Underestimation of the Calculated Area Under the Concentration-Time Curve Based on Serum Creatinine for Vancomycin Dosing

진성준,Ji Hyun Yoon,Bo Sook Ahn,Ji Ah Chung,송영구 대한감염학회 2014 Infection and Chemotherapy Vol.46 No.1

Background: The ratio of the steady-state 24-hour area under the concentration-time curve (ssAUC24) to the MIC (AUC24/MIC) forvancomycin has been recommended as the preferred pharmacodynamic index. The aim of this study was to assess whether thecalculated AUC24 (cAUC24) using the creatinine clearance (CLcr) differs from the ssAUC24 based on the individual pharmacokineticdata estimated by a commercial software. Materials and Methods: The cAUC24 was compared with the ssAUC24 with respect to age, body mass index, and trough concentrationof vancomycin and the results were expressed as median and interquartile ranges. A correlation between the cAUC24 andssAUC24 and the trough concentration of vancomycin was evaluated. The probability of reaching an AUC24/MIC of 400 or higherwas compared between the cAUC24 and ssAUC24 for different MICs of vancomycin and different daily doses by simulation in asubgroup with a trough concentration of 10 mg/L and higher. Results: The cAUC24 was significantly lower than the ssAUC24 (392.38 vs. 418.32 mg·hr/L, P < 0.0001) and correlated weakly withthe trough concentration (r = 0.649 vs. r = 0.964). Assuming a MIC of 1.0 mg/L, the probability of reaching the value of 400 orhigher was 77.5% for the cAUC24/MIC and 100% for the ssAUC24/MIC in patients with a trough concentration of 10 mg/L andhigher. If the MIC increased to 2.0 mg/L, the probability was 57.7% for the cAUC24/MIC and 71.8% for the ssAUC24/MIC at a dailyvancomycin dose of 4,000 mg. Conclusions: The cAUC24 using the calculated CLcr is usually underestimated compared with the ssAUC24 based on individualpharmacokinetic data. Therefore, to obtain a more accurate AUC24, therapeutic monitoring of vancomycin rather than a simplecalculation based on the CLcr should be performed, and a more accurate biomarker for renal function is needed.

“주민자치회와 정부는 평등한 관계여야”

진성준 한국자치학회 2020 월간 주민자치 Vol.103 No.-

노인에서 혈청 Cystatin C 농도를 이용한 반코마이신 투여용량 평가

진성준,배성창,김혜원,김혜경,나은주,안보숙,최준용,김창오,김준명,송영구 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Background : It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. Materials and Methods : Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. Results : Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5%). Conclusions : Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.

정당공천 폐지가 아니라 지방정당 허용이 해법이다

진성준 열린전북 2013 열린전북 Vol.165 No.-

노인에서 혈청 Cystatin C 농도를 이용한 반코마이신 투여용량 평가

진성준,김혜원,김혜경,안보숙,최준용,김창오,김준명,송영구,배성창,나은주 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.4

Background:It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. Materials and Methods:Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. Results:Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %). Conclusions:Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients. Background:It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients. Materials and Methods:Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated. Results:Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %). Conclusions:Predictive prowess of serum vancomycin concentrations on the basis of the serum cystatin C concentration could be better than that based on the serum creatinine concentration in elderly patients.

A Case of Libman-Sacks Endocarditis that Developed after Infective Endocarditis예

진성준,윤지현,김혜원,김희욱,임세중,송영구 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.5

Libman-Sacks endocarditis (LSE) is a valvular heart disease that is associated with autoimmune diseases such as systemic lupus erythematosus and antiphospholipid syndrome (APS). Cases of LSE and APS associated with infection have been reported during the last several years. Herein, we present a patient who was suspected to have developed LSE and catastrophic APS during the treatment of her definite infective endocarditis, which was caused by Staphylococcus aureus ,and the patient’s condition was complicated with cerebral abscess, sensorineural hearing loss, endophthalmitis, renal infarction, splenic abscess, and septic arthritis.

A Case of Noncompaction of the Ventricular Myocardium Combined with Situs Ambiguous with Polysplenia

조윤형,진성준,제현철,윤영원,홍범기,권혁문,김태훈,임세중 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.6

A 33-year-old man was admitted to our hospital with chest pain and exertional dyspnea. Two-dimensional echocardiography showed prominent trabeculations and deep intertrabecular recesses, findings consistent with noncompaction of the ventricular myocardium. Thoracoabdominal CT and cardiac magnetic resonance imaging (CMR) revealed situs ambiguous with polysplenia and noncompaction of the left ventricular myocardium. CMR also demonstrated delayed enhancement of the trabeculations located at the apical portion of the left ventricle. The coronary angiogram was normal. This is the first case of noncompaction of the ventricular myocardium associated with situs ambiguous with polysplenia.

Meropenem 내성 Ochrobactrum anthropi 균혈증 1예

김건민,진성준,유정선,김창오,최준용,김준명,송영구 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Ochrobactrum anthropi is an oxidase-producing, non-lactose-fermenting, gram-negative bacillus that is frequently isolated from the environment including sinks, baths, soil, and hospital water sources. Recently O. anthropi have been reported as an emerging opportunistic pathogen in immunocompromised patients, Particularly in those with indwelling venous catheters. Most O. anthropi were highly resistant to B-lactam antibiotics except carbapenem. We report a case of O. anthropi bacteremia with an unusual pattern of antibiotic resistance compared to previous reports. A 47-year-o1d woman undergoing camptobell/cisplatin chemotherapy via indwelling venous catheter (chemoport) for stage IV ovarian cancer, had septicemia due to O. anthropi of unknown origin. The isolates were resistant to all B-lactams and meropenem and susceptible to aminoglycoside, ciprofloxacin, and trimethoprim-sulfamethoxazole. She recovered from sepsis with combination treatment with imipenem and ciprofloxacin for 3 weeks.

구순구개열환자에서 자가입자망상골을 이용한 이차성 치조골이식에 관한 임상적 연구

김종렬,진성준,조영철,표세정,변준호 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

Purpose : This study is conducted to evaluate the clinical success of secondary alveolar bone grafting using autogenous iliac particulate cancellous bone marrow in cleft maxilla. Materials and methods : We evaluated 107 cleft patients who had been admitted to the Dept. of Oral and Maxillofacial Surgery of Pusan National University Hospital from January 1, 1991 to January 31, 1999 and had been performed secondary alveola bone grafting with autogenous particulated cancellous bone marrow from iliac crest. Results : 1. Men were 70 and women were 37, which shows 65.4% and 34.6% and the proportion of males to females was 1.9: 1. Unilateral cases were 89(83.2%) and bilateral cases were 18(16.8%). 2, Age of bone grafting is widely distributed from 7 to 29, and the average was 13.2. 3. Success rate was 97.8% in unilateral cases, 94.4% in bilateral cases. Overall success rate was 96.7%. 4. We evaluated the bone graft contour by the percentage of bone attachment level adjacent to the alveolar cleft and the menial side showed 82.4% and the distal 87.7%. 5. The amount of notching the alveolar ridge at the grafted site through the ratio of notching length up to the most apical base to the length of proximal segment anatomic root was 0.19.

Meropenem 내성 Ochrobactrum anthropi 균혈증 1예

김건민,진성준,유정선,김창오,최준용,김준명,송영구 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.1

Ochrobactrum anthropi is an oxidase-producing, non-lactose-fermenting, gram-negative bacillus that is frequently isolated from the environment including sinks, baths, soil, and hospital water sources. Recently O. anthropi have been reported as an emerging opportunistic pathogen in immunocompromised patients, particularly in those with indwelling venous catheters. Most O. anthropi were highly resistant to β-lactam antibiotics except carbapenem. We report a case of O. anthropi bacteremia with an unusual pattern of antibiotic resistance compared to previous reports. A 47-year-old woman undergoing camptobell/cisplatin chemotherapy via indwelling venous catheter (chemoport) for stage IV ovarian cancer, had septicemia due to O. anthropi of unknown origin. The isolates were resistant to all β-lactams and meropenem and susceptible to aminoglycoside, ciprofloxacin, and trimethoprim-sulfamethoxazole. She recovered from sepsis with combination treatment with imipenem and ciprofloxacin for 3 weeks.