Standardized protocol of blood pressure measurement and quality control program for the Korea National Health and Nutrition Examination Survey

Kim Hack-Lyoung,Park Sang Min,Cho In-Jeong,Kim Yu-Mi,Kim Dae-Hee,Sung Hye Kim,김광일,성기철,임상현,Shin Jinho,Yoonjung Kim,Kyungwon Oh,Lee Eun Mi 대한고혈압학회 2023 Clinical Hypertension Vol.29 No.-

Accurate blood pressure (BP) measurement is crucial for hypertension detection and management. The Korea National Health and Nutrition Examination Survey (KNHANES) assesses the health of Koreans using representative cross-sectional data. BP measurements were historically done with mercury sphygmomanometers for participants aged ≥10 years. However, KNHANES transitioned to Greenlight 300TM (mercury-free auscultatory device) in 2020 for participants aged ≥6 years and used dual devices (Microlife WatchBP Office AFIB and Greenlight) in 2021-2022. To ensure consistency, KNHANES will adopt Microlife as the unified BP device with Greenlight for device validation from 2023. Under the new protocol, participants aged ≥6 years will have their BP measured three times at 30-second intervals after a 5-minute rest under ambient temperature (20-25℃) and noise ≤65 dB. The average of the 2nd and 3rd readings will be used as the representative BP value. The quality control (QC) program involves four trained examiners passing the “quality control and assurance of BP measurement program” three times annually, and undergoing “video monitoring of weekly calibration process” once a year. Additionally, the QC team will conduct “on-site evaluations of BP measurement” at mobile examination centers three times a year. A Five-Step QC process for BP devices was also developed. This document outlines the standardized BP measurement protocol and rigorous QC program in KNHANES, aiming to ensure accurate and reliable BP data for epidemiological research and public health policymaking in South Korea.

Comparison of total energy intakes estimated by 24-hour diet recall with total energy expenditure measured by the doubly labeled water method in adults

Kim Eun-Kyung,Fenyi Justice Otoo,Kim Jae-Hee,Kim Myung-Hee,Yean Seo-Eun,Park Kye-Wol,Oh Kyungwon,윤성하,Ishikawa-Takata Kazuko,Park Jonghoon,Kim Jung Hyun,Yoon Jin-Sook 한국영양학회 2022 Nutrition Research and Practice Vol.16 No.5

BACKGROUND/OBJECTIVES The doubly labeled water (DLW) method is the gold standard for estimating total energy expenditure (TEE) and is also useful for verifying the validities of dietary evaluation tools. In this study, we compared the accuracy of total energy intakes (TEI) estimated by the 24-h diet recall method with TEE obtained using the doubly labeled water method. SUBJECTS/METHODS This study involved 71 subjects aged 20–49 yrs. Over a 14-day period, three 24-h diet recalls per subject (2 weekdays and 1 weekend day) were used to estimate energy intakes, while TEE was measured using the DLW method. The paired t-test was used to determine the significance of differences between TEI and TEE results, and the accuracy of the 24-h recall method was determined by accuracy predictions percentage, root mean square error, and bias. RESULTS Average study subject age was 33.4 ± 8.6 yrs. The association between TEI and TEE was positive and significant (r = 0.463, P < 0.001), and the difference between TEI (2,084.3 ± 684.2 kcal/day) and TEE (2,401.7 ± 480.3 kcal/day) was also significant (P < 0.001). In all study subjects, mean TEI was 12.0% (307.5 ± 629.3 kcal/day) less than mean TEE, and 12.2% (349.4 ± 632.5 kcal/day) less in men and 11.8% (266.7 ± 632.5 kcal/day) less in women. Rates of TEI underprediction for all study subjects, men, and women, were 60.5%, 51.4%, and 66.7%, respectively. CONCLUSIONS This study shows that 24-h diet recall underreports energy intakes. More research is needed to corroborate our findings and evaluate the accuracy of 24-h recall with respect to additional demographics.

Clostridium difficile에 의한 설사의 예후인자

김준형,김희정,구남수,김영근,최준용,신소연,박윤선,김연아,김명수,정수진,최희경,송영구,이경원,김준명 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

배경 : Clostridium difficile에 의한 설사(Clostridium difficile associated diarrhea; CDAD)는 임상 경과가 다양하다. 최근에 유럽과 북미에서 C. difficile 감염의 발생률이 증가하고 고전적 치료에 잘 반응하지 않으며 이환률이 증가하였고, 이러한 원인이 새로운 균주의 탄생에 기인한다고 보고되었다. CDAD의 예후에 영향을 미치는 세균성 요인과 숙주 요인을 확인하기 위해 본 연구를 진행하였다. 재료 및 방법 : 2002년 8월부터 2003년 12월까지 CDAD가 진단된 20세 이상인 환자들을 대상으로 후향적 Cohort 연구를 하였다. 세균성 요인을 확인하기 위해 cdt A, cdtB, tcd A, tcd A rep 그리고 tcd B 유전자(binary toxin)를 확인하였다. 설사가 치료 시작 후 11일 이상 지속되거나, 2달 이내에 재발하거나, 수술 혹은 다른 시술이 필요한 경우, 사망한 경우 예후가 좋지 않은 것으로 정의하였다. 결과 : 총 115예에서 toxin을 생성하는 C. difficile가 동정되었으며, Toxin A와 toxin B 모두 양성인 균이 91예, toxin B만 양성인 균이 24예였다. Toxin A 생성 여부가 예후에 영향을 미치지 않았지만, 제산제를 사용한 환자에서 그렇지 않은 환자에 비해 toxin B만 양성인 균이 많이 동정되었다(P<0.05). 예후가 좋지 않은 경우는 39예(33.9%)였고 76예(66.1%)에서 예후는 양호하였다. 단변량 분석에서 70세 이상의 고령, 남성, 증상 발현 후 사용한 항생제의 개수 사용, 증상 발현 후 carbapenem, aminoglycoside, glycopeptide 사용, 당뇨 및 뇌졸중 병력이 있는 경우, 그리고 높은 Charlson index가 불량한 예후 인자로 확인되었다. 그러나 독립적인 예후 인자를 조사했을 때에는70세 이상의 고령(odds ratio=3.378, P=0.009), 증상 발현후 carbapenem 사용(odds ratio 7.210, P<0.001)이 예후에 중요한 영향을 미치는 요소로 확인되었다. 결론 : 70세 이상의 고령과 증상 발현 후 carbapenem 사용이 CDAD 독립적인 불량한 예후인자이다. Background : Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. Materialsand Methods : A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. Results : Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P<0.001) as the independent poor prognostic factors. Conclusion : Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

Temperament and Character of High Suicide Risk Group Among Psychiatric Patients

Kim Kyungwon,Park Yong Chon,Choi Junho,Kim Daeho,Kim Eunkyeong 대한신경정신의학회 2022 PSYCHIATRY INVESTIGATION Vol.19 No.8

Objective The purpose of this study was to classify patients with suicidal tendencies into suicide attempts (SA), suicidal ideation (SI), and non-suicidal self-injury (NSSI) and to identify differences in temperaments and characters of the groups. It also aimed to identify difference between the groups and non-suicidal tendencies.Methods Using psychiatric diagnostic data of 195 patients, temperaments and characters were measured with the Temperament and Character Inventory, and the level of depression was measured with the Beck Depression Inventory. The subjects were classified into SA, SI, NSSI, psychiatric patients without suicidal tendencies (PP), and non-patient (Normal) groups, and multivariate analysis of variance and multinomial logistic regression were conducted.Results The NSSI group had higher novelty seeking compared to the SI group, while having higher harm avoidance, lower persistence, and lower self-directedness compared to the SA group. Furthermore, low persistence was a better predictor for the SA group between SA and NSSI groups, and low novelty seeking was found to be a better predictor for the SI group between the SI and NSSI groups.Conclusion As a result, the group differences in temperaments and characters were found, which would be useful to identify patients with suicidal tendencies and provide appropriate interventions tailored to the temperaments and characters of each group.

Seroprevalence of SARS-CoV-2 antibodies in the community based on participants in the 2020 Korea National Health and Nutrition Examination Survey

Kim Ah-Ra,Minn Dohsik,Kim Su Hwan,Do Hyeon-Nam,Kim Byoungguk,Choi Young Sill,Kim Dong-Hyun,Oh Eun-Jee,Oh Kyungwon,Kwon Donghyok,권준욱,Kim Sung Soon,Lee June-Woo 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES: The Korea National Health and Nutrition Examination Survey (KNHANES) is a nationwide cross-sectional surveillance system that assesses the health and nutritional status of the Korean population. To evaluate the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the community, we investigated the prevalence of antiSARS-CoV-2 antibodies in the sera of KNHANES participants. METHODS: Subjects were recruited between April 24 and December 12, 2020. In total, 5,284 subjects aged 10-90 years from 17 regions participated. SARS-CoV-2 antibodies were screened using the Elecsys Anti-SARS-CoV-2 assay. Positive samples were verified using 4 different SARS-CoV-2 antibody assays and the plaque reduction neutralizing test. The final seropositivity criteria were a positive screening test and at least 1 positive result from the 5 additional tests. RESULTS: Almost half (49.2%; 2,600/5,284) of participants were from metropolitan areas, 48.9% were middle-aged (40-69 years), and 20.5% were in their 20s or younger. The seropositivity rate was 0.09% (5/5,284). Three of the 5 antibody-positive subjects had a history of infection, of whom 2 were infected abroad and 1 was infected in a local cluster outbreak. CONCLUSIONS: The low SARS-CoV-2 antibody seroprevalence in Korea indicates that there have been few coronavirus disease 2019 (COVID-19) cases due to successful COVID-19 management measures (e.g., diagnostic tests for overseas arrivals, national social distancing, and strict quarantine measures). Moreover, asymptomatic infections were uncommon due to active polymerase chain reaction testing. However, hidden infections may exist in the community, requiring the continuation of quarantine and vaccination measures.

2015 밀라노 페어를 통해 본 가구디자인 문화 연구

김경원(Kyungwon Kim),김건수(Gunsoo Kim),김정호(Chung Ho Kim),김종서(Jongseo Kim) 한국가구학회 2015 한국가구학회지 Vol.26 No.3

Milano Fair is the most authoritative event in the world and the most noticeable exhibition for expecting stream of furniture design and future. Companies and designers, who participate in this event, pioneer independent market through the creative and creative products based on their own identity. Their competitiveness in the market comes from the identity of the brands and it is possible when making continuous efforts to make competitiveness by differentiated designs and products. Upright design culture will be made when respecting the value of designers and designs, making the history and tradition and striving for new challenges and pioneerings.

Development of Polymer-based Nanodiscs for Broad Spectrum Antivirals

Misoo KIM,Su-hyun KIM,Seokoh MOON,Jaehyeon HWANG,Junghyun YOON,Soomin KIM,Kyungwon KIM,Wonbum PARK,Dae-Hyuk KWEON 한국생물공학회 2022 한국생물공학회 학술대회 Vol.2022 No.9

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

헬리코박터 파일로리 제균에서 10일 사제 동시 치료와 Rebamipide, Ecabet 추가 요법의 치료성적의 비교

김준환 ( Joonhwan Kim ),김경원 ( Kyungwon Kim ),이준수 ( Jun Soo Lee ),김수영 ( Su Young Kim ),김경오 ( Kyung Oh Kim ),김윤재 ( Yoon Jae Kim ),권광안 ( Kwang An Kwon ),박동균 ( Dong Kyun Park ),정준원 ( Jun-won Chung ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4

목적: Rebamipide와 ecabet sodium은 위점막을 보호하여 위염, 위궤양 치료에 사용되며, H. pylori의 증식과 생장을 억제하여 제균 치료에도 이용될 수 있다는 보고가 있다. 본 연구에서는 rebamipide와 ecabet sodium을 PPI, amoxicillin, metronidazole, clarithromycin로 이루어지는 사제 동시 치료에 각각 추가하여 H. pylori의 제균에 어떠한 영향을 미치는지 확인하고자 하였다. 대상 및 방법: H. pylori 제균 치료가 필요한 환자들을 대상으로 PPI를 포함한 non-bismuth 사제 동시 치료, rebamipide추가 치료, ecabet 추가 치료를 각각 시행하였다. 제균율은 치료 종료 4주 후 ¹³C-요소호기 검사를 통해 확인하였다. 결과: 사제 동시 치료군 총 118명 중 97명(82.2%), rebamipide추가 요법군 총 85명 중 77명(90.6%), ecabet sodium 추가요법군 총 74명 중 66명(89.2%)이 제균되었으며, 통계적 유의성은 없었다. 약물 순응도는 세 군에서 차이가 없었으며, 사제동시 치료군(32.2%)보다 rebamipide 추가 요법군(50.6%)에서 통계적으로 유의하게 높은 부작용률을 보였다(p=0.01). 또한 다변량 분석에서 치료 순응도가 감소할수록 H. pylori 제균 실패의 위험도가 유의하게 증가하는 것으로 나타났다(odds ratio 3.52, 95% confidence interval 1.00-12.32; p=0.05). 결론: 본 연구에서는 rebamipide와 ecabet sodium을 기존의 PPI를 포함한 사제 동시 치료에 추가하여도 제균율이 유의하게 증가하지 않았다. 이러한 결과는 높은 항생제 내성과 관련이 있다고 생각되며 향후 전향적인 연구로 확인이 필요해 보인다. 또한 환자의 약물 순응도가 높을수록 H. pylori 제균치료 성공률이 높으므로 동시 치료 처방 시 약물 순응도의 중요성을 환자에게 교육 및 강조할 필요가 있다. Background/Aims: Although some previous studies reported that a treatment combined with mucoprotective agent could improve the eradication rate in dual or triple therapy, there are other reports that question the efficacy of combining these drugs in concomitant therapy (CoCTx). The aim of this study was to investigate the effects of rebamipide or ecabet on the Helicobacter pylori (H. pylori) eradication combined with CoCTx. Methods: We retrospectively reviewed the medical records of 277 patients with proven H. pylori infection. They were assigned to one of 3 regimens for 10 days, twice daily: (a) CoCTx (n=118): lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg; (b) CoCTx+rebamipide (100 mg) (n=85); (c) CoCTx+ecabet (1 g) (n=74). Results: The baseline characteristics were not significantly different. H. pylori eradication rates were 82.2% (97/118) in CoCTx, 90.6% (77/85) in CoCTx+rebamipide, and 89.2% (66/74) in CoCTx+ecabet (p=0.17), which were statistically insignificant. Overall adverse events were more frequently reported in the CoCTx+rebamipide (50.6%. 43/85) and CoCTx+ecabet (44.6%, 33/74) groups than in the CoCTx (32.2%, 38/118) (p = 0.03) group. Drug compliances were not different between three groups (CoCTx: 95.8%, 113/118; CoCT+rebamipide: 92.9%, 79/85; CoCTx+ecabet 98.6%,73/74) (p=0.209). Multivariate analysis showed that the risk of eradication failure was significantly increased with decreased drug compliance (odds ratio 3.52, 95% confidence interval 1.00-12.32; p=0.05). Conclusions: Addition of these mucoprotective agent was not superior to CoCTx alone for eradicating H. pylori infection with frequent adverse events. Rather, drug compliance is the most related factor affecting the eradication rate. Our data suggest the importance of drug compliance over the drugs used. (Korean J Gastroenterol 2018;71:204-212)

호중구 감소성 발열을 보인 고형암 환자의 임상양상 및 그람양성균 균혈증의 위험인자

구남수,김준형,최유경,정세진,오형중,윤기태,김연아,신소연,김명수,김영근,박윤선,최준용,송영구,이경원,김준명 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

목적 : 항암요법을 시행받고 호중구 감소성 발열이 발생한 고형암환자에서 임상양상을 분석하고 그람양성균균혈증의 위험인자를 알아보고자 하였다. 재료 및 방법 : 2002년 1월부터 2004년 12월까지 연세대학교 의과대학 세브란스 병원 종양내과에서 고형암으로 진단받고 항암요법을 시행받은 18세 이상의 암환자에서 호중구 감소성 발열이 있었던 288예를 대상으로 하였다. 결과 : 항암요법을 시행받은 고형암 환자 중 288예에서 호중구 감소성 발열이 발생하였다. 이중 원인을 찾을 수 있었던 경우는 130예로 전체 45.1% 이었으며 미생물학적 확인감염(microbiologically documented infection, MDI)은 53예(18.4%) 이었다. 균혈증이 동반된 호중구 감소성 발열의 원인균 분포를 보면 총 53예에서 그람양성균이 27예 분리되어 50.9%를 차지하였고 그람음성균이 25예(47.2%), 진균 1예(1.9%) 순이었다. 그람양성균 중에서 methicillin 내성 포도상구균의 비율은 35% 이었다. 호중구 감소성 발열 환자에서 그람양성균 균혈증의 독립적인 위험인자를 분석한 결과 중심정맥 카테터와 연관된 감염이 있는 경우, 구내 점막염이 발생한 경우, 그리고 피부 및 연조직 감염이 발생한 경우에서 그람양성균 균혈증의 위험이 높았다. 결론 : 호중구 감소성 발열이 발생한 고형암 환자에서그람양성균 균혈증이 가장 높은 빈도를 보였으며 특히 중심정맥 카테터와 연관된 감염이 있는 경우, 구내 점막염이 발생한 경우, 그리고 피부 및 연조직 감염이 발생한 경우에서 그람양성균 균혈증의 위험이 높음을 알 수 있었다. 따라서 호중구 감소성 발열이 발생한 고형암 환자에서 발열 당시에 위와 같은 위험인자가 있을 경우 glycopeptide의 조기 사용을 고려해야 할 것으로 사료되며 앞으로 더 많은 환자를 대상으로 하는 전향적 연구가 진행되어야 할 것으로 생각된다. Backgrounds : Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor. Materials and Methods : We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul. Results : We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor. Conclusions : Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.