개원의 연수강좌 1 : 최신 항생제

우흥정 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-

분편 인플루엔자백신(split influenza vaccine)의 임상효과 및 면역원성에 관한 연구

우흥정,김동림,정희진,천병철,이주연,안정배,김지희,박찬,신영규,김우주,김민자,박승철 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.1

목적 : 아단위 인플루엔자 백신 접종 후 백신의 인플루엔자 예방효과, 인플루엔자 방어 항체형성, 인플루엔자 백신의 안전성을 조사하고자 하였다. 방법 : 총 571명을 대상으로 인플루엔자 백신 접종을 하였고, 이들 접종자에서 인플루엔자 양질환의 이환을 조사하여 인플루엔자 백신의 인플루엔자예방효과를 알아보았고, 백신의 접종 전 및 접종 4주 후 혈청에서 혈구응집억제물(Hemagglutination Inhibition : HAI) 항체 검사를 실시하여 백신의 방어항체생성을 조사하였고, 백신의 안전성을 알아보기 위해 백신접종 후 1주일 이내의 부작용을 조사하였다. 결과 :백신 접종군과 백신 비접종군에서 인플루엔자 양 질환의 이환을 조사한 결과 접종군 28.35%, 비접종군 35.88%으로 나왔으며, p 값이 0.001로 통계적으로 접종군에서 유의하게 낮았고, 인플루엔자 양 질환의 예방 효과는 20.97%를 보였다. 백신의 방어항체 형성의 평가를 위해 유럽의 인플루엔자 백신 허가 기준을 조사하였는데 B/Guangdong/5/94균주의 백신접종 후 항체가 40이상의 비율을 제외한 다른 기준은 모두 만족 시켰다. 부작용은 전체 조사자 521명중 149명(29%)으로 주로 접종 부위의 국소 부작용을 호소했고, 전신 부작용은 2% 내외였으며 특별히 심각한 부작용은 발견되지 않았다. 결론 : 분편 인플루엔자 백신은 인플루엔자양질환의 예방과 방어항체생성에 효과 있으며 안전한 것으로 사료된다. Background : The safety and effectiveness of influenza vaccine are well known in developed country. The influenza vaccination has been recommended as one of the tentative immunization schedule for indicated persons since 1997 in Korea. But there are still no available data about them, even though nearly 5 million doses of influenza vaccine were used in 1997-1998 season. So it is immediately needed to investigate the safety. efficacy and immunogenicity of influenza vaccine among Korean. Methods : We studied the clinical efficacy of influenza vaccine by monitoring Occurrence of influenza-like illness in influenza risk group(vaccination ; 300, non-vaccination; 215) from December in 1997 to March in 1998. We used the split quadrivalent influenza vaccine containing 15 microgram of hemagglutinin of A/Beijing/262/95(HlNl), A/Wuhan/359/95(H3N2), B/Mie/1/93 and B/Guangdong/5/94. Hemagglutination inhibition(HA1) antibody titers were determined before immunization and 1 months after vaccination And we evaluated adverse effect of influenza vaccination at 7 days after vaccination. Results : Influenza vaccination was associated with si@icant reductions in influenza-like spptoms(vaccination group; 28.35%, non-vaccination group, 35.88%, p=0.001). The preventive effect of influenza-like i3lne.s among influenza risk goup was 20.97%. And immunogenicity of influenza A and B exceeded all of the European licensure criteria for immunogenicity except postvaccination proportion of titers 240 of B/Guangdong/5/94 strain. And the adverse effects were mainly local injection site problem and no serious adverse effect was noted. Conclusion : Split influenza vaccine is safe, inmunogenic and eff'tive in influenza risk group in Korea.

항생제 캠페인 세계 현황

우흥정 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.5

The campaign for proper use of antibiotics in Korea was begun in 2011 by the Korean Society of Infectious Diseases and the Korean Society of Chemotherapy. This article was prepared as a review of worldwide antibiotic campaigns. The European Antibiotic Awareness Day of the European Union and Get Smart: Know When Antibiotics Work, of the USA, are introduced here. These antibiotic campaigns are prepared and organized by government and have partnerships with medical association. The event known as annual awareness day or antibiotic week is held annually and the campaign materials are available online or from printed material. These campaigns have widened the range and depth of activity since the begining of the campaign. Therefore, the Korean antibiotic campaign could obtain some useful suggestions regarding successful conduct of campaign activity from these campaigns.

주사-경구용 항생제 전환요법

우흥정 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.2

산발적으로 발생한 전격성 수막구균혈증 1예

박승철,김민자,김우주,정희진,이진수,우흥정 대한감염학회 1998 감염 Vol.30 No.1

수막구균감염은 효과적인 치료법이 개발된 현재까지도 유행적 또는 산발적인 발생을 보인다. 최근에는 주로 군대의 훈련병과 같은 고위험군에서 산발적으로 발생되고 있으나 일단 감염되면 단순세균혈증으로부터 전격성 패혈증까지 다양한 임상양상을 나타내고 조기 진단과 치료가 되지 못하면 높은 사망율을 보이는 질환이다. 저자들은 발열과 피부의 점상출혈 및 자반성 병변을 주소로 내원한후 경험적 치료에도 불구하고 급격한 경과를 밟아 증상발현 3일만에 사망하였던 전격성 수막구균혈증 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Meningococcal disease is still a major cause of sporadic endemic and epidemic diseases throughout the world. In Korea meningococcal epidemics have been documented occasionally in military recruits, where as sporadic cases rarely reported. Meningococcemia represents a part of the various spectrum of the illness, and its clinical manifestations varied from mild fever to fulminant catastrophic events within a few hours after onset of symptoms. We experienced a case of a sporadic fulminant meningococcemia presenting with fever, petechiae, and purpura. The patient was a 21-year old female nursing school student. She had high fever, petechiae and purpura on both lower extremities, which spreaded to the whole body with peripheral gangrene during her admission days. Despite the treatment with ceftriaxone and chloramphenicol, refractory shock developed. She expired on the third day after onset of symptoms. Neisseria meningitidis was cultured from the blood after she died.

하부 호흡기 감염증에 있어서 Timentin의 효과

지종대,박승철,유세화,인광호,김민자,신현재,김우주,우흥정 대한감염학회 1993 감염 Vol.25 No.4

The combination of ticarcillin and clavulanic acid (Timentin) was used in a non-randomized open study in 30 patients with lower respiratory tract infection to assess the clinical efficacy and safety of the drug. The clinical diagnosis were: pneumonia (26), lung abscess (2), chronic bronchitis (1), and acute exacerbation of chronic obstructive pulmonary disease (1). Timentin 3.2g were administered every 6 or 8 hours for a mean duration of 10.6 days (range 3∼20 days). Timentin was clinically effective treatment in 23 (79%) of 29 evaluable patients. The isolated pathogens were P. aeruginosa(7), K.Pneumoniae(3). S.Pneumoniae(3), S.aureus(2), E. aerogenes (2) and other organisms(5). Four patients with infection due to P. aeruginosa were failed. Infection due to other organisms except P. aeruginosa were 14 cases and showed high cure rate of 86% (12/14). Adverse effects were reported from 3 patients: one drug fever, one urticaria and one mild elevation of transaminases. This open study shows Timentin to be a safe and effective antibiotic for the treatment of the lower respiratory tract infection.

VanA형 vancomycin 내성 enterococci 감염에 관한 연구

박승철,우흥정,김우주,정희진,김민자 대한감염학회 1998 감염 Vol.30 No.1

목 적 : VRE는 vancomycin을 비롯한 광범위 항균제의 사용과 관련되어 중요한 병원 감염균의 하나로 부각되어 미국에서는 수년사이에 20배에 달하는 분리빈도의 증가를 보이고 있다. MRSA 감염의 빈도가 높아 vancomycin사용량이 많은 국내에서도 VRE 감염증의 유행이 충분히 예견되므로 고대 구로병원에서 분리된 장구균중 VRE의 빈도를 조사하고 이들 균주가 분리된 환자들의 특성, 내성 정도 및 유전적인 성상을 연구하여 추후 신속하고 정확한 역학적 연구방법으로 사용할 수 있을지 가능성을 알고자 하였다. 방 법 : 1995년 7월부터 1996년 6월까지 고대 구로병원에서 분리된 장구균을 대상으로 디스크 확산법, break point screening, 최소발육 억제농도 등의 측정을 통하여 vancomycin 내성 여부를 확인하였고, vanA, vanB 중복 중합효소 연쇄반응법을 이용하여 유전자 형을 결정하였다. 확인된 VRE를 대상으로 PFGE를 통하여 미국에서 분리된 VRE, vancomycin 감수성 장구균 등과 유전적 상관성을 확인하였다. 결 과 : 1) 디스크 확산법 상에서 vancomycin에 중증도 이상의 내성이 있다고 판단된 68균주중 2 균주만이 break point screening 법 및 최소발육 억제농도 측정 결과 VRE임을 알수 있었다. 균주-1 및 균주-2의 vancomycin 및 teicoplanin의 MIC는 각각 512㎍/mL 및 64㎍/mL으로 동일하였으며, VanA 표현형이었다. 2) 중합효소 연쇄반응법에 의한 vancomycin내성 유전자형 검사 결과 VRE 두 균주 모두에서 vanA 형에 해당하는 385 bp의 band 증폭이 관찰되었다. 3) PFGE 결과 VRE 두 균주의 PFGE 양상은 동일하였고 dendrogram 분석상에서 두 균주의 유전적 상관성이 100%로서 유전적으로 같은 clone에서 유래된 균주임을 알수 있었다. 반면에 동시기에 미국에서 분리된 vancomycin 내성 E. faecium 과는 60%, vancomycin 내성 E. faecalis 와는 44%의 유전적 상관성만을 보여 미국에서서 유행하고 있는 VRE와 본원의 VRE는 유전적으로 확연히 다른 형별임을 알 수 있었다. 결 론 : 이미 본원에서도 VRE가 출현하고 있고 환자간의 균의 전달이 가능함을 알수 있었으나 분리 빈도는 1.0%로 매우 낮았다. 향후 국내의 대형병원에서도 VRE에 신속하게 대응할수 있는 대처법을 마련이 필요하다고 하겠다. Background : Vancomycin-resistant enterococci(VRE) have become one of major nosocomial pathogens in USA and Europe since 1986. In Korea only a few cases of VRE infection were reported until now. We investigated the rate of vancomycin resistance among clinical enterococcal isolates, characterized the genotypes of VRE isolates by using polymerase chain reaction(PCR), and analyzed the molecular relatedness of those isolates by using pulsed field gel electrophoresis(PFGE) technique. Methods : Standard disk diffusion test, break point screening test and measurement of minimal inhibitory concentration(MIC) were used for identification of VRE. Duplex vanA-vanB PCR for genotyping of vancomcyin resistance, and PFGE for molecular epidemiologic analysis were performed. Results : Incidence of VRE among clinical enterococcal isolates during the study period(July, 1995∼June, 1996) was 1.0%(2/202). Two strains among 68 suspicious VRE, which were identified by disk diffusion method, were confirmed as true VRE by break point screening and MIC test. MIC of both VRE isolates were same(vancomycin : 512㎍/ml, teicoplanin 64 ㎍/ml). Both VRE isolates were confirmed as vanA genotypes by duplex PCR and identical clones by PFGE and dendrogram analysis. Conclusion : Frequency of VRE among clinical enterococcal isolates is still very low(1%) in this hospital. We reported two VRE isolates which were confirmed by MIC determination and PCR genotyping. Judicious surveillance study of VRE and strict control of vancomycin usage are required to prevent the emergence and dissemination of VRE.

TP-40 : Thematic Poster ; Pulmonary Nocardiosis in Patient with IgG3 Subclass Deficiency

이재은,우흥정,김철홍,현인규,최정희 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Pulmonary nocardial infections are rare diseases usually associated with various immunocompromised conditions such as transplantation and malignancies. IgG subclass deficiency has been popularized as a potential explanation for apparent infection- susceptibility in adults with normal total serum concentrations of IgG, IgA and IgM. Here, we report a patient of pulmonary nocardiosis with IgG3 subclass deficiency who was treated with antibiotics and intravenous immunoblobulin (IVIG). 43 year-old man was hospitalized with fever and chest pain. He had pulmonary nontuberculous mycobacterial infection 1 year ago. Chest computed tomography showed multifocal consolidation with perilesional centrilobular nodules and ground glass opacity in right middle lung and both lower lungs. Nocardia species were cultured in sputum and bronchial washing. Serum total IgG, IgA and IgM levels were normal while serum IgG3 subclass was low (12.2 mg/dL). He was treated with trimethoprim- sulfamethoxazole at first, but he developed generalized skin rash, high fever and elevation of AST and ALT levels about 3 weeks after medication, which was compatible with Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) syndrome. The antibiotic was changed to minocycline and monthly IVIG (400μg/kg) was added. During the subsequent follow- ups lasted about 4-months, he showed much improvement. Pulmonary nocardial infections are rare diseases usually associated with various immunocompromised conditions such as transplantation and malignancies. IgG subclass deficiency has been popularized as a potential explanation for apparent infection- susceptibility in adults with normal total serum concentrations of IgG, IgA and IgM. Here, we report a patient of pulmonary nocardiosis with IgG3 subclass deficiency who was treated with antibiotics and intravenous immunoblobulin (IVIG). 43 year-old man was hospitalized with fever and chest pain. He had pulmonary nontuberculous mycobacterial infection 1 year ago. Chest computed tomography showed multifocal consolidation with perilesional centrilobular nodules and ground glass opacity in right middle lung and both lower lungs. Nocardia species were cultured in sputum and bronchial washing. Serum total IgG, IgA and IgM levels were normal while serum IgG3 subclass was low (12.2 mg/dL). He was treated with trimethoprim- sulfamethoxazole at first, but he developed generalized skin rash, high fever and elevation of AST and ALT levels about 3 weeks after medication, which was compatible with Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) syndrome. The antibiotic was changed to minocycline and monthly IVIG (400μg/kg) was added. During the subsequent follow- ups lasted about 4-months, he showed much improvement.

Pseudomonas aeruginosa와 Acinetobacter baumannii에 대한 Imipenem, Panipenem 및 Meropenem의 시험관내 항균력 비교

송원근,우흥정,강희정,김재석,박민정,이규만 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.3

목적 : Pseudomonas aeruginosa와 Acinetobacter baumannii는 중요한 병원감염균으로 알려져 있으며 다약제 내성을 잘 유발한다. 최근 들어 전 세계적으로 carbapenem제에 대한 감수성이 떨어지고 있어 문제가 되고 있다. 이에 저자들은 한국에서 분리된 P. aeruginosa와 A. baumannii를 대상으로 imipenem, panipenem 및 meropenem의 항균력을 비교하고자 하였다. 방법 : 150주의 P.aeruginosa (imipenem 감수성, 62주; imipenem 내성. 88주)와 53주의 A.baumannii (imipenem 감수성, 9주; imipenem 내성 44주)를 대상으로 National Committee for Clinical Laboratory Standards의 기준에 따라 미량액체배지희석법으로 imipenem, panipenem. meropenem에 대한 최소억제농도(MIC)를 측정하였다. 결과 : 총 150주의 P. aeruginsa 균주의 MIC_50/MIC_90은 imipenem, panipenem 및 meropenem이 각각 16/64, 16/64 및 4/32㎍/mL이었다, 53주의 A.baumannii 균중의 MIC_50/MIC_90은 imipenem, panipenem 및 meropenem이 각각 32/64, 32/64 및 16/32 ㎍/mL이었다. 88주의 imipenem 내성 P. aeruginosa 균주 중 33주 (38%)는 감수성 결과를 보였으나 그 반대의 결과를 보인 경우는 없었다. 결과 : MIC 결과 상 imipenem에 내성인 P. aeruginosa와 A. baumannii에 대하여 meropenem이 impenem이나 panipenem보다 좀더 강한 활성이 있음을 알 수 있었다. Background : Pseidomonas aeruginosa and Acinetobacter baumannii are important nosocomial pathogens. Many strains are multi-drug resistant, with decreased susceptibility to carbapenem emerging worldwide. We investigated the in vitro activity of imipenem, panipenem, and meropenem against P. aeruginosa and A. baumannii isolates in Korea. Methods : One hundred and fifty strains of P. aeruginosa (imipenem-susceptible, 62strains; imipenem-resistant, 88 strains) and 53 strains of A baumannii (imipenem-susceptible, 9 strains; imipenem-resistant, 44 strains) were examined. Minimal inhibitory concentration (MIC) testing for imipenem, panipenem, and meropenem was performed using the broth microdilution method as described by the National Committee for Clinical Laboratory Standards. Resilts : The MIC_50/MIC_90 of imipenem, panipenem, and meropenem against the clinical isolates were: 16/64, 16/64, and 4/32 ㎍/mL, respectively, against P. aeruginosa; 32/64, 32/64, and 16/32 ㎍/mL against A. baumannii. 33 (38%) of the 88 strains of impenem-resistant P. aeruginosa were susceptible to meropenem but the reverse was observed in none. Conclusion : The MIC data showed that meropenem was more active than imipenem and panipenem against imipenem-resistant P. aeruginosa and A. baumannii isolates.

포스터 발표 전시 순서 : 감염 ; 화상환자에서 발생한 반코마이신내성 장알구균에 의한 감염성 심내막염 (초)

김용욱,우흥정,박경하,이규만,송원근 대한내과학회 2009 대한내과학회지 Vol.77 No.4S