오염된 완충용액으로 인한 Alcaligenes xylosoxidans의 가유행성 발생

김옥선,윤성원,백경란,박선영,이남용,송재훈 대한병원감염관리학회 2003 의료관련감염관리 Vol.8 No.1

급성 백혈병 환자에서 발생한 감염 양상의 분석(1986~1992)

박선양,오명돈,김양수,백경란,김병국,최강원,김성민 대한감염학회 1993 감염 Vol.25 No.3

Infection is a major complication and potentially life-threatening in patients with acute leukemia. The patients require prompt broad-spectrum antibiotics therapy when fever develops. One of the keys to successful patient management is the recognition of institutional trends of the spectrum of infections and infecting microorganisms. So we evaluated 138 patients with acute leukemia and blastic crisis of chronic myelogenous leukemia admitted to Seoul National University Hospital from July 1986 to June 1992. The results are following: 1) Total number of febrile episodes was 224 and 60% of them occurred after chemotherapy. 2) Microbiologically-defined infection, clinically-defined infection, and unexplained fever accounted for 28%, 45%, 27% of the febrile episodes respectively. 3) Fifty-eight percent of microbiologically-defined infections were caused by gram-negative bactria, and 36% were gram-positive bacteria. There was a tendency to a greater proportion of gram (+) organisms than that of the last study (p>0.1). Escherichia coli was the most common organism, and coagulase-negative staphylococci, Pseudomonas aeruginosa, Klebsiella pneumoniae were common in decreasing order. 4) Pneumonia was the most common type of infection, followed by skin and soft tissue infection, perianal infection, gingivitis and primary septicemia. 5) Seventy-two percent of total infections improved with therapy and this success rate was higher than that of the last study(p<0.001).

폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예

이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.

Collaborative Response to COVID-19 Pandemic, and Development of Treatment Guidelines

Peck Kyong Ran 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.1

Therapeutic Efficacy of Meropenem for Treatment of Experimental Penicillin-Resistant Pneumococcal Meningitis

Peck Kyong Ran,Song Jae Hoon,Kang Soo Jung,Lee Hyuck,Kim Shin Woo,Jin Joung Hwa,Jung Sook In,Kim Yeon Sook,Kim Choon Kwan,Oh Won Sup,Kim Sungmin 대한의학회 2004 Journal of Korean medical science Vol.19 No.1

임상강좌 : 감염 질환에서 흔히 보는 비특이적 검사 이상의 해석

백경란 ( Kyong Ran Peck ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

황색포도알균에 의한 감염성 심내막염의 임상적 특성

백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ),김은석 ( Eun Seok Kim ),주은정 ( Eun Jeong Joo ),하영은 ( Young Eun Ha ),위유미 ( Yu Mi Wi ),정혜숙 ( Hae Suk Cheong ),이진서 ( Jin Seo Lee ),강철인 ( Cheol In Kang ),정두련 ( Doo 대한내과학회 2009 대한내과학회지 Vol.76 No.3

Background/Aims: The risk factors and clinical outcome of infective endocarditis (IE) have changed over the past few decades. Recently, the incidence of Staphylococcus aureus IE (SAIE) has increased. We investigated the clinical and microbiological characteristics and clinical outcomes of SAIE. Methods: All patient cases that were diagnosed as IE according to the modified Duke criteria in Samsung Medical Center during the period of January 1995 to December 2006 were reviewed retrospectively. The clinical and microbiological characteristics of patients with SAIE were compared to those of non-SAIE patients with IE. Results: We enrolled 304 patients with IE. Of these, 240 cases were IE culture-positive, including 73 cases of SAIE. The mean age of patients with SAIE was 48.15±19.87 years, with male patients accounting for 71.2% of our study group. Congenital heart disease (8.2%) was less common among SAIE patients. Hospital-acquired IE was significantly more common in SAIE than in non-SAIE cohorts (p<0.05). Surgical treatment was performed in 33 cases (45.2%). Valvular regurgitation with heart failure was the most frequent cause of surgery (39.3%). Twenty-three cases exhibited complications, including extra cardiac embolization (16.4%) and heart failure (5.6%). Fever persisting for a period longer than seven days was more common among those in the SAIE group. Twelve patients (16.4%) died and four patients (5.4%) were discharged without hope of improvement. The in-hospital mortality rate was higher among SAIE patients (17.3%) compared to that among non-SAIE patients (11%), although this comparison was not statistically distinct (p>0.05). Methicillin resistance and non-surgical treatment were significant risk factors for in-hospital mortality. Conclusions: SAIE is more strongly associated with systemic embolization, persistent fever, and longer hospital stays compared to non-SAIE. Further studies are warranted to evaluate adequate treatment and to improve the outcome of patients with SAIE. (Korean J Med 76:329-337, 2009)

국내 감염증의 항생제 치료 : 중추 신경계 감염증의 치료

백경란 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.2

PCR fingerprinting을 이용한 국내분리 다제 내성 폐렴구균의 페니실린 결합단백 유전자의 구조 분석

백경란,송재훈,진정화,김성민,양지원,이혁,이남용 대한감염학회 1998 감염 Vol.30 No.2

목 적 : 세계 최고의 내성률을 보이고 있는 국내에서의 폐렴 구균 내성은 단기간에 급증한 현상을 보이고 있다. 본 연구는 폐렴구균의 내성률이 국내에서 급증한 원인 중의 하나로서 내성의 전파가 작용하고 있을 가능성을 입증하고자, 베타락탐 항균제 내성 균주에서 변화하는 PBP 1A, 2X, 2B 유전자의 구조를 분석하고자 하였다. 이는 분자 역학의 일환으로 균주 간의 유전적 상관성을 검토할 수 있을 뿐 아니라, 폐렴구균이 항균제 내성 기전을 규명하기 위한 중요한 기초 자료로 이용될 수 있다. 방 법 : 1989년부터 1996까지 국내 2대 대학병원에서 분리된 다제 내성균주 22주를 대상으로 하였다. 이 균주들의 염색체 핵산을 분리한 후 PBP 1A, 2X, 2B 유전자를 각각의 특이 primer로 증폭하는 PCR을 시행하였다. PCR로 얻은 PBP 유전자를 HinfI과 MseI+DdeI으로 절단하고 [α-?P]dCTP나 [α-?P]dTTP로 end-labeling하여 절편 양상을 분석하였다. 절편의 비교 분석과 함께 UPGMA법을 이용하여 dendrogram을 구하여 유전적 근친도를 분석하였다. 결 과 : PBP 1A 유전자의 증폭 산물은 Hinf I으로 절단하여 얻은 fingerprinting pattern은 5균주를 제외한 17균주에서 거의 동일한 양상을 보였다. Dendrogram 상 PBP 1A는 77%, 2X 77%, 2B 82%의 균주가 90% 이상의 유사성을 보이는 cluster를 이루고 있었다. 결 론 : 이상으로 PCR fingerprinting 방법을 이용하여 다제내성 폐렴구균의 PBP 1A, 2X, 2B 유전자의 구조 분석을 시행한 결과 70% 이상의 균주가 동일한 fingerprinting pattern을 보여 상호간에 유전적으로 연관되어 있을 가능성을 강력히 시사하였다. 이러한 결과는 기존에 보고되었던 분자역학 연구의 결과들과 함께 국내에서 폐렴구균 내성의 전파를 증명하는 자료가 될 수 있을 것으로 생각된다. Background : The rate of pneumococcal resistance in Korea has surged up to the world's highest level in a short period. To investigate the genetic relatedness and the spread of resistant pneumococci within Korea, and to obtain the basic data about structural changes of penicllin-binding proteins(PBPs), we performed a fingerprinting analysis of PBP 1A, 2X, and 2B genes of multidrug-resistant pneumococci isolated in Korea. Methods : A total of 22 pneumococcal strains isolated from clinical specimens in 2 university-affiliated hospitals during the period from 1989 to 1996 were tested. PBP 1A, 2X, and 2B genes were amplified from chromosomal DNA by the polymerase chain reaction with specific primers. Amplified products were digested with HinfI or MseI and DdeI and were followed by end-labeling with [α- ?P] dCTP. Direct comparison of fingerprinting patterns between resistant strains and dendrogram analysis which was based on the UPGMA method were carried out. Results : Fingerprinting analysis of PBP 1A, 2X, and 2B genes digested with HinfI showed that 17 out of 22 strains had almost identical patterns. Dendrogram showed that clusters with greater than 90% similarities existed in 77%, 77%, and 82% of strains with PBP 1A, PBP 2X, PBP 2B, respectively. Fingerprinting patterns with Msel and Ddel were the same as those with HinfI. Conclusion : Data from PCR fingerprinting analysis of PBP 1A, 2X, 2B genes of multidrugresistant pneumococci in this study indicate the genetic relatedness between the resistant strains and suggest the possible spread of pneumococcal resistance within Korea.

간비(肝脾)칸디다증의 임상상

백경란,오명돈,김병국,최강원 대한감염학회 1992 감염 Vol.24 No.4

Hepatosplenic candidiasis is a distinct clinical variant of candidiasis in immunocompromised patients. It has become a major problem in the patients with acute leukemia, whose disease is in remission after successful induction chemotherapy. Manifestations of disease at the time when hepatic involvement is documented are localized to the liver and/or spleen. Patients with focal hepatosplenic candidiasis have fever unresponsive to antimicrobial therapy, prominent gastrointestinsl symptoms and signs, elevated levels of alkaline phosphatase, and hepatosplenic defects noted on abdominal US or CT. Histopathologic demonstration of Candida organisms in tissue specimens is necessary for a definite diagnosis. Cultures taken from involved tissues are often negative. Response to conventional therapy with amphotericin B is poor, and this form of candidiasis often persists after months of therapy. We report three cases of hepatosplenic candidiasis in leukemic patients, and review clinical, laboratory, radiologic findings, and treatment of hepatosplenic candidiasis in the medical literatures.