Extended-spectrum β-lactamase 를 생산하는 Enterobacteriaceae 요로감염에서 카바페넴 이외의 항생제 사용 가능성에 대한 고찰

서유빈,이재갑,김영근,송원근 대한의료관련감염관리학회 2016 의료관련감염관리 Vol.21 No.2

Background: Alternatives to carbapenem are increasingly needed to decrease the usage of carbapenem. We evaluated the possibility of using non-carbapenem antibiotics against urinary tract infections (UTI) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Methods: This retrospective study was performed at 2 university hospitals between October 2010 and December 2012. All diagnosed adult cases of ESBL-PE UTI were identified from the microbiological database. The subjects were divided into 3 groups based on the empirical antibiotic classes and susceptibility: carbapenem (C) group, susceptible non-carbapenem (SNC) group, and non-susceptible non-carbapenem (NSNC) group. Results: A total of 84 patients were eligible for analysis. For empirical therapy, 41, 23, and 20 patients were included in the NSNC, SNC, and C empirical groups, respectively. During the empirical therapy, 7 patients (17.1%) in the NSNC group, 18 patients (78.3%) in the SNC group, and 19 patients (78.3%) in the C group experienced clinical improvement. No significant difference was observed between the SNC and C empirical groups (P=0.192). Severe sepsis or shock was the predictor of empirical SNC treatment failure (P=0.048). There was a tendency to use carbapenem as a definite therapy in cases of NSNC. In contrast, empirical SNC was maintained as a definite therapy. Conclusion: SNC could be considered as an alternative to carbapenems for treating ESBL-PE UTI. This strategy might decrease the usage of carbapenem without clinical deterioration. However, it should be noted that SNC therapy may fail in the case of severe sepsis or shock.

Successful Aging Transition and Its Impact on Self-Rated Health and Life Satisfaction: Findings from the Korean Longitudinal Study of Aging (2006-2018)

서유빈,양윤준 대한임상건강증진학회 2022 Korean Journal of Health Promotion Vol.22 No.2

Background: The concept of successful aging (SA) is becoming more emphasized. Since this status can change over time, it is necessary to evaluate the pattern of change and its effect on subjective well-being. Methods: In this study, the participants aged 65 or older in the Korean longitudinal study of aging (KLoSA) were divided into four groups based on the change in SA (2006-2018), and its relationships with self-rated health and life satisfaction were evaluated. Results: Compared to the non-SA (NSA)→NSA group, the odds ratio for positive self-rated health was 4.30 (95% confidence interval [CI], 1.64-11.31) in the SA→SA group, 3.92 (95% CI, 1.94-7.95) in the NSA→SA group, and 1.79 (95% CI, 1.28-2.50) in the SA→NSA group. High life satisfaction was 2.42 (95% CI, 1.19-4.94) in the SA→SA group and 2.50 (95% CI, 1.36-4.59) in the NSA→SA group. Conclusions: Maintenance or improvements of a SA state has a significant association with positive self-rated health and high life satisfaction.

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

서유빈,노지윤,허중연,이재갑,송준영,한승규,김우주,정희진 대한감염학회 2007 Infection and Chemotherapy Vol.39 No.5

한국 성인의 전자담배사용과 금연: 국민건강영양조사 제7기, 2016-2018

서유빈,이언숙,이준형 대한금연학회 2021 대한금연학회지 Vol.12 No.2

연구배경: 전자담배의 위해성과 가능성에 대해서는 논란이 지속되고 있으며, 특히 전자담배의 금연 효과에 대해서는 연구 결과가 혼재되어 있다. 여러 선행연구에서 전자담배를 사용하는 흡연자는 그렇지 않은 흡연자에 비해 금연 시도가 많으며 니코틴 의존도가 높다는 것을 보여주었지만, 국내에서 전자담배 사용과 금연의 관계에 대해 분석한 연구는 부족하다. 이에, 본 연구는 국민건강영양조사 자료를 이용하여 전자담배 사용 여부와 금연과의 연관성을 알아보고자 한다. 방법: 제7기 1,2,3차년도(2016-2018)에서 6,915명의 평생 흡연 경험자를 대상으로 하였고, 대상자들을 전자담배 ‘비사용’ (5589명), ‘과거사용’ (964명), ‘현재사용’ (362명) 군으로 나누어 살펴보았다. 각 집단에서 인구사회학적 특성과, 과도한 음주 여부, 스트레스 인지 정도를 비교하였으며, 이 중 전자담배 사용에 따라 차이를 보이는 요인을 보정하여 전자담배 평생 사용 및 현재 사용과 1달 이상 또는 1년 이상 금연과의 연관성을 분석하였다. 통계분석은 다중 로지스틱 회귀분석을 실시하였으며, SPSS ver. 25.0 (IBM Corp.)을 사용하였다. 결과: 평생 흡연 경험자에서 전자담배 사용에 따라 유의한 차이를 나타냈던 요인을 보정하여 과거 1달 및 1년 금연에 대한 교차비를 분석하였을 때, 평생 전자담배 경험은 비사용에 비해 1달 이상 금연에 대한 교차비가 0.30 (95% CI: 0.24-0.36, P<0.001), 1년 이상 금연에 대한 교차비가 0.20 (95% CI: 0.16-0.25, P<0.001)로 나타났다. 또한 전자담배 현재 사용은, 비사용을 기준으로 1달 이상 금연에 대한 교차비가 0.14 (95% CI: 0.10-0.22, P<0.001), 1년 이상 금연에 대한 교차비가 0.07 (95% CI: 0.04-0.12, P<0.001)로 나타났다. 추가적으로, 국내 전자담배가 2007년 도입되었다는 사실을 감안하여, 2007년 이전부터 금연을 유지해오고 있던 과거 흡연자를 제외한 모집단을 대상으로 위와 같이 로지스틱 회귀분석을 실시하였으며, 여전히 전자담배와 금연은 유의한 음의 상관관계를 나타냈다. 결론: 많은 흡연자들이 금연을 목적으로 전자담배를 사용하지만, 전자담배의 사용은 낮은 금연율과 연관이 있다. 향후 전자담배 사용자에서 니코틴 의존도 및 흡연의 생화학적 지표를 포함하여 분석한 전향적 연구가 필요하다.

금연치료지원사업을 위한 임상진료지침

서유빈,백유진,이철민,이언숙,강혜선,김수영,노성원,박동원,안유석,조상호 대한금연학회 2023 대한금연학회지 Vol.14 No.2

Background: An evidence-based guideline was formed that addresses several questions regarding pharmacotherapy for smoking cessation among tobacco-dependent adults. Methods: The multidisciplinary guideline panel selected seven clinical key questions and adopted the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology. The recommendations were verified through literature search and selection, evidence synthesis and evaluation, and the recommendation grade selection process. Results: For smoking cessation in general population, our recommendation is to use varenicline rather than the nicotine patch or bupropion. We conditionally suggest combining varenicline with a nicotine patch instead of using varenicline alone. As for the duration of treatment, we recommend using extended-duration therapy (more than 12 weeks) rather than standard-duration therapy (6-12 weeks). For tobacco-dependent adults who are not yet ready to quit smoking, we recommend initiating treatment with varenicline rather than waiting for them to be ready. In special populations, for adults with a comorbid psychiatric condition, varenicline is preferred over the nicotine patch. Additionally, pharmacotherapy is strongly recommended for adults with chronic obstructive pulmonary disease. Conclusion: Seven recommendations that focused on drug treatment for smoking cessation were developed. Moreover, the guideline panel expects that following these guidelines will increase the effectiveness of smoking cessation intervention. 연구배경: 국내에서 금연약물치료가 승인된 19세 이상 성인을 대상으로 약물치료를 중심으로 하여 금연진료지침을 개발하고 자 한다. 방법: 다학제적으로 구성된 개발위원회에서 국내 의료현실에 필요한 7개의 핵심질문을 선정하였으며, Grading of Recommendations Assessment, Development and Evaluation (GRADE)-ADOLOPMENT 방법론을 채택하였다. 결과: 문헌 검색과 선택, 근거 합성 및 평가, 권고 등급 선정 과정을 통해 다음 권고내용을 확정하였다. 일반인구집단에서 1차 선택약제로 니코틴패치보다 바레니클린을, 부프로피온보다 바레니클린을, 표준치료보다는 연장치료를, 금연준비가 안된 흡연자에게 바로 치료를 시작하는 것을 권고하며, 바레니클린 단독요법보다 바레니클린과 NRT 병합요법을 선택적으로 적용할 것을 권고한다. 특수집단에서는 정신질환자와 만성폐쇄성폐질환환자에서도 약물치료를 권고한다. 결론: 금연약물치료에 초점을 맞춰 작성된 7개 권고안을 제시하였으며, 개발위원회에서는 이러한 지침의 활용으로 일선에서 금연약물치료의 효과를 높일 수 있기를 기대한다.

2011년도 성인 미코플라스마 폐렴의 임상역학적 특성

서유빈,양태언,김인선,홍경욱,송준영,정희진,김우주 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.5

Background: Recent data regarding the clinical epidemiologic characteristics of Mycoplasma pneumoniae pneumonia in Korean adults are insufficient. This study was conducted in order to compare epidemics in different ages and to identify the clinical characteristics in adults. Material and Methods: We investigated patients who visited Korea University Guro Hospital from January to December 2011 due to community acquired pneumonia and underwent mycoplasma antibody tests. M. pneumoniae pneumonia was diagnosed if mycoplasma antibody titer was ≥1:320 at any time, seroconversion or 4-fold rise was seen at convalescent phase. Patients under the age of 19 were classified as child and adolescent, otherwise adult. We investigated the number of monthly cases in all patients and reviewed the medical records of adult patients. Results: A total of 249 young patients aged ≤18 years and 29 adults were diagnosed with M. pneumoniae pneumonia. Among young patients, 75.5% were concentrated in the 0-6 years age group and 58.6% of adults belonged to the 26-40 years age group. The number of young patients began to increase in July and continued to increase in December, while the number of adult patients began to increase in August and occurred continuously until December. The correlation coefficient of the epidemic trend between the two groups was 0.682 (P=0.015). Median age of adult patients was 33.3 years. Fever was observed in all patients and 25 patients (86.2%)complained of purulent sputum. The average white blood cell count was 7,066/mm3. The average values for aspartate aminotransferase, alanine aminotransferase,creatinine, and sodium were within the normal range. In chest X-ray study, ipsilateral lower patchy consolidation was found in 24 patients (82.8%). Twenty one adult patients (72.4%) were hospitalized. The mean duration of hospitalization was 7.3days. Twenty three patients (79.3%) were initially treated with combinations of third generation cephalosporin and macrolide. Among them, five patients (17.2%)showed poor responses. Six cases (20.7%) were initially treated with quinolone, and treatment was maintained until the end without changing antibiotics. Development of cryptogenic organizing pneumonia occurred in one case and there was no occurrence of death. Conclusions: When M. pneumoniae pneumonia is epidemic among children and adolescents, it should also be suspected in adult patients with community-acquired pneumonia. Some patients showed poor responses to macrolide. Overall, it appears that additional studies are needed for evaluation of the effectiveness of macrolide in treatment of M. pneumoniae pneumonia in adults.

Etiology and Clinical Outcomes of Acute Respiratory Virus Infection in Hospitalized Adults

서유빈,송준영,최민주,김인선,양태운,홍경욱,정희진,김우주 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.2

Background: Etiologies and clinical profiles of acute respiratory viral infections need to be clarified to improve preventive andtherapeutic strategies. Materials and Methods: A retrospective observational study at a single, university-affiliated center was performed to evaluate therespiratory viral infection etiologies in children compared to that in adults and to document the clinical features of common viralinfections for adults from July 2009 to April 2012. Results: The common viruses detected from children (2,800 total patients) were human rhinovirus (hRV) (31.8%), adenovirus (AdV)(19.2%), respiratory syncytial virus (RSV) A (17.4%), RSV B (11.7%), and human metapneumovirus (hMPV) (9.8%). In comparison,influenza virus A (IFA) had the highest isolation rate (28.5%), followed by hRV (15.5%), influenza virus B (IFB) (15.0%), andhMPV (14.0%), in adults (763 total patients). Multiple viruses were detected in single specimens from 22.4% of children and 2.0%of adults. IFA/IFB, RSV A/B, and hMPV exhibited strong seasonal detection and similar circulating patterns in children and adults. Adult patients showed different clinical manifestations according to causative viruses; nasal congestion and rhinorrhea were morecommon in hRV and human coronavirus (hCoV) infection. Patients with RSV B, hRV, or AdV tended to be younger, and those infectedwith RSV A and hMPV were likely to be older. Those with RSV A infection tended to stay longer in hospital, enter the intensivecare unit more frequently, and have a fatal outcome more often. The bacterial co-detection rate was 26.5%, and those caseswere more likely to have lower respiratory tract involvement (P = 0.001), longer hospital stay (P = 0.001), and higher mortality (P= 0.001). Conclusions: The etiologic virus of an acute respiratory infection can be cautiously inferred based on a patient’s age and clinicalfeatures and concurrent epidemic data. Large-scale prospective surveillance studies are required to provide more accurateinformation about respiratory viral infection etiology, which could favorably influence clinical outcomes.

혈액학적 변수에 미치는 흡연의 영향의 성별 차이

서유빈,이언숙,이준형 대한금연학회 2022 대한금연학회지 Vol.13 No.3

배경: 흡연자에서 혈색소, 백혈구수, 혈소판 수가 증가하고 이런 변화가 암, 심혈관질환 등 흡연관련 질환의 기전이 될 수 있다. 혈전성질환의 위험이나 흡연율이 성별의 차이가 있음에도 불구 하고 혈액학적 지표에 미치는 성별의 차이를 본 연구는 많지 않다. 이에 본 연구에서 성.별을 나누어서 혈액학적 지표에 미치는 흡연의 영향을 보았다. 방법: 제 7기, 8기 국민건강영양조사 자료를 이용하였고 성인 남.녀 22,501명을 대상으로 하였다. 흡연 상태는 설문으로 현재 흡연자, 과거흡연자, 비흡연자로 나누었고 코티닌 검사로 흡연 자와 비흡연자로 나누어 구분하였다. 혈액학적 지표로는 혈색소, 헤마토크리트, 총 백혈구 수, 혈소판 수를 측정하였다. 적혈 구증가증은 2017년 WHO 진단 기준을 근거로 하여 남성에서 혈색소 >16.5 g/dL인 경우, 여성에서 혈색소 >16.0 g/dL인 경우로 정의하였다. 모든 분석은 남.녀를 구분하여 시행하였다. 다변량 분석에서 연령, 교육수준, 가구총수입, BMI, 신체활동량, 음주, 만성질환 등 혈액학적지표에 영향을 줄 수 있는 요인들을 보정하였다. 결과: 본 연구 결과 현재 흡연은 혈색소, 헤마토크리트, 백혈구수 및 혈소판수 등 혈액학적지표의 증가와 연관성이 있었고, 남.녀 각각에서 확인되었다. 남성에서는 모든 혈액학적 지표와 흡연량의 양-반응 관계를 보였지만 여성에서는 백혈구 수와 혈액 학적 지표의 양-반응 관계를 보였다. 흡연에 의한 적혈구증가증 의 위험은 남성에서만 관찰되었다(OR 1.567, 95% CI 1.334- 1.841). 결론: 흡연은 남.녀 모두에서 백혈구 수의 증가와 양-반응 관계를 보였다. 그러나 혈색소, 혈소판 수, 적혈구증가증 등은 남성에 서만 흡연량 증가와의 연관성을 보였다. 흡연이 혈액학적 지표 에 미치는 영향의 성별 차이 및 질환 발생에 미치는 영향에 대해 향후 추가 연구가 필요하다.

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.

Comparison of immunogenicity and safety of an influenza vaccine administered concomitantly with a 13-valent pneumococcal conjugate vaccine or 23-valent polysaccharide pneumococcal vaccine in the elderly

서유빈,최원석,Jacob Lee,송준영,정희진,김우주 대한백신학회 2017 Clinical and Experimental Vaccine Research Vol.6 No.1

Purpose: Previous studies have demonstrated the immunogenicity and safety of the co-administration of the trivalent inactivated influenza vaccine (IIV3) with the polysaccharide pneumococcal vaccine (PPV) or pneumococcal conjugate vaccine (PCV). However, there is no direct comparison study that evaluates the immunogenicity and safety of IIV3 given concomitantly with PCV13 or PPV23 in the elderly. Materials and Methods: During the 2012-2013 influenza vaccination period, 224 healthy elderly volunteers aged 65 years and older randomly received IIV3 given concomitantly with either PCV13 (PCV13+IIV3) or PPV23 (PPV23+IIV3) in a 1:1 ratio. Serum hemagglutination-inhibiting antibodies for IIV3 were measured at the time of vaccination and 1 month after vaccination. Adverse events were recorded prospectively in a clinical diary during a 7-day period. Results: A total of 220 participants blood samples for analysis of immunogenicity and kept a clinical diary for safety analysis (PCV13+IIV3, n=110; PPV23+IIV3, n=110). One month after vaccination, both groups satisfied the Committee for Medical Products for Human Use criteria for A/H1N1, A/H3N2 and B strains, showing comparable seroprotection rates, seroconversion rates and geometric mean titer fold. The assessments of immunogenicity were similar in both groups. The most common local and systemic reactions were pain at the injection site and generalized myalgia. They were generally mild or moderate in intensity. The adverse events were not statistically different between the two groups. Conclusion: PCV13+IIV3 and PPV23+IIV3 demonstrated similar immunogenicity and safety in the elderly.