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Vancomycin 내성 장구균의 분포 및 Vancomycin, penicillin 및 Gentamicin의 병용 효과
김활웅 ( Hal Woong Kim ),이위교 ( Wee Gyo Lee ),유기원 ( Ki Won Ryu ),김각현 ( Kag Hyu Kim ),관연식 ( Yun Sik Kwak ) 대한임상검사과학회 1998 대한임상검사과학회지(KJCLS) Vol.30 No.3
Infections caused by vancomycin-resistant enterococci (VRE) are becoming increasingly prevalent throughout the world Because of the resistance of vancomycin resistance is troublesome. The optimum drug regimen for treatment of infections due to VRE is not known Very few data have been published concerning in VRE-infected patients. The combined regimen may offer a treatment for patients infected with VRE. The IXJI1Xl8e of this study was to examine the incidence of VRE among total enterococci from clinical specimen and investigate the antimicrobial synergistic killing of clinical isolates of VRE belonging to genotypic resistance classes vanA, vanB, and vanC. A total of 1,286 enterococcal isolates from patients over a period of 12 months were screened for vancomycin resistance using brain heart infusion agar plates supplemented with 6 ug/ml, of vancomycin. The incidence of VRE among enterococcal isolates was calculated form microbiology statistics program Nine strains of VRE and 2 strains of vancomycin-susceptible enterococci were utilized in this study. Minimal inhibitory concentrations (MIC) were determined by agar dilution method Synergistic inhibition of growth was assessed by addition vancomycin, penicillin, gentamicin, or combinations of these antibiotics to cultures in the early loganthmic phase of growth Synergy was defined as a decrease in CFU/mL by at least 2 log10 after 24h compared with the effect of the most active single agent In the 12 months, the incidence of VRE was 3.2%. Among 9 strains, analyses, the frequency of uanB, uanC1, and uanC2 types was 2, 4, and 3 strains, respectively, Vancomycin-penicillin-gentamicin, and vancomycin-penicillin resulted in 2 or more logs of killing above that the most effective single agent for all vanA and vanB strains. All vanC strains were resistant to any antibiotics combination. Continued vigilance, strict enforcement of infection control, and curtailment of vancomycin use seem to be our best approaches to controlling this increasingly important problem For this purposes, accurate and timely detection of vancomycin resistance and periodic investigation for incidence is essential. Triple combination therapy and vancomycin plus penicillin regimen may be effective for the treatrrent of infections caused by vancomyin-resistant enterococci belonging to genotypic classes vanA and vanB. Further studies are needed for the new therapeutic regimen against vanC strains.
Vancomycin 내성 장구균에 대한 Vancomycin, Penicillin 및 Gentamicin의 병용효과
이위교,이선민,곽연식 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.2
목적 : VRE의 출현으로 인하여 내성 균주에 의한 감염시 치료 요법 선택에 어려움이 예상되며 여러 약제의 병합 요법이 강구되고 있다. 본 연구의 목적은 VanA, B, 및 C형 내성 균주에 대하여 vancomycin, penicillin 및 gentamicin의 병용에 의한 살균 효과를 알아보고자 하였다. 방법 : VRE 9 균주와 vancomycin 감수성 2균주를 대상으로 하였고 MIC는 한천 희석법을 시행하였다. 시험 약제는 vancomycin 8㎍/mL, penicillin 2㎍/mL, 및 gentamicin 1㎍/mL 였고 병용에 의한 상승 효과는 24시간 후 균수가 2log_(10) CFU/mL 이상 감소시 유효하다고 판정하였다. 결과 : VanA와 VanB 균주는 Vancomycin-penicillin-gentamicin 및 vancomycin-penicillin 병용에 대하여 억제 효과를 보였고 VanC 균주는 어떠한 약제 병용에도 저항성이었다. 결론 : 3 약제 병합 요법과 vancomycin-penicillin 병용 요법은 VanA와 VanB 균주에 치료효과가 기대되며 VanC 균주에 대한 치료 방법에 대해서는 새로운 모색이 필요하다고 사료된다. Background : Because of the resistance that enterococci already exhibit to a 2a riety of antimicrobial agents, the emergence of vancomycin resistance is troublesome. The combined regimen mag offer a treatment for patients infected with vancomycin-resistant enterococci. We examined the antibiotic synergistic killing of clinical isolates of vancomycm-resistant enterococci belonging to genotypic resistance classes A, B, and C. Methods : Nine strains of vancomycin-resistant enterococcl and 2 strains of vancomycin-susceptible enterococci were utilized in this study. MICs were determined by agar dilution method. Synergistic inhibition of growth was assessed by addition vancomycin(8 ㎍/mL), peniciilin( 2 ㎍/mL), gentamicin( 1 ㎍/mL), or combinations of these antibiotics to cultures in the early logarithmic phase of growth. Synergy was defined as a decrease in CFU/mL by at least 2 log10 after 24 h compared with the effect of the most active single agent. Results : Vancomycin-penicillin-gentamicin, and vancomycin-penicillin resulted in 2 or more logs of killing above that the most effective single agent for all VanA and VanB strains. All VanC strains were resistant to any antibiotics combination. Conclusion : Triple combination therapy and vancomycin plus penicillin regimen may be effective for the treatment of infections caused by vancomycin-resistant enterococci belong to genotypic classes VanA and VanB, Futher studies are needed for the new therapeutic regimen agaist VanC strains.
이위교,전희선,곽연식,김종태 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1
Background: Salmonella infections in human present a spectrum of clinical syndromes that include enteric fever, acute gastroenteritis, bacteremia, localized infections, asymptomatic intestinal infections and transient, convalescent and chronic intestinal carrier states. Recently the incidence of reported nontyphoidal Salmonella cases has increased. Among them, group B Salmonella is an important enteric pathogen and increased incidence of bacteremia in infants is also reported. We performed a retrospective analysis to evaluate the incidence of group B Salmonella infection, the clinical manifestation, the laboratory findings and the pattern of susceptibility to commonly used antibiotics. Methods: The serogroups of Salmonella strains isolated from stool and blood from June 1994 to September 1995 were typed and the antimicrobial susceptibility was tested by agar diffusion method. We reviewed clinical records of patients who had positive culture for group B Salmonella. The age, sex, body temperature, white blood cell count and Widal test results of those patients were analyzed. Results: 1. Among 124 strains, group B Salmonella was 58(48.8%). 2. About 57% of patients were infants and early childhood and most of cases(77.6%) occurred between May and October, 3. Two patients(4.7%) were associated with bacteremia. 4. The resistance to Tetracycline, Ampicillin, Trimethoprim-Sulfamethoxazole (TMP-SXT), cefamandole and ceftriaxone for group B was 62%, 32.7%, 8.6%, 1.7% and 0% respectively. Multiple resistant strains were 7(12.1%). Conclusion: Most patients with acute gastroenteritis due to group B Salmonella are under two years old and the resistant strains to first line antibiotics have increased. Young infants are at particular risk for bacteremia, so if group B Salmonellosis is suspected in infants, blood culture should be obtained and proper antibiotic therapy should be given.