국내 의료기관의 항생제 사용 실태와 규제 시스템 조사

방지환,송경호,박완범,김성한,조재현,김홍빈,김남중,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 이전 연구들에 따르면 아직까지 국내에서 불필요한 항생제 사용은 무시할 수 없는 수준이며, 특히, 수술환자들에 대한 예방적 항생제 투여가 문제로 지적되고 있다. 많은 병원에서 불필요한 항생제 처방을 제한하려는 노력을 하고 있지만 구체적인 현황에 대한 자료는 적은 실정이다. 이에 본 연구자 등은 국내 의료기관의 항생제 규제 시스템의 현황과 수술시 예방적 항생제 사용의 적정성을 알아보고자 한다. 재료 및 방법 : 전임 감염내과 전문의가 근무하는 의료기관 55곳에 대해 설문조사를 시행하였다. 설문의 내용은 적정한 항생제 사용을 유도하기 위한 정책 및 규제 프로그램, 실제 각 의료기관의 예방적 항생제 사용 현황 등으로 이루어져 있다. 결과 : 55개의 의료기관에 보낸 설문 중 44개가 회수되었다. 회신한 의료기관에서 항생제 처방 관리는 제한항생제 시스템을 가장 많이 이용하고 있었고(95.5%), 항생제에 대한 교육(79.5%), 전산시스템에서 관리(59.1%), 감염내과에 의뢰(54.5%), 항생제 사용 실적 검토(52.3%) 등의 순이었다. 대개의 병원에서 glycopeptides (100.0%), carbapenems (93.0%), quinupristin/dalfopristin 또는 linezolid(93.0%), 4세대 cephalosporin (74.4%), caspofungin 또는 voriconazole (62.8%), liposomal amphotericin B (60.5%) 등을 제한항생제로 분류하여 관리하고 있었다. 모든 의료기관에서 위절제술 및 유방절제술시에 불필요하게 예방적 항생제를 사용하고 있었다. 슬관절치환술의 경우 2세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았으며(30.2%), 관상동맥우회술의 경우 3세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았다(47.2%). 예방적 항생제의 투여 기간을 살펴보면 위절제술시 70.5%에서 4일을 초과하여 사용하고 있었고, 유방절제술시에는 63.6%에서, 슬관절치환술시에는 81.8%에서, 관동맥우회술시에는 81.1%에서 4일을 초과하여 장기간 예방적 항생제를 투여하고 있었다. 한편, 예방적 항생제 투여시 aminoglycoside계 항생제를 병용하는 경우도 많았다. 결론 : 아직까지 국내 의료기관에서 항생제 오남용을 막기 위한 노력이 더 필요할 것으로 생각되며, 특히 수술시 예방적 항생제의 올바른 투여에 많은 관심이 필요하다. Background : Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery. Materials and Methods : We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital. Results : Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem. Conclusion : This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.

성인 급성 골수성 백혈병에서 6-Thioguanine, Cytarabine, Doxorubicin(TAD) 3제 복합화학요법의 효과 : 최종보고

최환석,윤휘중,우인숙,박지훈,김정희,김시영,조경삼 大韓血液學會 1995 大韓血液學會誌 Vol.30 No.2

흰쥐 척수 및 등뿌리신경절에서 Tyrosine Hydroxylase 함유구조물의 분포

박매자,배용철,조희중,김지윤,김용주,김지윤 경북대학교 병원 1998 경북대학교병원의학연구소논문집 Vol.2 No.1

정상 흰쥐의 각 분절별 척수 및 등뿌리신경절에서 catecholamine 함유구조물의 분포를 알아보고자 tyrosine hydroxylase(TH)에 대한 항체를 이용하여 면역조직화학적 염색을 실시하였다. 그 결과 TH 함유신경세포는 목척수분절과 엉치척수분절에서 관찰되었다. 목척수분절의 TH 함유신경세포는 첫째와 둘째 목척수분절에서만 관찰되었으며 신경돌기가 잘 발달된 다각형의 세포인 것으로 보아 이들은 뇌줄기의 TH 함유신경세포군이 목척수분절로 연장된 것이라 생각된다. 그러나 엉치척수분절에서 관찰되는 대부분의 TH 함유신경세포는 세포돌기가 보이지 않고 세포체부분만 면역염색되어 관찰되는 것으로 보아 퇴화단계의 세포인 것으로 생각된다. TH 함유신경섬유는 척수의 모든 분절에서 관찰되었으며 이들 TH 함유신경섬유가 각 척수분절의 등뿔보다 배쪽뿔과 중간뿔에서 훨씬 높은 밀도로 관찰되는 것으로 보아 catecholamine은 척수에서 체성감각뿐만 아니라 자율신경계 및 운동신경계의 조절에 관여하리라 생각된다. 등뿌리신경절에서 관찰되는 TH 함유신경세포는 척수의 엉치분절에서 관찰되는 것과 마찬가지로 세포돌기가 거의 보이지 않고 세포체부분만 염색되어 보였다. 또한 등뿌리 신경절의 TH 함유신경섬유는 혈관의 벽을 나선형으로 감고 돌아가는 형태로 관찰되었으며 어느 것도 등뿌리신경절의 신경세포와 연관되어 관찰되지는 않았다. 이로 보아 정상 쥐의 등뿌리신경절에서 catecholamine은 신경세포 사이의 신경전달이나 졸절보다는 신경절 내의 혈류조절과 관계있을 것으로 생각된다. With the aim of gaining more insight into the catecholaminergic system in the nervous system of the rat, we have studied the precise distribution pattern of the tyrosine hydroxylase immunoreactive (TH-IR) fibers and soma in the spinal cord and dorsal root ganglion. In the dorsal root ganglion (DRG) TH-IR fibers were observed to run along the vessel wall, spirally and not found in the neural tissue itself. A few TH-IR fibers were found in the spinal nerve, not in the ventral root. Many TH-IR neurons were distributed in the L3, 4, 5, and 6 DRG but none of them were found in the other DRG segments. In the spinal cord, TH-IR fibers have shown sparse distribution all over spinal cord but relatively dense distribution in the ventral hom, intermediolateral column, lamina I of the dorsal horn of the cervical, lumbar, sacral, and coccygeal segment. TH-IR neurons were found in the interrmediolateral column, dorsal gray commissure, dorsal horn of the C1 and C2 segments and S1-4 segments. TH-IR neurons in the cervical segments were polygonal or spindle shaped with well developed processes. In contrast to this, TH-IR neurons in the sacral segments were oval or spindle shaped withe no processes. In conclusion, neurons in the DRG were not influenced by catecholaminergic nervous input. Intrinsic catecholaminergic nervous systems were found in both of spinal cord and DRG.

국내 다기관에서 조사한 지역사회획득 메티실린내성 황색포도알균의 빈도와 임상적 특성

송진수,최평균,송경호,조재현,김성한,방지환,이창섭,박경화,박경운,신수,최희정,김의석,김동민,이미숙,박완범,김남중,오명돈,김의종,김홍빈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 최근 전세계적으로 지역사회획득 메티실린내성 황색포도알균(community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA)의 보고가 증가하고 있다. 하지만, 우리나라에서는 CA-MRSA 감염증에 대한 증례보고만 있을 뿐 아직까지 체계적인 연구결과가 없는 실정이다. 저자들은 국내에서 CA-MRSA의 빈도, 감염증의 임상적 양상, 분리된 균주의 항균제내성 양상을 조사하였다. 재료 및 방법 : 2005년 1월부터 2005년 6월까지 7개 병원에서 MRSA가 분리된 환자의 명단을 파악한 후 의무기록지와 건강보험심사평가원의 자료를 검토하였다. 외래나 응급실에서 혹은 입원 후 72시간 이내에 균주가 분리되고 MRSA 획득과 관련된 위험인자가 없는 경우 CA-MRSA로 정의하였으며, 분리된 균주의 임상적 의미에 따라 원인병원체(pathogen), 집락화(colonizer), 미결정(undetermined)으로 분류하였다. Penicillin과 oxacillin을 제외하고 3개 이상의 다른 계열 항균제에 내성이면 다제내성으로 정의하였다. 결과 : 연구기간동안 총 3,251주의 황색포도알균이 분리되었으며, 이 중 MRSA는 1,900주(58.4%)였다. MRSA 가운데 CA-MRSA는 114주(6.0%) 였으며, 이들이 분리된 부위는 귀(62주), 비뇨기계(14주), 피부 및 연부조직(11주), 호흡기계(10주), 혈액(3주) 등이었다. CA-MRSA 균주 가운데 집락균은 22주, 원인병원체는 22주였으며, 나머지 균주에 대해서는 그 임상적 의미를 결정할 수 없었다. 항균제 감수성 검사를 시행한 73균주 중 47주(64.4%)는 다제내성이었다. CA-MRSA 감염증 22예 중 피부 및 연부조직 감염(9예)과 중이염/외이도염(9예)이 가장 흔하였다. 침습적 감염증(invasive infection)은 4명(원발성 균혈증 3예, 감염성 관절염 1예)에서 확인되었지만, CA-MRSA 감염증으로 사망한 환자는 없었다. 결론 : 병원내 감염증에서는 MRSA가 심각한 문제이지만, 아직까지 지역사회 감염증에서 CA-MRSA는 흔하지 않았다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). Material and Methods : Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. Results : Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides β-lactams. Conclusion : Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.

골수구성 백혈병 환자에게 발생한 결핵성 림프절염

이창섭,송진수,최평균,조재현,방지환,박경화,박완범,김홍빈,김남중,윤성수,박선양,김병국,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

혈액질환 가운데 결핵 발생이 증가한다고 알려진 것은 호지킨 림프종을 포함한 림프증식성질환 그리고 모양세포성 백혈병 등이 있다. 또한 동종 골수이식을 받은 환자에서도 결핵은 증가한다고 알려져있다. Kaplan 등은 골수구성 백혈병 환자에서 결핵 발생이 증가한다고 보고하였다. 그러나 골수구성 백혈병 환자에서 결핵의 발생이 증가하는 이유에 대해서는 아직까지 정확하게 밝혀지지 않았다. 저자들이 2년 동안 후향적으로 조사한 180명의 성인 골수구성 백혈병 환자들 가운데 결핵이 발생한 환자는 4명이었고, 발생 부위는 모두 림프절이었다. 결핵은 골수구성 백혈병의 특정 아형에만 국한되어 발생하지 않았지만, 50%에서 FAB 분류에 의한 M4였다. 림프절이 종대된 골수구성 백혈병 환자에서 특히, 결핵의 유병율이 높은 나라에서는 결핵성 림프절염도 감별진단에 포함시켜야 한다. During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.

Characterization of comQ and comX Required for Production of ComX Pheromone in Bacillus mojavensis

Ji Joong Cho,Yong Un Cho,Hong Chul Kim,Sang Wan Gal,Sang Won Lee,Han Dae Yun,Soo Jeong Cho 한국생명과학회 2006 한국생명과학회 심포지움 Vol.46 No.-

Cancer Pain Control for Advanced Cancer Patients by Using Autonomic Nerve Pharmacopuncture

Kang, Hwi-Joong,Yoon, Jung-Won,Park, Ji-Hye,Cho, Chong-Kwan,Yoo, Hwa-Seung KOREAN PHARMACOPUNCTURE INSTITUTE 2014 Journal of pharmacopuncture Vol.17 No.3

Objectives: The purpose of this study is to report a case series of advanced cancer patients whose cancer pain was relieved by using autonomic nerve pharmacopuncture (ANP) treatment. ANP is a subcutaneous injection therapy of mountain ginseng pharmacopuncture (MGP) along the acupoints on the spine (Hua-Tuo-Jia-Ji-Xue; 0.5 cun lateral to the lower border of the spinous processes of vertebrae) to enhance the immune system and to balance autonomic nerve function. Methods: Patients with three different types of cancer (gastric cancer, lung cancer, colon cancer with distant metastases) with cancer pain were treated with ANP. 1 mL of MGP was injected into the bilateral Hua-Tuo-Jia-Ji-Xue on the T1-L5 sites (total 12-20 mL injection) of each patient's dorsum by using the principle of symptom differentiation. During ANP treatment, the visual analogue scale (VAS) for pain was used to assess their levels of cancer pain; also, the dosage and the frequency of analgesic use were measured. Results: The cancer pain levels of all three patients improved with treatment using ANP. The VAS scores of the three patients decreased as the treatment progressed. The dosage and the frequency of analgesics also gradually decreased during the treatment period. Significantly, no related adverse events were found. Conclusion: ANP has shown benefit in controlling cancer pain for the three different types of cancer investigated in this study and in reducing the dosage and the frequency of analgesics. ANP is expected to be beneficial for reducing cancer pain and, thus, to be a promising new treatment for cancer pain.

Three-dimensional volumetric gray-scale uterine cervix histogram prediction of days to delivery in full term pregnancy

( Ji Youn Kim ),( Hai Joong Kim ),( Meong Hi Hahn ),( Hye Jin Jeon ),( Geum Joon Cho ),( Sun Chul Hong ),( Min Jeong Oh ) 대한산부인과학회 2013 Obstetrics & Gynecology Science Vol.56 No.5

Objective Our aim was to figure out whether volumetric gray-scale histogram difference between anterior and posterior cervix can indicate the extent of cervical consistency. Methods We collected data of 95 patients who were appropriate for vaginal delivery with 36th to 37th weeks of gestational age from September 2010 to October 2011 in the Department of Obstetrics and Gynecology, Korea University Ansan Hospital. Patients were excluded who had one of the followings: Cesarean section, labor induction, premature rupture of membrane. Thirty-four patients were finally enrolled. The patients underwent evaluation of the cervix through Bishop score, cervical length, cervical volume, three-dimensional (3D) cervical volumetric gray-scale histogram. The interval days from the cervix evaluation to the delivery day were counted. We compared to 3D cervical volumetric gray-scale histogram, Bishop score, cervical length, cervical volume with interval days from the evaluation of the cervix to the delivery. Results Gray-scale histogram difference between anterior and posterior cervix was significantly correlated to days to delivery. Its correlation coefficient (R) was 0.500 (P = 0.003). The cervical length was significantly related to the days to delivery. The correlation coefficient (R) and P-value between them were 0.421 and 0.013. However, anterior lip histogram, posterior lip histogram, total cervical volume, Bishop score were not associated with days to delivery (P >0.05). Conclusion By using gray-scale histogram difference between anterior and posterior cervix and cervical length correlated with the days to delivery. These methods can be utilized to better help predict a cervical consistency.

Therapeutic potential of targeting sphingosine kinase 1 in ovarian cancer

( Ji Yoon Ryu ),( Hye Kyung Jeon ),( Young Jae Cho ),( Young Ae Park ),( Jeong Won Lee ),( Tae Joong Kim ),( Chel Hun Choi ),( Yoo Young Lee ),( Ha Jung Kim ),( Jung Joo Choi ),( Byoung Gie Kim ),( Du 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

Oncogenic lipid enzyme SK1 (sphingosine kinase 1) has multiple roles in cell proliferation, inflammation, migration and apoptosis. The purpose of this study is to test the effects of SK1 inhibition on cell survival in A2780par, SKOV3ip1 ovarian cancer cell lines. We examined the expression of SK1 in various ovarian cancer cell lines by Western blotting and selected the A2780par and SKOV3ip1. To investigate the role of SK1 action in ovarian cancer cell growth control, we knocked down the expression of SK1 with its inhibitor (FTY720) and SK1 specific siRNA. The cells were analyzed by MTT assay for proliferation and flow cytometry using Annexin V staining for apoptotic activity. When A2780par and SKOV3ip1 cells were transfected with SK1 specific siRNA, the viability of the transfected cells was decreased by nearly (20~30%) in time dependently and the levels of the apoptotic positive cells were increased in SK1 knock down cells. In the treatment of the cells with FTY720, the same result was obtained as in the case of SK1 specific siRNA transfection. In order to confirm the SK1 activity by its inhibitors, we performed sphingosine kinase activity assay using commercialized sphingosine kinase activity assay kit. And inhibition of SK1 led to decrease of enzymatic activity in A2780par, SKOV3ip1 ovarian cancer cell lines (30~40%). These results suggest that SK1 may have the role in modulating cell proliferation and apoptotic response in ovarian cancer cells.

A Rare Case of Transient Friction Melanosis of the Finger: A Case Report

( Ji Ha Yoon ),( Ye Ji Jang ),( Eun Byul Cho ),( Eun Joo Park ),( Kwang Ho Kim ),( Kwang Joong Kim ) 대한피부과학회 2021 Annals of Dermatology Vol.33 No.6

Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated. Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.