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전국의료관련감염감시체계 중환자실 부문 재원일수와 기구일수 자료 수집에 관한 설문조사
송제은,오강복,최영화,김성란,한수하,유소연,유현미,최지연,신명진,곽이경 대한의료관련감염관리학회 2023 의료관련감염관리 Vol.28 No.1
Background: National surveillance data should be validated to identify data quality issues. Denominator data can substantially affect the healthcare-associated infection (HAI) rate; however, they are relatively overlooked compared to numerator data. We analysed the status of and problems with collecting denominator data by the Korean National Healthcare-associated Infections Surveillance System (KONIS). Methods: This study was conducted in 21 (10.8%) of the 193 hospitals that participated in the KONIS ICU module between July 2016 and June 2017. A survey examined denominator data collection methods, such as patient days and device days of central lines and urinary catheters, between November and December 2017. The knowledge of central lines and urinary catheters specifically for KONIS reporting purposes, and the correct answer rate to questionnaires regarding specific situations related to the calculation of device days, were also evaluated. Results: Counting the denominator data, the respective proportions using manual or electronic methods were 52.4% vs. 42.8% for patient days, 66.7% vs. 33.3% for central line days, and 61.9% vs. 38.1% for urinary catheter days. The rate of accurately understanding and responding to the case questions on device days through a survey was 19.0–81.0% for the central lines and 33.3–95.2% for the urinary catheters. Conclusion: It is important to collect accurate denominator data in addition to numerator data to maintain the reliability of the national HAI surveillance data. Continued education of the surveillance personnel on the definition of denominator data and accurate data collection methods is required.
송제은,김무현,정우용,정인영,오동현,김용찬,김은진,정수진,구남수,김준명,최준용 대한감염학회 2016 Infection and Chemotherapy Vol.48 No.3
Background: Septic shock remains a leading cause of death, despite advances in critical care management. The Surviving Sepsis Campaign (SSC) has reduced morbidity and mortality. This study evaluated risk factors for mortality in patients with septic shock who received treatment following the SSC bundles. Materials and Methods: This retrospective cohort study included patients with septic shock who received treatments following SSC bundles in an urban emergency department between November 2007 and November 2011. Primary and secondary endpoints were all-cause 7- and 28-day mortality. Results: Among 436 patients, 7- and 28-day mortality rates were 7.11% (31/436) and 14% (61/436), respectively. In multivariate analysis, high lactate level (odds ratio [OR], 1.286; 95% confidence interval [CI], 1.016-1.627; P = 0.036) and low estimated glomerular filtration rate (OR, 0.953; 95% CI, 0.913-0.996; P = 0.032) were independent risk factors for 7-day mortality. Risk factors for 28-day mortality were high lactate level (OR, 1.346; 95% CI, 1.083-1.673; P = 0.008) and high Acute Physiology and Chronic Health Evaluation II score (OR, 1.153; 95% CI, 1.029-1.293; P = 0.014). Conclusion: The risk of mortality of septic shock patients remains high in patients with high lactate levels and acute kidney injury.
간이식 환자에서 아스페르길루스에 의해 발생한 관절 주위 피하 조직의 다낭성 종괴 감염 1예
송제은,오동현,김민형,김용찬,안진영,성수진,구남수,김혜원,김선빈,한상훈,최준용,김창오,송영구,김준명 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.6
Invasive aspergillosis can be occured in immune-compromised patients with hematopoietic stem cell transplantation, solid organ transplantation and prolonged neutropenia. The major area of invasive aspergillosis involves the sinopulmonary tract but can occur around the joint areas rarely. A 72-year-old man, who had received a liver transplant 6 years earlier, presented with a mass lesion around the right knee joint that developed 3 year earlier. Knee MRI revealed a multicystic subcutaneous mass around the knee joint. An excision was performed, and many fungal hyphae that were morphologically most consistent with Aspergillus spp. were observed in tissue. After amphotericin B therapy for 2 weeks, the patient did not show any evidence of a recurrence of invasive aspergillosis for 15 months. As Aspergillus spp. can cause a range of infections in solid organ transplants, invasive aspergillosis must be considered in patients with a recurrent cystic mass lesion.
Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis
안진영,송제은,안혜원,전용득,안미영,정인영,김무현,정우영,정수진,구남수,김준명,나성원,조성래,최준용 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.7
Purpose: Severe sepsis is associated with functional disability among patients surviving an acute phase of infection. Efforts to improvefunctional impairment are important. We assessed the effects of early exercise rehabilitation on functional outcomes in patientswith severe sepsis. Materials and Methods: A prospective, single-center, case-control study was conducted between January 2013 and May 2014 at a tertiary care center in Korea. Patients with severe sepsis and septic shock were enrolled and randomized to receive standard sepsistreatment or intervention. Intervention involved early targeted physical rehabilitation with sepsis treatment during hospitalization. Participants were assessed at enrollment, hospital discharge, and 6 months after enrollment. Functional recovery was measured using the Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Instrumental Activities of Daily Living (IADL). Results: Forty participants (21 intervention patients) were included in an intention-to-treat analysis. There were no significant differences in baseline MBI, FIM, and IADL between groups. Intervention yielded greater improvement of MBI, FIM, and IADL in the intervention group at hospital discharge, but not significantly. Subgroup analysis of patients with APACHE II scores ≥10 showed significantly greater improvement of physical function at hospital discharge (MBI and FIM) in the intervention group, compared to the control group (55.13 vs. 31.75, p=0.048; 52.40 vs. 31.25, p=0.045). Intervention was significantly associated with improvement of MBI in multiple linear regression analysis (standardized coefficient 0.358, p=0.048). Conclusion: Early physical rehabilitation may improve functional recovery at hospital discharge, especially in patients with high initial severity scores.
Two Cases of Mushroom Poisoning by Podostroma Cornu-Damae
안진영,석순자,송제은,최중호,최준용,김창오,송영구,김준명,한상훈 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.1
Podostroma cornu-damae is a rare fungus that houses a fatal toxin in its fruit body. In this case report, two patients collected and boiled the wild fungus in water, which they drank for one month. One patient died, presenting with desquamation of the palms and soles, pancytopenia, severe sepsis and multiple organ failure. The other patient recovered after one month of conservative care after admission. We found a piece of Podostroma cornu-damae in the remaining clusters of mushrooms. Mushroom poisoning by Podostroma cornu-damae has never been previously reported in Korea.
최승임,최흔,박성연,곽이경,송제은,신소연,백지현,신현일,오홍상,김용찬,염준섭,한진희,김민재 대한기생충학ㆍ열대의학회 2022 The Korean Journal of Parasitology Vol.60 No.1
Plasmodium vivax exhibits dormant liver-stage parasites, called hypnozoites, which can cause relapse of malaria. The only drug currently used for eliminating hypnozoites is primaquine. The antimalarial properties of primaquine are dependent on the production of oxidized metabolites by the cytochrome P450 isoenzyme 2D6 (CYP2D6). Reduced primaquine metabolism may be related to P. vivax relapses. We describe a case of 4 episodes of recurrence of vivax malaria in a patient with decreased CYP2D6 function. The patient was 52-year-old male with body weight of 52 kg. He received total gastrectomy and splenectomy 7 months before the first episode and was under chemotherapy for the gastric cancer. The first episode occurred in March 2019 and each episode had intervals of 34, 41, and 97 days, respectively. At the first and second episodes, primaquine was administered as 15 mg for 14 days. The primaquine dose was increased with 30 mg for 14 days at the third and fourth episodes. Seven gene sequences of P. vivax were analyzed and revealed totally identical for all the 4 samples. The CYP2D6 genotype was analyzed and intermediate metabolizer phenotype with decreased function was identified.
김용찬,박지은,김민형,송제은,안진영,오동현,김진호,이승현,표정윤,조양제,구남수,한상훈,김준명,최준용 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.6
Clinical presentations associated with acute human immunodeficiency virus (HIV)infection are various and nonspecific. Neurologic manifestations may accompany acute HIV infection. Aseptic meningitis has been described in several reports;however, acute encephalitis during acute HIV infection is rare. Some studies have suggested that antiretroviral therapy for treatment of symptomatic acute HIV infection could be beneficial, especially in severe cases. Encephalitis is lifethreatening;therefore, early diagnosis and antiretroviral therapy may be needed. We report on a case of encephalitis associated with acute HIV infection. The patient received early antiretroviral therapy and recovered from encephalitis without neurological sequelae.ㅎ