중환자실에 근무하는 의료인의 전비강에서 PBP2a Rapid Kit와 직접 Coagulase 검사를 이용한 Methicillin-resistant Staphylococcus aureus의 검출

홍승복 ( Seung-bok Hong ),신경아 ( Kyung-a Shin ),손재철 ( Jae-cheol Son ),신경섭 ( Seob-kyeong Shin ) 대한임상검사과학회 2010 대한임상검사과학회지(KJCLS) Vol.42 No.2

We evaluated the performance of a novel screening test, PBP2a MRSA rapid kit (Dinona Inc., Iksan, Korea), for methicillin-resistant Staphylococcus aureus (MRSA) based on a immunochromatographic assay. The test is able to detect penicillin-binding protein 2a (PBP2a) using the nasal specimens from health care workers. The nasal specimens were obtained from 69 healthcare workers and were incubated in enrichment broth followed eight hours incubatin in BHI with cefoxitin 4 μg/mL. These broth were tested by PBP2a Rapid Kit. The enrichment broths were also directly tested for tube coagulase using the conventional identification method. 19 of 22 MRSA showed positive results by PBP2a rapid test and direct coagulase test (the sensitivity for detection of MRSA, 86.36%). While, 8 of 47 non-MRSA showed false positive results for the two tests. All of the 8 non-MRSA which showed false positive were co-colonizing isolates with MRCNS and MSSA. In addition, 46 of 49 methicillin-resistant staphylococci (MRS) showed positive results for PBP2a MRSA rapid kit (the sensitivity for detection of MRS, 93.8%), and all of 20 non-MRS showed negative results (specificity, 100%). The combination of PBP2a MRSA rapid kit and direct coagulase test showed the good sensitivity for detection of MRSA from anterior nares but frequently showed false positive results from the co-colonizing carrier with MRCNS and MSSA.

당화혈색소 측정을 위한 Norudia^® HbA1c 키트의 평가

홍승복,김은중,Hong, Seung-Bok,Kim, Eun-Joong 대한임상검사과학회 2009 대한임상검사과학회지(KJCLS) Vol.41 No.1

Measurement of hemoglobin A1c is used as an objective indicator of long-term blood glucose control in diabetic patients. We evaluated recently introduced Norudia$^{(R)}$ HbA1c (Daiichi Pure Chemical Co. Ltd, Tokyo, Japan) test reagent using enzyme method for HbA1c assay. Linearity, precision and correlation with VARIANT$^{TM}$ II Turbo HbA1c analyzer (BIO-RAD, Hercules, CA, USA) were evaluated. The reference range was determined from 201 healthy subjects. The Norudia$^{(R)}$ HbA1c test reagent was founded to be linear in a range of 5.6% to 14.0% ($r^2=0.9885$). The within-run and between-day precision were 0.954% and 1.03% for low level (HbA1c 5.24%), 0.67% and 1.28% for high level (HbA1c 9.01%), respectively. Comparison study between Norudia$^{(R)}$ HbA1c test reagent and VARIANT$^{TM}$ II Turbo showed good correlation with a slope of 1.0489. an intercept at -0.9717, and coefficient of correlation was 0.9907. The reference range of HbA1c obtained from this reagent was 4.07-5.50%. The Norudia$^{(R)}$ HbA1c test reagent showed good linearity, precision and correlation with HbA1c analyzer with HPLC method. In addition, the exclusive analyzer is not required for assay and then this kit may be useful for HbA1c assay in clinical laboratory.

Coulter® LH 750TM에 의한 백혈구 감별계산 및 Suspect Flags의 평가

홍승복 ( Seung Bok Hong ),최종태 ( Jong Tae Choi ),이성규 ( Seong Kyu Lee ),김현수 ( Hyun Soo Kim ) 대한임상검사과학회 2005 대한임상검사과학회지(KJCLS) Vol.37 No.3

Automatic hematology analyzers provide the leukocyte differential count and the useful flags of the various hematological parameters. We compared LH 750 (Beckman Coulter Co., Miami, FL, USA) with manual method on differential leukocyte counts and evaluated the usefulness of the suspect flags, provided by this instrument. The comparison of leukocyte differential counts between two methods showed good correlation coefficient (r), which were 0.95 (neutrophil), 0.92 (lymphocyte), 0.82 (monocyte) and 0.95 (eosinophil). The frequency of the total flags displayed on LH 750 were 15.5%, which included immature granulocyte/left shift 63.5%, nucleated RBC 14.6%, platelet clumps 13.1%, variant lymphocyte 50% and blast 16.6%. This instrument showed higher positive predictive value in the flags such as platelet clumps 68.8%, immature granulocyte/left shift 61.5%, nucleated RBC 27.3%, variant lymphocyte 50% and blast 16.7%. In this study, the leukocyte differential counts of LH 750 showed good correlation with manual method and the suspect flags also showed a good performance for applying the criteria of re-examination in the clinical laboratory.

Hafnia alvei 에 의한 균혈증 1예

홍승복 ( Seung Bok Hong ),신경섭 ( Kyeong Seob Shin ) 대한임상검사과학회 2005 대한임상검사과학회지(KJCLS) Vol.37 No.2

Hafnia alvei is a gram-negative facultatively anaerobic bacillus that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, pneumonia, meningitis, bacteremia, and nosocomial wound infections. But, only one case of extraintestinal H. alvei infection was documented in Korea to our knowledge. A 74-years old women with bronchial tuberculosis and cerebral infarct was admitted to out hospital via the internal medicine department due to the use of anti-tuberculotic agents. The two consecutive blood cultures yielded H. alvei. The organism was susceptible to all antimicrobial agents tested, except ampicillin and amoxacillin-clavulanic acid. The patients was treated with ceftriaxone and recovered effectively.

SE-9000 자동 혈구계산기에서 EDTA 검체의 보관기간 및 온도가 CBC 및 백혈구 감별계산에 미치는 영향

홍승복 ( Seung Bok Hong ),김종석 ( Jong Seok Kim ),신경섭 ( Kyeong Seob Shin ) 대한임상검사과학회 2006 대한임상검사과학회지(KJCLS) Vol.38 No.3

Although various automated CBC analyzers with different WBC analytical principles were consequently introduced to clinical laboratory, the specific information concerning the suitability or unsuitability of aging samples is scarce. For this reason, we studied the effect of storage duration and temperature on CBC parameter in SE-9000 (SYSMEX Medical Electronics Co., Ltd., Kobe, Japan), automated CBC analyzer. We tested 32 K3-EDTA specimens with SE-9000 during 72 hours. Specimens were kept at room temperature (RT) and refrigerated and were analyzed at 0 hr, 4 hr, 8 hr, 24 hr, 48 hr and 72 hr after the collection of the specimens. The percentage changes from initial value for each parameters were calculated. Among the CBC parameters, hemoglobin, red blood cell count, mean corpuscular hemoglobin and platelets were stable for the study period at both temperatures. The mean corpuscular volume (MCV), hematocrit (Hct) and red cell distribution (RDW) increased and the mean corpuscular hemoglobin concentration (MCHC) decreased over time at room temperature. These parameters were stable when refrigerated. The leukocyte count was stable during 72hr at RT and when refrigerated. At room temperature, the relative percentages of neutrophils tend to increase, whereas those of lymphocyte and monocytes tend to decrease after 48 hours. When refrigerated, those of neutrophils and monocytes tend to increase, whereas those of lymphocytes tend to decreased over time. CBC parameters of refrigerated specimen were reliable for 72 hr for the exception of differential count from 24 hr but many CBC parameters, such as MCV, Hct, MCHC, RDW and differential count of leukocyte of blood stored at room temperature for 24 hr were unreliable.

한국 노인의 대사증후군 예측인자로서 혈중 Non HDL 콜레스테롤과 중성지방/HDL 콜레스테롤 비의 의의

홍승복 ( Seung Bok Hong ),신경아 ( Kyung-a Shin ) 대한임상검사과학회 2018 대한임상검사과학회지(KJCLS) Vol.50 No.3

한국 노인을 대상으로 대사증후군 예측인자로서 혈중 Non HDL-콜레스테롤과 중성지방/HDL-콜레스테롤 비율의 임상적용 가능성을 평가하고자 하였다. 2015년 1월부터 2017년 12월까지 경기지역 종합병원의 건강검진센터를 내원하여 건강검진을 실시한 65세 이상 노인을 1,543명을 대상으로 하였다. 대사증후군은 American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI)기준에 따라 진단하였다. 복부비만은 World Health Organization (WHO) West Pacific Region에서 제시하는 아시아-태평양인의 기준을 적용하였다. Non HDL-콜레스테롤은 총콜레스테롤과 HDL-콜레스테롤의 차이로 계산하였다. 대사증후군 예측력은 Non HDL-콜레스테롤보다 중성지방/HDL-콜레스테롤 비율이 높게 나타났다. 관련요인을 보정한 후 중성지방/HDL-콜레스테롤 비율은 1사분위수보다 4사분위수의 대사증후군 발병 위험이 높았다. 또한 대사증후군 발병을 예측하는 중성지방/HDL-콜레스테롤 비율의 적정 기준값은 2.8이었다. 중성지방/HDL-콜레스테롤 비율은 대사증후군 위험을 평가하는 간단하고 실용적인 지표가 될 수 있겠다. We evaluated the possible clinical application of Non HDL-cholesterol and triglyceride to HDL-cholesterol ratio as a metabolic syndrome predictor for the elderly in Korea. 1,543 elderly persons aged 65 years or older who visited the health examination center of Gyeonggi Regional General Hospital from January 2015 to December 2017 and had a health checkup were enrolled in this study. Metabolic syndrome was diagnosed based on the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) standards. Abdominal obesity was assessed by the Asia-Pacific standards presented at the World Health Organization (WHO) West Pacific Region. Non-HDL-cholesterol was calculated as the difference between total cholesterol and HDLcholesterol. The metabolic syndrome predictive power was higher for triglyceride to HDLcholesterol ratio than for Non HDL-cholesterol. After correcting for related factors, triglyceride to HDL-cholesterol ratio was higher in the 4^th quartile, which had a higher risk of developing metabolic syndrome, than in the 1^st quartile. The optimal cutoff value for the triglyceride to HDL-cholesterol ratio that predicts the onset of metabolic syndrome was 2.8. triglyceride to HDL-cholesterol ratio can be a simple and practical indicator of the risk of metabolic syndrome.

당화혈색소 측정을 위한 Norudiaⓡ HbA1c 키트의 평가

홍승복 ( Seung Bok Hong ),김은중 ( Eun Joong Kim ) 대한임상검사과학회 2009 대한임상검사과학회지(KJCLS) Vol.41 No.1

Measurement of hemoglobin A1c is used as an objective indicator of long-term blood glucose control in diabetic patients. We evaluated recently introduced Norudiaⓡ HbA1c (Daiichi Pure Chemical Co. Ltd, Tokyo, Japan) test reagent using enzyme method for HbA1c assay. Linearity, precision and correlation with VARIANTTM II Turbo HbA1c analyzer (BIO-RAD, Hercules, CA, USA) were evaluated. The reference range was determined from 201 healthy subjects. The Norudiaⓡ HbA1c test reagent was founded to be linear in a range of 5.6% to 14.0% (r2=0.9885). The within-run and between-day precision were 0.954% and 1.03% for low level (HbA1c 5.24%), 0.67% and 1.28% for high level (HbA1c 9.01%), respectively. Comparison study between Norudiaⓡ HbA1c test reagent and VARIANTTM II Turbo showed good correlation with a slope of 1.0489. an intercept at -0.9717, and coefficient of correlation was 0.9907. The reference range of HbA1c obtained from this reagent was 4.07-5.50%. The Norudiaⓡ HbA1c test reagent showed good linearity, precision and correlation with HbA1c analyzer with HPLC method. In addition, the exclusive analyzer is not required for assay and then this kit may be useful for HbA1c assay in clinical laboratory.

Metallo-${\beta}$-lactamase를 생성하여 Imipenem에 내성인 Pseudomonas aeruginosa에 대한 항균제 병합요법의 효과

홍승복,김홍철,이장원,손승렬,Hong, Seung-Bok,Kim, Hong Chul,Lee, Jang-Won,Son, Seung-Yeol 한국미생물학회 2008 미생물학회지 Vol.44 No.4

This study was to detect MBL (metallo-${\beta}$-lactamase) among glucose non-fermenting Gram-negative bacilli isolated from clinical specimen and to search antimicrobial combination therapy against MBL producing Pseudomonas aeruginosa. Among fifty one isolates of Gram-negative bacilli with reduced imipenem susceptibility ($MIC{\ge}8{\mu}g/ml$), nine isolates have shown positive results in MBL detection test. They were seven Achromobacter xylosoxidans subsp. xylosoxidans and two P. aeruginosa. The results from EDTA-DDST coin-cided with those of PCR and nucleotide sequence analysis which showed the presence of $bla_{VIM-2}$. The combination of aztreonam (AZT) and piperacillin-tazobactarn (TZP) or AZT and amikacin (AN) screened by one disk synergy test showed no synergistic effect. Triple antibiotic combination therapy with AZT, TZP and AN, however, was shown to be effective and the most synergistic after 8 hrs of exposure. This result strongly suggest that the triple combination therapy of AZT, TZP, and AN could be useful for the treatment of infection caused by MBL producing Gram-negative bacilli. 국내 대학병원에서 분리되어 imipenem 에 대한 최소억제농도가 $8{\mu}g/ml$ 이상인 51개의 포도당비발효 그람음성 간균들 중 metallo-${\beta}$-lactamase (MBL)을 생성하는 균주들을 분리하고, 그들 중에서 내성이 강한 Pseudomonas aeruginosa에 대한 항균제 병합요법의 효과를 알아보기 위하여 상승효과를 보이는 항균제 조합을 찾아보았다. 9개의 균주(Pseudomonas aeruginosa 2주 및 Achromobacter xylosoxidans subsp. xylosoxidans 7주)가 MBL 양성을 나타냈으며, PCR 결과 9주 모두에서 $bla_{VIM-2}$ 유전자가 관찰되었다. 이들 중에서 P. aeruginosa DK569는 aztreonam (MIC; $8{\mu}g/ml$)을 제외하고 실험한 모든 ${\beta}$-lactam 항균제, aminoglycoside, ciprofloxacin에 내성을 보여 aztreonam 함유 배지를 이용하여 상승효과률 보이는 항균제를 찾고자 하였다. One disk synergy test 에서 선별된 항균제 조합을 이용하여 생존률 검사 실험을 한 결과, aztreonam (AZT)와 piperacillin-tazobactam (TZP)의 병합은 항균제 노출 6시간 후에 AZT 또는 TZP의 단독 항균제 노출시 보다 균수가 1/18.7로 감소하였다. 그리고 AZT와 amikacin (AN)의 병합에서도 항균제 노출 6 시간 후에 AZT 또는 AN의 단독항균제의 투여보다 균수가 1/17.1 로 감소하였다. 결국 위 두 조합은 의미있는 상승효과를 보이지 못하여 위 세 항균제를 조합하여 실험하였다. 위의 세 항균제를 병합하였을 때 항균제 노출 8시간 후에 AZT, TZP 및 AN의 단독 투여에 비하여 병합요법에 의해 균수가 1/183.3 로 감소하여 의미있는 상승효과를 보였다. 이 결과는 치료가 쉽지 앓은 MBL 생성균에 의한 감염에 대한 치료에 AZT, TZP 및 AN의 세 가지 항균제 병합요법이 유용할 것이라는 것을 의미한다.

공공 화장실에서 사용하는 액체 손세정제의 세균 오염도 조사

홍승복,Hong, Seung Bok 대한임상검사과학회 2020 대한임상검사과학회지(KJCLS) Vol.52 No.3

세정제로 손을 씻는 것은 감염의 가능성이 있는 미생물을 줄이는 중요한 방법이지만 재사용하는 액체 형 세정제는 외부의 오염에 취약하다. 이 연구의 목적은 공공화장실에서 사용하고 있는 액체 세정제의 오염도를 측정하는 것이다. 저자는 6개 건물에 있는 58개의 공공 화장실에서 액체 형 손 세정제를 조사하였다. 균의 동정은 전통적인 생화학적 검사와 질량분석기를 이용하였으며 항균제 감수성 검사는 Vitek II 시스템을 이용하였다. 58개의 화장실 중 27개(46.55%)의 화장실에서 세정제를 다시 채워 재사용하고 있었으며, 이들 중 25개(92.59%) 화장실의 세정제가 세균에 오염되어 있었다. 오염된 균은 1.6×10³ to 2.7×10⁵ CFU/mL의 범위였으며, Serratia liquefaciens (12 균주), Achromobacter xylosoxidans (9 균주), Serratia marcescens (4 균주), Staphylococcus pastueri (1 균주), Achrombacter spanius (1 균주) 순으로 분리되었다. A. xylosoxidans 1 균주를 제외하고 같은 건물에서 분리된 같은 균 종은 동일한 감수성 양상이었다. 결론적으로 오염된 손 세정제로 손을 씻는 것은 공공보건 시설에서 세균의 전파가능성이 높일 수 있으므로 면역이 감소한 환자들이 이용하는 병원의 화장실은 손 세정제를 재사용하는 것을 제한할 필요가 있다. Handwashing with soap is an important practice to reduce the transmission of potentially pathogenic microorganisms, but liquid soaps with refillable dispensers are prone to extrinsic bacterial contamination. This study investigated the bacterial contamination of liquid soaps in 58 public restrooms in six buildings. The bacteria were identified by a biochemical test and MALDI-TOF mass spectrophotometry. The antimicrobial susceptibility was determined using the Vitek II system. Of the 58 restrooms examined, 27(46.55%) were using a refill dispenser, of which 25(92.59%) were contaminated with bacteria. The bacteria recovered from the soaps ranged from 1.6×10³ to 2.7×10⁵ CFU/mL. Serratia liquefaciens (12), Achromobacter xylosoxidans (9), S. marcescens (4), Staphylococcus pastueri (1), and Achromobacter spanius (1) were isolated. Except for one A. xylosoxidans, bacteria of the same species isolated in the same building showed a unique resistance pattern. In conclusion, handwashing with contaminated soap may play a role in the transmission of bacteria in public health settings. Therefore, it is necessary to limit the use of refillable liquid soaps in the restrooms of hospitals used by patients with reduced immunity.

주요 임상 내성균에 대한 어성초 에탄올 추출물의 항균효과

홍승복 ( Seung Bok Hong ),이천휘 ( Chun Hee Lee ) 대한임상검사과학회 2015 대한임상검사과학회지(KJCLS) Vol.47 No.3

The increase in resistance by pathogenic bacteria to multiple antimicrobial agents has become a significant treat, as the effective antimicrobial agents available for the patients infected by such resistant bacteria are reduced, or even eliminated. Several natural plant extracts have exhibited antibacterial and synergistic activity against various resistant microorganisms. Houttuynia cordata is frequently used by many traditional medicine practicioners for its antimicrobial, antiviral, and anti-inflammatory properties. This study investigated the antibacterial effects of H. cordata extract against clinical multi-resistant bacteria, and compared the two methods used for the antimicrobial susceptibility testing. Thirty isolates of Methicillin-resistant Staphylococcus aureus (MRSA, 10), Vancomycin-resistant Enterococcus faecium (VRE, 10), Carbapenem-resistant Acinetobacter baumannii (CRAB, 10) were included in this study. The antibacterial effect of H. cordata was tested by disk diffusion and microbroth dilution methods as per CLSI guidelines. In disk diffusion, all isolates (30) showed no inhibition to 30,000 ug/mL of H. cordata. But in the microbroth dilution method, MIC90 of H. cordata was 4,096 ug/mL, 8,192 ug/mL and 4,096 ug/mL in MRSA, VRE and CRAB, respectively. These results demonstrate that H. cordata exhibits antibacterial activity against MRSA, VRE and CRAB. Moreover, the microbroth dilution method is a more effective method than disk diffusion to evaluate the antibacterial activity of natural products. The Disk diffusion method used to evaluate the antibacterial activity of natural products required new standard guidelines including inoculum concentration of bacteria.