Nationwide Analysis of Antimicrobial Prescription in Korean Hospitals between 2018 and 2021: The 2023 KONAS Report

Yun I Ji,Park Hyo Jung,Chae Jungmi,Heo Seok-Jae,Kim Yong Chan,Kim Bongyoung,Choi Jun Yong 대한감염학회 2024 Infection and Chemotherapy Vol.56 No.2

Background Data on antimicrobial use at the national level are crucial for establishing domestic antimicrobial stewardship policies and enabling medical institutions to benchmark each other. This study aimed to analyze antimicrobial use in Korean hospitals. Materials and Methods We investigated antimicrobials prescribed in Korean hospitals between 2018 and 2021 using data from the Health Insurance Review and Assessment. Primary care hospitals (PCHs), secondary care hospitals (SCHs), and tertiary care hospitals (TCHs) were included in this analysis. Antimicrobials were categorized according to the Korea National Antimicrobial Use Analysis System (KONAS) classification, which is suitable for measuring antimicrobial use in Korean hospitals. Results Among over 1,900 hospitals, PCHs constituted the highest proportion, whereas TCHs had the lowest representation. The most frequently prescribed antimicrobials in 2021 were piperacillin/β-lactamase inhibitor (9.3%) in TCHs, ceftriaxone (11.0%) in SCHs, and cefazedone (18.9%) in PCHs. Between 2018 and 2021, the most used antimicrobial classes according to the KONAS classification were ‘broad-spectrum antibacterial agents predominantly used for community-acquired infections’ in SCHs and TCHs and 'narrow spectrum beta-lactam agents' in PCHs. Total consumption of antimicrobials decreased from 951.7 to 929.9 days of therapy (DOT)/1,000 patient-days in TCHs and 817.8 to 752.2 DOT/1,000 patient-days in SCHs during study period; however, no reduction was noted in PCHs (from 504.3 to 527.2 DOT/1,000 patient-days). Moreover, in 2021, the use of reserve antimicrobials decreased from 13.6 to 10.7 DOT/1,000 patient-days in TCHs and from 4.6 to 3.3 DOT/1,000 patient-days in SCHs. However, in PCHs, the use increased from 0.7 to 0.8 DOT/1,000 patient-days. Conclusion This study confirmed that antimicrobial use differed according to hospital type in Korea. Recent increases in the use of total and reserve antimicrobials in PCHs reflect the challenges that must be addressed. Background Data on antimicrobial use at the national level are crucial for establishing domestic antimicrobial stewardship policies and enabling medical institutions to benchmark each other. This study aimed to analyze antimicrobial use in Korean hospitals. Materials and Methods We investigated antimicrobials prescribed in Korean hospitals between 2018 and 2021 using data from the Health Insurance Review and Assessment. Primary care hospitals (PCHs), secondary care hospitals (SCHs), and tertiary care hospitals (TCHs) were included in this analysis. Antimicrobials were categorized according to the Korea National Antimicrobial Use Analysis System (KONAS) classification, which is suitable for measuring antimicrobial use in Korean hospitals. Results Among over 1,900 hospitals, PCHs constituted the highest proportion, whereas TCHs had the lowest representation. The most frequently prescribed antimicrobials in 2021 were piperacillin/β-lactamase inhibitor (9.3%) in TCHs, ceftriaxone (11.0%) in SCHs, and cefazedone (18.9%) in PCHs. Between 2018 and 2021, the most used antimicrobial classes according to the KONAS classification were ‘broad-spectrum antibacterial agents predominantly used for community-acquired infections’ in SCHs and TCHs and 'narrow spectrum beta-lactam agents' in PCHs. Total consumption of antimicrobials decreased from 951.7 to 929.9 days of therapy (DOT)/1,000 patient-days in TCHs and 817.8 to 752.2 DOT/1,000 patient-days in SCHs during study period; however, no reduction was noted in PCHs (from 504.3 to 527.2 DOT/1,000 patient-days). Moreover, in 2021, the use of reserve antimicrobials decreased from 13.6 to 10.7 DOT/1,000 patient-days in TCHs and from 4.6 to 3.3 DOT/1,000 patient-days in SCHs. However, in PCHs, the use increased from 0.7 to 0.8 DOT/1,000 patient-days. Conclusion This study confirmed that antimicrobial use differed according to hospital type in Korea. Recent increases in the use of total and reserve antimicrobials in PCHs reflect the challenges that must be addressed.

병원에서의 제한항균제 관리제도 실시

현영란,최경업 한국병원약사회 1997 병원약사회지 Vol.14 No.2

The cost of antibiotic therapy, the emergence of resistant organisms, and the inappropriate use of antimicrobial agents dictate the need for surveillance programs. It is well known that the antimicrobial use review(AUR) program has increased the quality of antimicrobial therapy in hospital settings. In this report, we describe our experiences with AUR program at Samsung Medical Center since September 1, 1995. Four intravenous antimicrobial agents, amikacin, aztreonam, carumonam and imipenem/cilastatin were selected and controlled as restricted agents. The prescriber was required to complete the antibiotic order sheet (AOS) which states the indication for use (prophylaxis, empirical therapy, or treatment of documented infection), the site of infection and the suspected or documented organism. Prior to dispensing the above antibiotics, Inpatient Pharmacy should receive the AOS approved by the Infectious Diseases Specialist. The use of restricted antimicrobials was reviewed 8 months before and after the start of AUR program. Prescription of amikacin and aztreonam had been reduced by 64.4% and 64.1%, respectively. However, the change of imipenem/cilastatin use was insignificant was not prescribed at all during the study period. Restricted utilization of the antimicrobial agents was successfully optimized with implementation of the antimicrobial restriction policy.

전북대학교병원 입원환자에서의 항생제 사용 실태

송재호,김정수,Song, Jae Ho,Kim, Jung Soo 대한소아감염학회 2000 Pediatric Infection and Vaccine Vol.7 No.2

목 적 : 올바른 항생제의 사용을 위해서는 우선 항생제 사용 실태의 파악과 함께 검사실의 확충, 의료진의 협조 등 다양한 노력과 보완이 요구된다. 본 연구는 적절한 항생제 사용의 기반을 마련하고자 현재 시행되고 있는 항생제 사용 실태를 조사하였다. 방 법 : 전북대학교병원에 입원한 환자 총 1,833명을 대상으로 의무기록을 통하여 항생제의 사용 여부, 종류, 사용 기간, 용량, 항생제의 투약 시작 시기 및 투여 목적을 조사하였다. 결 과 : 전체 조사 대상 환자 1,833명 중 입원 기간 중 항생제를 사용한 환자는 1,231명으로 67.2%였으며, 계별로 살펴보면 내과계는 전체 1,014명 중 497명(49.0%)이 항생제를 사용하였고, 외과계는 819명 중 734명(89.6%)에서 항생제를 사용하였다. 전체 항생제를 사용한 환자 1,231명 중 706명(57.4%)에서 예방 목적으로 사용하였고, 525명(42.6%)에서 치료 목적으로 사용하였다. 항생제를 사용한 환자의 경우 사용된 항생제의 갯수를 살펴보면 총 1,231명 중 1가지 항생제를 사용한 경우는 125명(10.2%)이었으며, 2가지를 사용한 경우는 311명(25.3%), 3가지를 사용한 경우는 562명(45.6%), 4가지 이상을 사용한 경우는 233명(18.9%)으로, 70% 이상의 환자에서 3가지 이상의 항생제가 사용하였다. 사용 항생제의 종류는 ${\beta}$-lactam, aminoglycoside, quinolone, macrolide, 항진균제, metronidazole, clindamycin, trimethoprim-sulfamethoxazole, glycopeptide, 그리고 fosfomycin 등으로 아주 다양하였다. 전체적인 그룹별 사용률을 보면 ${\beta}$-lactam은 57.0%, aminoglycoside는 34.5%, quinolone은 3.6% 그리고 기타 그룹은 4.9%로, ${\beta}$-lactam과 aminoglycoside가 가장 많이 사용되었다. 결 론 : 대부분의 환자에서 2가지 이상의 항생제의 병합요법이 보편화되어 있다는 점은 진지하게 검토되어야 할 것으로 생각된다. 아울러 임상적으로 전신 세균 감염이 확실한 경우에도 원인 병원체를 찾아내기 위한 적극적인 노력이 부족한 경우도 상당수 있어 이에 대해서도 검사실과 함께 적극적인 개선의 노력이 필요할 것으로 생각된다. 수술 환자의 예방적 화학 요법에 대해서도 개선이 필요할 것으로 생각된다. Purpose : The use antimicrobial agents is one of the important strategies for the treatment and prophylaxis of microbial infections. But injudicious abuse and misuse of antimicrobial agents is problem to add an extra weight on medical fee, increase of resistant bacteria and side effects according to the antibiotic use. This study was performed to establish the pertinent use of antimicrobial agent in Chonbuk National University Hospital(CNUH). Characteristics of antibiotics use was analysis by reviewing the medical records of patients admitted to CNUH during the period of May 1998. Methods : One thousand eight hundred and thirty three patients were enrolled in this study(medical division 1,014 cases, surgical division 819 cases). Medical records were retrospectively reviewed to classify the rate of antibiotics use, name of antibiotics used, appropriateness of antibiotics use. Results : The overall rate of antibiotic usage in CNUH was 67.2%(1,231/1,833), showing higher rate in surgical division(89.6%) compare to that of medical division(49.0%). Among 1,231 patients to whom antimicrobial agents were given, only 125(10.2%) were treated with single antimicrobial agents. 311(25.3%) were treated with two antimicrobial agents, and 795(64.5%) patients received 3 or more antibiotics. ${\beta}$-lactams(56.4%) were most frequently used followed by aminoglycosides(35.3%), the others(4.9%) and quinolons(3.4%). Amoxicillin-clavulanate was the mostly commonly used antibiotics followed by amoxicillin and unasyn. Prophylactic use of antibiotics was carried in seven hundred six patients(57.4%), mostly in surgical division, which can be considered somewhat inappropriate in the initiation time and duration of antibiotic use. Conclusion : Importance of monotherapy and appropriate prophylactic antibiotic use should be emphasized. Strategies of antibiotics use, such as restriction of drug use, continuous monitoring system, flow sheet system should be considered to reduce antibiotics use and establish the appropriate use of antibiotics as well as inhibiting the occurrence of resistant strains.

Antimicrobial Activities of Extracts of Camellia sinensis (L.) O. Kuntze and Profile of Antimicrobial Agents Resistance for Carbapenem-Resistant Enterobacteriaceae

Jong Hwa Yum 대한의생명과학회 2019 Biomedical Science Letters Vol.25 No.3

In vitro antimicrobial activities of hot water extracts of Camellia sinensis (L.) O. Kuntze, for carbapenem-resistant Enterobacteriaceae (CRE) were compared to commonly used conventional antimicrobial agents. CRE was not only resistant to imipenem, meropenem or ertapenem, but also to various antimicrobial agents, such as amikacin (> 128 μg/mL). The hot water extracts of Camellia sinensis (L.) O. Kuntze had the lowest MIC (0.06~0.5 μL/mL) of the carbapenemresistant E. coli, K. pneumoniae, and Enterobacter spp. tested, and it was possible more potent than various conventional antimicrobial agents. Synergistic combinations of the extract with used commonly antimicrobial agents might even improve its antimicrobial chemotherapy property.

Pharmacokinetics/Pharmacodynamics models of veterinary antimicrobial agents

Wanhe Luo,Dongmei Chen,Mengru Wu,Zhenxia Li,Yanfei Tao,Qianying Liu,Yuanhu Pan,Wei Qu,Zonghui Yuan,Shuyu Xie 대한수의학회 2019 Journal of Veterinary Science Vol.20 No.5

Misuse and abuse of veterinary antimicrobial agents have led to an alarming increase in bacterial resistance, clinical treatment failure, and drug residues. To address these problems, consistent and appropriate dosage regimens for veterinary antimicrobial agents are needed. Pharmacokinetics/Pharmacodynamics (PK/PD) models have been widely used to establish rational dosage regimens for veterinary antimicrobial agents that can achieve effective prevention and treatment of bacterial diseases and avoid the development of bacterial resistance. This review introduces building methods for PK/PD models and describes current PK/PD research progress toward rational dosage regimens for veterinary antimicrobial agents. Finally, the challenges and prospects of PK/PD models in the design of dosage regimens for veterinary antimicrobial agents are reviewed. This review will help to increase awareness of PK/PD modeling among veterinarians and hopefully promote its development and future use.

자돈 설사 분변에서 분리한 Bacillus cereus BY06의 장 독소 생성 및 항균제 감수성

오위걸,노용환,안병용,Wu, Wei-Jie,Rho, Youg-Hwan,Ahn, Byung-Yong 한국식품영양학회 2014 韓國食品營養學會誌 Vol.27 No.2

적리를 동반하는 돼지 분변에서 용혈성 균주를 분리 동정한 후, 장 독소 생성 유 무 및 항생제 감수성 시험을 수행하였다. 분리된 용혈성 균주 B. cereus BY06의 gyrB 유전자 염기서열을 분석한 결과, B. cereus와 99% 유사성을 나타내었다. PCR법에 의한 장 독소 유전자 검출 시험에서 B. cereus BY06는 장 독소 분비 양성으로 판정됨에 따라 설사형 식중독 균임이 확인되었다. B. cereus BY06를 이용한 항균제의 감수성 시험 결과, penicillin G에는 내성을 나타낸 반면 cephalothin, vancomycin, clindamycin, fusidic acid, gentamicin, ciprofloxacin, tetracycline 및 rifampin에 대하여 감수성을 나타냈다. 본 연구를 통해 돼지 분변에서 분리된 B. cereus 균주는 설사를 유발하는 장 독소를 분비하며, penicillin G에 대한 내성을 확인하였다. The enterotoxin production and antimicrobial susceptibility on hemolytic strains from stools of diarrheal pigs was investigated in this study. Through morphological observation, gyrB nucleotide sequence, and API kit analysis, the selected potential pathogenic strain BY06 was identified as Bacillus cereus. Because the characteristic of enterotoxin symptoms were widely caused by Bacillus cereus strains, a PCR test was carried out in order to check the enterotoxin genes (hblA) in this strain. According to the results, this strain was an enterotoxin positive strain containing the hblA gene. The minimum inhibitory concentrations of 10 different antimicrobial agents were screened by the agar dilution test, indicating that this strain was resistant to penicillin G and intermediate to erythromycin; however, it susceptible to cephalothin, vancomycin, clindamycin, fusidic acid, gentamicin, ciprofloxacin, tetracycline and rifampin. These results suggest that the B. cereus BY06 isolated from pig feces has a potential risk of producing enterotoxin and is resistant to penicillin G, but susceptible to various antimicrobial agents.

Antimicrobial Effect of Inula britannica Flower Extract against Methicillin-resistant Staphylococcus aureus

이나경,이장현,이영주,안신혜,엄수진,백현동 한국미생물·생명공학회 2013 한국미생물·생명공학회지 Vol.41 No.3

The antimicrobial effect of the methanol extract of Inula britannica flowers against methicillin resistant Staphylococcus aureus (MRSA) was investigated. It was confirmed that the methanol extract is mainly composed of quercetin, which has antimicrobial properties. The antimicrobial effect of the methanol extract against 3 MRSA strains was determined by the disc diffusion method. The minimal inhibitory concentrations were ranged from 0.625 mg/ml to 1.25 mg/ml, and the minimum bactericidal concentrations were 2.5 mg/ml. Time kill kinetics revealed bactericidal activities, and the morphological alterations in S. aureus ATCC 33591 treated with the extract were observed using a scanning electron microscope. The methanol extract affected the expression of the resistant genes, mecA, mecI, and mecRI in mRNA. Therefore, the methanol extract of I. britannica flowers clearly demonstrated an antimicrobial effect against MRSA and these results suggest a potential for application as a natural antimicrobial agent.

유기향균제를 이용한 타올의 향균가공에 관한 연구

이문수,송윤준,Lee, Mun-Soo,Song, Yoon-Jun 배재대학교 자연과학연구소 1999 自然科學論文集 Vol.11 No.1

The study was investigated to the effect of antimicrobial finishing of towel treated by organic antimicrobial agent. It was measured for the optimal condition such as treated time, treated concentration and temperature. After amtimicrobial treatment, mechanical and fastness properties, anti-laundering property were measured.The antimicrobial activity of samples was analyzed quantitatively by masureing the number of colonies of Staphylococcus aureus using the shake flask method. Towel samples treated with the optimal condition such as treated time of 10 minute, and treated temperature of $30^{\circ}C$, concentration of organic antimicrobial agent of 3.5% were shown a high reduction rate in the number of colonies grown and clear zones of inhibition.The effect of reduction rate for laundering until the number of 20 times was shown high reduction rate of over 80%. And the mechanical properties of samples treated with organic antimicrobial agent were not changed approximately. 유기실리콘 제4급 암모늄염을 이용하여 타올에 향균제를 처리하였을 때의 향균성에 가장 많은 영향을 미치는 처리농도, 시간, 온도에 대한 향균성 변화를 비교 조사하였고, 향균처리 후 물성변화, 내세탁성을 측정하였다. 타올의 향균성에 가장 우수한 향균성을 나타내고 많은 영향을 미치는 처리농도는 3.5%이며, 처리온도 $30^{\circ}C$에서, 처리시간 10분간 향균가공 처리하여도 균감소율이 95% 이상 향균성능을 유지함을 알 수 있었다. 또한 세탁 횟수에 따른 균 감소율은 20회까지 세탁하여도 80%이상 높은 향균성을 나타내었고, 향균제 가공처리 후 측정한 타올의 인장강도 및 신도는 큰 변화가 없었다.

Protease Inhibitors from Plants with Antimicrobial Activity

Kim, Jin-Young,Park, Seong-Cheol,Hwang, Indeok,Cheong, Hyeonsook,Nah, Jae-Woon,Hahm, Kyung-Soo,Park, Yoonkyung Molecular Diversity Preservation International (MD 2009 INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol.10 No.6

<P>Antimicrobial proteins (peptides) are known to play important roles in the innate host defense mechanisms of most living organisms, including plants, insects, amphibians and mammals. They are also known to possess potent antibiotic activity against bacteria, fungi, and even certain viruses. Recently, the rapid emergence of microbial pathogens that are resistant to currently available antibiotics has triggered considerable interest in the isolation and investigation of the mode of action of antimicrobial proteins (peptides). Plants produce a variety of proteins (peptides) that are involved in the defense against pathogens and invading organisms, including ribosome-inactivating proteins, lectins, protease inhibitors and antifungal peptides (proteins). Specially, the protease inhibitors can inhibit aspartic, serine and cysteine proteinases. Increased levels of trypsin and chymotrypsin inhibitors correlated with the plants resistance to the pathogen. Usually, the purification of antimicrobial proteins (peptides) with protease inhibitor activity was accomplished by salt-extraction, ultrafiltration and C<SUB>18</SUB> reverse phase chromatography, successfully. We discuss the relation between antimicrobial and anti-protease activity in this review. Protease inhibitors from plants potently inhibited the growth of a variety of pathogenic bacterial and fungal strains and are therefore excellent candidates for use as the lead compounds for the development of novel antimicrobial agents.</P>

천연 항균복합제재용액을 침지 및 재배용수로 처리한 콩나물의 선도유지 효과

정준호,조성환 한국식품저장유통학회 ( 구 한국농산물저장유통학회 ) 2004 한국식품저장유통학회지 Vol.11 No.1

본 실험에서는 식품의 미생물작용에 의한 변질의 저해 효과가 뛰어난 식물성천연항균제품(botanical antimicrobial agent)에 천연보조제(인삼추출물, 알로에, 매실추출물)를 첨가하여 paper disk법에 의한 항균성 검사를 실시한 결과, 인삼추출물을 처가한 천연복합항균제재(BAAG)에서 생육저해환이 가장 크고 뚜렷하게 나타났다. 한편, 천연 항균복합제재 용액에 콩나물용 콩을 농도별로 각각 침비 처리하여 냉장 및 상온에 저장하면서 대장균수, 총균수의 변화를 살펴보고, 외관상의 변화에 미치는 영향을 수도수로 침지처리한 대조구와 비교하면서 조사하였다. 실험 결과, 대장균은 BAAG의 침지처리에 의해 성장이 억제되었으며 처리농도가 증가시밀수록 균증식 억제 효과가 뚜렷하였고, 총균수도 BAAG처리구의 콩나물이 가장 낮은 수치를 나타내었다. 외관상의 변화와 상품 가치를 측정한 결과는 수도수처리구인 대조구 콩나물이 저장 3일후부터 부패취와 함께 표피의 점질성 갈변이 형성되어 상품가치가 크게 떨어진 상태였다. 위와 같은 결과, BAAG용액 속에서 콩나물 콩을 발아시켜 침지 처리함으로써 콩나물의 유통기간을 상당기간 연장할 수 있을 것으로 기대된다. The antimicrobial effect of mixed solution of botanical antimicrobial agent-citrus product (BAAC) and such a natural additive as aloe, ginseng or Prunus mume extract on the spoilage microorganisms of soybean sprouts were investigated by paper dist method. The mixture (BAAG) of BAAC and ginseng extract showed the remarkable antimicrobial activity in the result of the experiment. Therefore, we used BAAG as pre-soaked and cultivated in the BAAG-diluted solution (50 ppm) showed 2.5 x 10 CFU/mL and 1.3 x 10 cfu/mL in comparison with 3.5 x 10³ cfu/mL and 5.8 x 10³ cfu/mL of the control, respectively. BAAG-treated soybean sprouts also showed no slimy brown product and undesirable oder characterized in the control. It was confirmed that BAAG could be a proper pre-soaking and cultivating solution of soybean sprouts