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윤영경,김지은,문치숙,이미숙,허지안,이호진,김신우 대한의학회 2019 Journal of Korean medical science Vol.34 No.47
Background: This study evaluated the antimicrobial susceptibility of pathogens isolated from Korean patients with intraabdominal infections (IAIs). Methods: This multicenter study was conducted at 6 university-affiliated hospitals in Korea between 2016 and 2018. All patients with microbiologically proven IAIs were retrospectively included, while patients with spontaneous bacterial peritonitis or continuous ambulatory peritoneal dialysis peritonitis were excluded. Identification and antimicrobial susceptibility testing were performed using automated microbiology systems. Results: A total of 2,114 non-duplicated clinical isolates were collected from 1,571 patients. Among these pathogens, 510 (24.1%) were isolated from nosocomial infections, and 848 isolates (40.1%) were associated with complicated IAIs. The distribution of the microorganisms included aerobic gram-negative (62.6% of isolates), aerobic gram-positive (33.7%), anaerobic (0.9%), and fungal (2.8%) pathogens. The most common pathogens were Escherichia coli (23.8%), followed by Enterococcus spp. (23.1%) and Klebsiella spp. (19.8%). The susceptibility rates of E. coli and Klebsiella spp. to major antibiotics were as follows: amoxicillin/clavulanate (62.5%, 83.0%), cefotaxime (61.4%, 80.7%), ceftazidime (63.7%, 83.1%), cefepime (65.3%, 84.3%), ciprofloxacin (56.4%, 86.3%), piperacillin/tazobactam (99.0%, 84.8%), amikacin (97.4%, 98.3%), and imipenem (99.8%, 98.8%). The susceptibility rates of Enterococcus spp. to ampicillin were 61.0%, amoxicillin/clavulanate, 63.6%; ciprofloxacin, 49.7%; imipenem, 65.2%; and vancomycin, 78.2%. The susceptibility rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 77.4% and 36.7%, respectively. Conclusion: Enterococcus spp. with susceptibility to limited antibiotics was one of the main pathogens in Korean IAIs, along with E. coli and Klebsiella spp., which were highly susceptible to imipenem, amikacin, and piperacillin/tazobactam. Meanwhile, the low susceptibilities of E. coli or Klebsiella spp. to amoxicillin/clavulanate, advanced-generation cephalosporins, and ciprofloxacin should be considered when determining empirical antibiotic therapy in clinical practice.
심내막염을 합병한 메티실린 내성 황색포도알균에 의한 치명적인 말초 패혈성 혈관염 부검 1예
윤영경,김철환,김현철,이정현,김정연,박대원,손장욱,김민자 대한감염학회 2010 Infection and Chemotherapy Vol.42 No.4
Persistent methicillin-resistant Staphylococcus aureus bacteremia (PMRSAB) has recently become a serious problem in patient care. However, it is an unusual complication of peripheral thrombophlebitis. An 80-year-old woman with head trauma suffered from suppurative thrombophlebitis on the insertion site of a peripheral venous catheter of her right wrist. She died of septic shock following fatal PMRSAB. Autopsy was requested to evaluate the extent of the infection, and disclosed septic thrombophlebitis with abscess formation in the right wrist and infective endocarditis on the leaflets of mitral valve.
Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections
윤영경,박찬순,김재욱,황규린,이세영,김태훈,박도양,김현준,김동영,이현종,신현영,유용규,박동아,김신우 대한감염학회 2017 Infection and Chemotherapy Vol.49 No.4
These guidelines were developed as part of the 2016 Policy Research Servicing Project by the Korea Centers for Disease Control and Prevention. A multidisciplinary approach was taken to formulate this guideline to provide practical information about the diagnosis and treatment of adults with acute upper respiratory tract infection, with the ultimate aim to promote the appropriate use of antibiotics. The formulation of this guideline was based on a systematic literature review and analysis of the latest research findings to facilitate evidence-based practice, and focused on key questions to help clinicians obtain solutions to clinical questions that may arise during the care of a patient. These guidelines mainly cover the subjects on the assessment of antibiotic indications and appropriate selection of antibiotics for adult patients with acute pharyngotonsillitis or acute sinusitis.
윤영경,이재갑,김상일,백경란 대한의학회 2020 Journal of Korean medical science Vol.35 No.44
Coronavirus disease 2019 (COVID-19) has penetrated our daily lives, leading us to a new normal era. The unexpected impact of COVID-19 has posed a unique challenge for the health care system, bringing innovation around the world. Considering the current pandemic pattern, comprehensive preparedness strategies of healthcare resources need to be implemented to prepare for a large resurgence of COVID-19 within a short time. With the unprecedented spread of the new pandemic and the impending influenza season, scientific evidence-based schemes need to be developed through cooperation, coordination, and solidarity. Based on the early experience with the current pandemic, this narrative interpretive review of qualitative studies suggests a 6-domain plan to establish a better health care system that is prepared to deal with the current and future public health crises. The 6 domains are medical institutions, medical workforce, medical equipment, COVID-19 surveillance, data and information application, and governance structure.
윤영경 대한의학회 2020 Journal of Korean medical science Vol.35 No.47
I had a meaningful opportunity to contribute to an editorial for the latest article on antibiotic usage in hospitalized patients with community-acquired pneumonia.1 Abuse and overuse of antimicrobials are the main drivers in the development of antimicrobial-resistant pathogens. The clinical and economic implications of antimicrobial resistance pose a major threat to global public health. To alleviate this threat, global, regional, and national strategies have been established all over the world. In line with the global action plan adopted by the World Health Assembly in May 2015, the Korean 5-year action plan for containment of antimicrobial resistance has been also in operation since August 2016. This Korean strategy included a 6-pillar national action plan, and one of which was to strengthen the surveillance system for antimicrobial consumption.2
윤영경,김홍빈,김의석,허지안,이신원,김신우,정진원,추은주 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.3
Background: Carefully switching from intravenous to oral antibiotic therapy has shown to reduce treatment costs and lengths ofhospital stay as well as increase safety and comfort in patients with infections. The aim of this study was to compare the clinicalefficacy and safety between the patients treated with glycopeptides (case group), and the patients given oral antibiotics, as theinitial or step-down therapy (control group), in the treatment of patients with methicillin-resistant Staphylococcus aureus (MRSA)infection. Materials and Methods: A multicenter observational study was retrospectively performed in 7 teaching hospitals in Korea fromJanuary to December 2012. The study included adult patients (≥ 18 years) with infection caused by MRSA isolates, susceptibleto clindamycin, erythromycin, and ciprofloxacin. The primary end point was treatment outcome, including all-cause mortalityand switching of antibiotics. Drug-related adverse events and the lengths of hospital stay were also compared between the twotreatment groups. Results: During the study period, 107 patients (43 cases and 64 controls) with MRSA infections were enrolled from the participatinghospitals. The most common sites of MRSA infection were skin and soft tissue (n = 28) and bone and joint (n = 26). Themedian Charlson comorbidity index (P = 0. 560), the frequency of severe sepsis (P = 0.682) or thrombocytopenia (P = 1.000),and median level of serum C-reactive protein (P = 0.157) at the onset of MRSA infections were not significantly different betweenthe case and control groups. The oral antibiotics most frequently prescribed in the case group, were fluoroquinolones(n = 29) and clindamycin (n = 8). The median duration of antibiotic treatment (P = 0.090) and the occurrence of drug-relatedadverse events (P = 0.460) did not reach statistically significant difference between the two groups, whereas the total length ofhospital stay after the onset of MRSA infection was significantly shorter in the case group than the control group [median (in-terquartile range), 23 days (8-41) vs. 32 days (15-54), P = 0.017]. In multivariate analyses, the type of antibiotic used was notan independent risk factor for treatment failure. The statistically significant factors associated with treatment failure includedunderlying hepatic diseases, prior receipt of antibiotics, and foreign body retention. Conclusions: This study indicates that oral antibiotic therapy with active agents against MRSA isolates can be considered as theinitial or step-down therapy for the treatment of MRSA infections and also reduce the length of hospital stay.