexamethasone) failed to induce a complete response. Complete remission was obtained after high-dose therapy using melphalan (100 mg/m²) followed by autologous peripheral stem cell transplantation. Hemodialysis was performed every day or every other day during induction and high- dose therapy. The adverse events during transplantation consisted of mucositis and neutropenic fever. This case demonstrated that a sustained complete response can be achieved in multiple myeloma complicated by end-stage renal failure using hemodialysis and high-dose chemotherapy without serious toxicity.