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유도성 DHA-1β-Lactamase를 생성하는 폐렴 간균에 의한 균혈증이발생한 환자에게 투여된 감수성 있는 Cephalosporin의 치료실패 경험
강철인,김홍빈,오명돈,김의종,최강원,배현주,김성한 대한감염학회 2004 Infection and Chemotherapy Vol.36 No.3
Backgroud : The therapeutic option is limited for the infections caused by organisms producing plasmid- mediated AmpC beta-lactamases, increasingly identified worldwide. Two sporadic patients with bacteremia caused by K. pneumoniae possessing an unusual inducible β-lactam resistant phenotype were found in a university hospital.Materials & Methods : We conducted antibiotic susceptibility test according to NCCLS guideline. Also, we characterized β-lactamase by isoelectric focusing.Results : DHA-1 gene conferred the resistant phenotype. The patients had experienced treatment failure when treated with extended-spectrum cephalosporin. For the isolates the cephalosporin resistance was induced by clavulanic acid (and cefoxitin).Conclusion : Theses results suggest that the extended-spectrum cephalosporins might not provide optimal therapeutic option for inducible DHA-1-producing K. pneumoniae infection, even when the pathogens are susceptible in vitro. 목 적:AmpC beta-lactamase를 생성하는 Klebsiella pneumoniae 균주가 보고되고 있으나 이에 대한 적절한 치료 항균제 선택에 제한이 있다. Cephalosporin 내성이 유도되는 형질을 지닌 K. pneumoniae에 의한 균혈증이 2례 발생하였다. 혈액에서 분리된 이 균주들의 내성 기전을 확인하고 항균제 감수성의 특성을 알아보고자 하였다. 방 법:NCCLS 지침에 따라 항균제 감수성 검사와 ESBL 확인 검사를 시행하였다. Isoelectric focusing과 PCR을 이용하여 beta-lactamase characterization을 시행하였다. 결 과:균주들은 DHA-1 AmpC beta-lactamase를 생성하고 있었고 clavulanic acid에 의해 cephalosporin 내성이 유도되었다. 항균제 감수성 검사 결과 내성이 아닌 광범위 cephalosporin을 투여받았으나 환자들은 치료 실패를 경험하였다. 결 론:이러한 결과들은 DHA-1을 생성하는 K. pneumoniae에 의한 중증 감염증에 광범위 cephalosporin을 투여하는 것은 감수성이 있는 항균제라 하더라도 적절한 항균제 선택이 아닐 수 있음을 시사한다
강철인 대한의사협회 2011 대한의사협회지 Vol.54 No.3
Over the past decade, infections caused by antimicrobial-resistant bacteria have increased and continued to challenge physicians. Recent data show rapidly increasing rates of infection due to multidrug-resistant (MDR) gram-negative bacilli. Furthermore, pandrug-resistant infections now occur, especially due to gram-negative bacilli, and our therapeutic options for these pathogens are extremely limited. Infection caused by MDR bacteria was associated with a greater likelihood of inappropriate antimicrobial therapy, and inappropriate antimicrobial therapy has an adverse effect on survival in patients with serious infections. Consequently, it may be presumed that serious infections caused by MDR bacteria have a worse prognosis because of the delay in initiation of appropriate antimicrobial therapy. Empirical antibiotics for serious infections should be recommended on the basis of the distribution of pathogens and their susceptibility patterns in the institution where the regimen is administered. Therefore, physicians who are caring for patients with bacterial infection should be familiar with local antimicrobial susceptibility patterns and the epidemiology of MDR bacterial infections, in order to improve the treatment outcome of the patients. This comprehensive review aims to describe the epidemiology and clinical implications of MDR gram-negative bacterial infections in Korea, a country with a high prevalence of antimicrobial-resistant pathogens.
강철인 대한의사협회 2022 대한의사협회지 Vol.65 No.8
Background: Increase in antimicrobial-resistant bacteria continues to be challenge to physicians. Particularly, multidrug-resistant (MDR) gram-negative bacilli (GNB), such as extended-spectrum beta-lactamase (ESBL)- producers and carbapenem-resistant pathogens, are becoming a major human health problem globally. Current Concepts: Gram-negative bacteria have developed resistance via mechanisms encoding AmpC beta lactamases, ESBLs, and carbapenemases. The therapeutic options available for these pathogens are extremely limited. Infection by MDR bacteria is associated with ineffective antimicrobial therapy, which poses a major threat to the survival of patients with serious infections. Physicians should be familiar with the local epidemiology of MDR bacterial infections and the available therapeutic options. Carbapenems are considered as the drugs of choice for treating ESBL or AmpC-producers. However, increased use of carbapenems in response to an increased prevalence of MDR pathogens could be associated with the rapid emergence of carbapenem resistance. Therefore, there is an ongoing quest for carbapenem-sparing regimens for the treatment of MDR-GNB. Treatment of MDR-GNB infections need not be limited to carbapenems as novel antimicrobial agents are now available. Discussion and Conclusion: This comprehensive review aims to describe therapeutic options available for MDR-GNB infections in Korea, a country with a high prevalence of MDR pathogens. Recently developed anti microbial agents that should be urgently introduced in Korea include ceftolozane-tazobactam, ceftazidime avibactam, meropenem-vaborbactam, imipenem-relebactam, and cefiderocol. These drugs have been shown to be effective against carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.
국내 젊은 남성들의 Epstein-Barr 바이러스 항체보유율
강철인,최창민,박정탁,박태성 대한감염학회 2007 감염과 화학요법 Vol.39 No.2
This study was performed to determine the seroprevalence of EBV infection in young adults of South Korea. A total of 196 subjects were enrolled for the analysis of EBV seroprevalence. All subjects were males and their median age was 21 years old (range, 19-24 years). The overall anti-VCA IgG seropositivity prevalence was 87.2% (171/196). This result suggests that approximately 10% of young adults belongs to the risk group of infectious mononucleosis, even in South Korea that has been known as a highly seroprevalent country.
강철인,최창민,홍성신,김홍빈,김남중,오명돈,최강원 대한감염학회 2006 Infection and Chemotherapy Vol.38 No.1
We described a population-based study of the epidemiology of herpes zoster in military personnel of Korea. A total of 132 cases of herpes zoster were ascertained from May 2004 to April 2005. The most common site of involvement was thoracic area (55%). The annual incidence, based on 132 cases in about 80,000 person-years, was 165 per 100,000 person (95% CI, 138-196). It is noted that herpes zoster occurred frequently in otherwise healthy military personnel.