증례 : 감염: 신병훈련소의 군인에서 발생한 아데노바이러스 55형 폐렴

윤진구 ( Jin Gu Yoon ),이샘나 ( Saem Na Lee ),이정민 ( Jung Min Lee ),노지윤 ( Ji Yun Noh ),송준영 ( Joon Young Song ),정희진 ( Hee Jin Cheong ),김우주 ( Woo Joo Kim ) 대한내과학회 2016 대한내과학회지 Vol.90 No.4

Adenoviral pneumonia is rare in healthy adults. However, several cases were recently reported in a military training center in South Korea. Adenovirus genotype 3, 6, and 7 are predominant in South Korea. More recently, genotype 55, which emerged sporadically in China, has been reported in South Korea. In this study, we present a case of adenoviral pneumonia caused by genotype 55 in a healthy soldier from an army recruit training center in South Korea. (Korean J Med 2016;90:365-368)

대유행 인플루엔자(H1N1 2009)의 역학, 임상적 특성 : 일개 거점병원의 경험

노지윤,임선영,허중연,최원석,송준영,정희진,김우주 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

Background: Since early outbreaks in North America in April 2009, the new influenza virus spread rapidly all over the world, and WHO declared a pandemic in June 2009. The objective of this article is to describe the epidemiological and clinical characteristics of patients confirmed with pandemic influenza (H1N1 2009). Material and Methods: Among all patients confirmed with pandemic influenza (H1N1 2009) in Korea University Guro Hospital from 2 May 2009 to 31 March 2010, we selected 10% of patients aged more than 15 years randomly. Medical records were reviewed retrospectively and clinical findings were analyzed: social history, underlying disease, initial symptoms, and clinical course. Comparative analysis of initial symptoms was performed by time to presentation and age groups: 15-29 years, 30-49 years, 50-59 years, and more than 60 years. In addition, we described fatal cases of pandemic influenza (H1N1 2009). Results: From 2 May 2009 to 31 March 2010, total number of laboratory-confirmed cases of pandemic influenza (H1N1 2009) was 7,888. The most cases (1,632) developed at epidemic week 46, 2009. The median age of patients was 13 years and more than half of patients (55.4%) were less than 15 years. The median time to presentation was 1 day from onset of symptom. Clinical symptoms were cough (86.9%), sore throat (69.4%), myalgia (63.3%), chill (60.6%), rhinorrhea (57.7%), headache (57.6%), nausea or vomiting (27.4%), and diarrhea (9.3%). Fever was noted more frequently at 15-29 years group than ≥30 years group. Antiviral agent was administered to 274 patients (77.8%): 267 cases with oseltamivir and 7 cases with zanamivir. The median time to administration was 2 days and mean time to defervescence was 3 days. Cough was the most persistent symptom: initial visit (94.1%), on third day (82.4%), and on sixth day (52.9%) by the serial follow up at the same patients. Case fatality rate was 0.05%, and all fatal cases occurred in patients aged ≥50 years. Conclusions: Children and adolescents were the most affected group. Clinical symptoms were similar to seasonal influenza. Gastrointestinal symptoms were relatively common, and cough was the most long-lasting symptom.

A Case of Disseminated Tuberculosis with Miliary Central Nervous System Tuberculoma

Noh, Ji Yun,Heo, Jung Yeon,Lee, Kwang Gyun,Yoon, Young Kyung,Lee, Jacob,Song, Joon Young,Cheong, Hee Jin,Kim, Woo Joo 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Disseminated tuberculosis occurs through lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli. The exact incidence of disseminated tuberculosis is still unknown and its diagnosis presents a challenge since the symptoms are not specific of the disease. Brain tuberculoma is one of the complications of tuberculosis. The literary review of brain tuberculoma shows that it mainly occurs in the cerebrum and cerebellum, whereas involvement of the brainstem is rare. Recently, we have experienced a case of 46-year-o1d man with fever of 2 months duration who was diagnosed with disseminated tuberculosis with miliary central nervous system (CNS) tuberculomas; brain tuberculomas were found even in the brainstem and the spinal cord. Pulmonary, intestinal, renal, and choroidal involvements were also noted.

감염성 당뇨 족부 궤양 : 심부 조직 배양 검사 결과에 기초한 원인균 분석

서유빈,노지윤,허중연,이재갑,송준영,한승규,김우주,정희진 대한감염학회 2007 감염과 화학요법 Vol.39 No.5

목적 : 심부 조직 검사를 통한 배양 결과를 토대로 감염성 당뇨 족부 궤양의 원인 균에 대한 분포 파악하고, 감염성 족부 궤양의 위험 인자로 알려져 있는 당뇨병 이환기간 및 혈당 조절 정도, 조직 허혈 정도와 원인균 분포의 상관 관계를 분석하고자 하였다 재료 및 방법 : 2006년 9월 1일부터 2007년 3월 31일까지 총 7개월 동안 1개 대학 병원에 중증의 감염성 당뇨 족부궤양으로 입원한 환자 94명 중 심부 조직 배양 검사를 시행한 74명의 환자를 대상으로 연구를 진행하였다. 원인 균의 분포를 조사하고, 원인 균에 따라서 성별, 나이, 재원 기간, 당뇨 종류, 당뇨 이환 기간, 혈당화색소(HbA1c), 신경병증, 혈관병증 및 당뇨성 신병증 유무, 조직 산소 농도, 골수염 유무, 내원 전 항생제 노출력, 입원 시 발열 유무, 백혈구(WBC), 적혈구 침강계수(ESR), C-반응성 단백질(CRP)의 차이가 있는지 조사하였다. 결과 : 호기성 그람양성균에 의한 감염이 76.4% (39예)로 대부분이었으며, MRSA가 29.4% (15예)로 가장 많았다. 그 외 호기성 그람음성균에 의한 감염이 전체 감염의 33.3% (17예)을 차지하였으며, 그 중 Enterobacteriaceae가 13.7% (7예)로 가장 많았다. 혐기성 균은 동정되지 않았으며 곰팡이 감염은 한 예에서만 관찰되었다. 호기성 그람양성균과 호기성 그람음성균에 감염된 환자들에서의 임상상과 검사실 소견을 비교하였으나 차이가 없었으며, MSSA와 MRSA 또한 차이가 없었다. 이전 항생제 노출이 있었던 환자들 중에서는 MRSA가 27.2% (12예)으로 가장 많이 동정되었고, 혼합감염은 이전 항생제 노출력이 있었던 6명에서만 관찰되었다. 결론 : 감염성 당뇨 족부 궤양의 치료를 위해 입원한 환자들의 가장 흔한 원인균은 MRSA 였다. 그람양성균과 그람음성균, MSSA와 MRSA 감염에 따른 임상상과 검사실 소견의 차이는 보이지 않았다. 이전 항생제 노출력이 있는 경우 혼합 감염이 흔하게 관찰되었으며, 항생제 노출력이 있는 중증 감염의 경우는 그람양성균과 그람음성균에 모두 감수성 있는 광범위 항생제를 투약하는 것이 적합할 것이다. Background : The annual prevalence of foot ulcer in Korea is 99.5 per 100,000 people with diabetes and 49.8 cases among them go through amputation. Moreover, amputation due to uncontrolled infection accounts for 50% of all non-traumatic limb amputations. Therefore, reliable microbiological documentation is important. Materials and Method : We enrolled 74 patients with diabetic foot infection, who referred to Korea University Hospital from September 2006 to March 2007. Deep tissue biopsies were taken from the base of ulcer after surgical debridement and cleansing at admission. We analyzed the microbiological differences according to the sex, age, type and duration of diabetes, glycemic control, presence of neuropathy or angiopathy, diabetic nephropathy, osteomyelitis, transcutaneous oxygen tension and prior antibiotic use. Result : Gram-positive aerobic bacteria were the most common organisms isolated (76.4%), followed by Gram-negative aerobic bacteria (33.3%) and fungus (2.0%). Of the Gram-positive aerobes, methicillin-resistant Staphylococcus aureus (MRSA) was found most frequently (29.4%). The clinical and laboratory findings showed no significant clinical differences between gram-positive and gram-negative infections. Moreover, there was no difference in clinical findings between methicillin-susceptible and methicillin-resistant S. aureus infections. Mixed infection was not common (average, 1.2 organisms with each diabetic foot infection). Of note, mixed infection was more frequently found in patients with prior antibiotic use. Conclusion : MRSA was the most common pathogen in diabetic foot infection among patients referred to tertiary hospital. There was no significant difference of clinical and laboratory findings with regard to gram stain results and methicillin resistance in S. aureus. Mixed infection was not common, but broad spectrum antibiotics are recommended for severe diabetic foot infection with prior antibiotic exposure.

면역저하 성인에서 발생한 호흡기 세포융합바이러스 하기도 감염 2예

이순재,노지윤,최원석,기세윤,송준영,이창규,김우주,정희진 대한감염학회 2006 감염과 화학요법 Vol.38 No.4

호흡기 융합 바이러스는 면역 저하자, 노인, 심혈관계합병증이 있는 환자에서 폐렴 등의 중증 감염을 유발할수 있다. 최근 바이러스 배양법을 대체할 수 있는 진단법들이 개발되어 보다 신속한 진단이 가능할 것으로 보이며, 유행 시기에 위와 같은 위험군의 환자에서 발생한 폐렴의 경우 반드시 인플루엔자와 함께 호흡기 융합 바이러스의 가능성을 고려함으로서, 정확한 진단 및 치료와 함께 불필요한 항생제 사용을 줄일 수 있을 것으로 생각된다. Respiratory syncytial virus (RSV) is a common etiological agent in children and infants causing pneumonia, bronchitis and bronchiolitis. RSV is rarely associated with lower respiratory tract infection in immunocompetent adults. But in immunocompromised host, the elderly and patients with cardiopulmonary cormobidities, RSV can cause life threatening infections. Nevertheless, this disease is unrecognized by most internists, in part because the possibility of RSV is not considered but also because diagnosis is difficult to make during the acute illness. Early suspicion of RSV infection is important in making accurate diagnosis and preventing unnecessary antibiotic use. The authors report two cases of RSV pneumonia: one in a 62 year old woman with multiple myeloma and the other in a 72 year old woman with malignant lymphoma.

국내 침습성 폐렴사슬알균 감염증의 임상양상

최원석,노지윤,허중연,윤영경,김미정,조유미,김정연,송준영,박대원,김우주,김민자,정희진 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Streptococcus pneumoniae is one of the most important causes of pneumonia, meningitis, bacteremia, and other invasive diseases in children and adults. The 23-valent polysaccharide pneumococcal vaccine (PPV) has been recommended to adults with high risk conditions by the Korea Society of Infectious Diseases in 2007, but there is no data on the epidemiology of invasive pneumococcal disease in Korean adults to support this recommendation. Therefore, we performed a study to investigate the epidemiology of invasive pneumococcal disease in Korean population. Materials and Methods: We collected clinical and microbiologic data of patients diagnosed with invasive pneumococcal disease (IPD) in 3 universityhospitals located in Seoul and Gyeonggi-do from January 2002 to December 2007. Results: A total of 168 patients were diagnosed with IPD in the selected hospitals during the study period. Invasive pneumonia and meningitis were the most common forms of IPDs. The mean length of hospitalization of patients with IPD was 18.5±26.7 days and mortality rate of IPD was 18.6%. Among the isolates from patients with IPD, 59.7% was susceptible to penicillin and 38.3% was susceptible to erythromycin. Mortality rate of IPD increased with age and in patients with Eastern Cooperative Oncology Group performance status 4. Conclusions: Epidemiology of IPD in Korean population was described. Further studies should be performed to secure the risk factors of invasive pneumococcal diseases and to confirm the appropriateness of recommendation for vaccination with the 23-valent PPV.

Voriconazole로 치료한 침습성 아스페르길루스부비동염 1예

은채령,허중연,노지윤,윤영경,이현주,신봉경,이재갑,송준영,정희진,김우주 대한감염학회 2008 감염과 화학요법 Vol.40 No.2

두개저를 침범한 침습성 아스페르길루스증은 드물지만 이환되었을 경우 사망률이 높은 심각한 질환이다. 하지만, 임상양상이 비 특이적이기 때문에 진단이 쉽지 않고, 치료 방법이 명확하게 확립되어 있지 않다. 제 2형 당뇨병력이 있는 52세 여자 환자가 우안 시력 저하 및 우측 안구통 주소로 내원하였다. 뇌 자기공명영상 촬영에서 부비동-안와를 포함하고 두 개저까지 침범한 병변을 확인하였고 치료 및 진단적 수술을 통해서 침습성 아스페르길루스증을 진단하였다. 진단 후 amphotericin B로 치료를 시작하였으나 치료 반응이 좋지 않아 vohconazole로 치료 약제를 변경하였다. Voriconazole은 1일 째에 300 mg씩 2회 부하 용량으로 정맥 투여한 후, 총 7주간 200 mg씩 1일 2회 정맥 투여하고, 이어서 총 7주간 200mg씩 1일 2회 경구 투여하였다. 뇌 자기공명영상으로 치료 반응을 추적 관찰하였으며, 치료 종료 1년 후까지 추적한 결과 임상 소견 및 영상 검사 결과 모두 호전된 것을 확인하였다. 당뇨 환자에서 발생한 두개저를 침범한 침습성 아스페르길루스증에 대해서 종괴에 대한 조대술(marsupialization) 후 voriconazole 3개월 치료로 완치를 보인 증례를 문헌고찰과 함께 보고하는 바이다. Skull base-invading, invasive aspergillosis is rare, but it is a potentially life-threatening disease. Nevertheless, the standard method and the optimal duration of treatment are not known yet. A 52-year-o1d female diabetic patient complained of ophthalmalgia and decreased visual acuity. MRI and CT scan revealed an enhancing mass in the right orbital fissure and showed an infiltratina process in the skull base around the right orbit apex and paranasal sinuses. The histological investigation revealed invasive aspergillosis of paranasal sinuses and the skull base. Clinical improvement occurred after marsupialization and post-operative systemic antifungal therapy with voriconazole for 14 weeks. We suggest that voriconazole treatment could show effective results for invasive aspergillosis of skull base and paranasal sinuses.

3차병원 중환자실 내 전향적 감사와 피드백을 통한 항생제 사용 중재 효과

윤진구,최하늘,김성란,조민희,최유정,남엘리엘,성혜,노지윤,정희진,김우주,송준영 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

Background: The implementation of antibiotic stewardship program (ASP) has been encouraged in developed countries in response to increasing antibiotic resistance. However, the implementation of ASP has been limited owing to a lack of manpower and awareness. We aimed to analyze the effectiveness of prospective audit and feedback (PAF), one of the core strategies in ASP, by applying it to the intensive care units (ICUs). Methods: In this study, we applied PAF to the neurological/surgical ICUs of a tertiary hospital starting from March 1, 2023, we compared the data of 6 months before (from September 2022 to February 2023) and after (from March 2023 to August 2023) the implementation to assess the difference in antimicrobial use density (AUD) and the acquisition rates of antibiotic-resistant bacteria. Furthermore, we surveyed the satisfaction of PAF using a questionnaire. PAF was conducted twice a week during rounds by the ASP team, which consisted of an infectious disease specialist and one assistant. Results: Before and after the implementation of PAF, AUD showed a tendency to decrease in the classes of beta-lactam/beta-lactamase inhibitors, cephalosporins and glycopeptides, although the changes were not statistically significant. The acquisition rate of carbapenem-resistant Acinetobacter baumannii decreased slightly in the surgical ICU. Most participating interns and residents reported that PAF was clinically and educationally helpful in the survey. Conclusion: Implementing PAF twice a week in the neurological/surgical ICUs could reduce antibiotic usage and the acquisition rates of some resistant bacteria.