• 한국임상약학회지
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• 제20권1호
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• pp.78-84
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• 2010

Background: Clostridium difficile is the primary reason of the nosocomial diarrhea. The antimicrobial therapy plays a central role in the pathogenesis of Clostridium difficile associated diarrhea (CDAD). Although nearly all classes of antimicrobial agents have been associated with CDAD, clindamycin and the third-generation cephalosporins have traditionally been considered to the greatest risk factor. Recent studies have also implicated fluoroquinolones as high-risk agents due to increasing use of the agents. This study was to determine the incidence and the risk factors of CDAD related to the administered antibiotics and to assess the therapeutic regimen of metronidazole or vancomycin based on the C. difficile toxin assay Methods: A retrospective study was performed in patients with Clostridium difficile toxin assay at I Hospital (Incheon, South Korea) during the period from January 2007 through December 2007. Administrative, laboratory, and pharmacy data were collected from Electronic Medical Databases. Results: The analysis included 129 reported C.difficile toxin assay results, with 42 positive cases and 87 negative cases. Significant antibiotic risk factors for CDAD included the use of the fourth-generation cephalosporinse (OR=5.97, 95% CI 1.37-25.98, P=0.017). Administration of metronidazole was protective against CDAD (OR=0.30, 95% CI 0.12-0.74, P=0.009). Prolonged antimicrobial therapy has been associated with an increased risk of CDAD. The third-generation cephalosporins (OR=3.81, 95% CI 1.08-13.41, P=0.037) and aminoglycoside (OR=5.50, 95% CI 1.43-21.10, P=0.013) demonstrated greater risk for CDAD over 15 days than 8days or less days of treatment duration. Conclusions: The fourth and third generation cephalosporin, aminglycoside were the significant risk factors compared with other antibiotics, whereas metronidazole appears to be protective. The longer duration of antiobiotic use increased CDAD.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.24-30
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• 2004

목 적: 급성 설사는 소아가 병원을 찾는 가장 흔하고 중요한 원인 중 하나이며 아직도 소아과 입원 원인 중 흔한 질환이다. 급성 설사를 효과적으로 치료하기 위하여 생균제가 거론되고 있는데 본 연구에서는 영유아를 포함한 소아의 급성 설사에서 생균제의 일종인 L. acidophilus를 투여하여 그 치료 효과에 대하여 알아보고자 하였다. 방 법: 2002년 9월부터 2003년 7월까지 국립 경찰병원 소아과에 설사를 주소로 내원한 3개월에서 5세 미만의 환아 중 하루 3회 이상의 묽은 변이나 물설사가 있었던 41명의 환아를 대상으로 하였다. 이 중 21명을 무작위로 추출하여 치료군으로 설정하고 L. acidophilus를 $0.5{\times}10^8$ colony forming unit (CFU)씩 하루 세 번 경구로 복용하게 하였으며 나머지 20명의 대조군은 위약을 동일한 방법으로 복용하게 하였다. 입원 후 의료진이 매일 설사 횟수를 조사하였고 설사 기간은 의료진에 의해 입원 당시부터 마지막 설사를 한 시점까지로 하였다. 결 과: 총 41명의 환아들이 참여하였고 입원 전의 치료군과 대조군 사이에는 임상소견의 통계적으로 유의한 차이는 없었으며 치료 시작 후 L. acidophilus를 투여한 군에서 설사 횟수의 감소(p=0.01)와 설사 기간이 유의하게 감소(p=0.001)하였다. 본 연구에서는 로타바이러스 양성인 환아에서 설사 기간의 감소에서는 유의한 차이를 보였으나(p=0.027) 설사 횟수는 통계학적으로 유의하게 감소하지 않았다(p=0.169). 로타바이러스 음성인 환아에서 L. acidophilus가 치료군에서 통계적으로 더 의미 있게 설사 기간을 감소시켰고(p=0.002) 설사 횟수 역시 감소함을 보였으나 통계적인 의의는 없었다(p=0.089). 결 론: 급성 설사가 있는 소아에서 L. acidophilus를 투여한 군에서 대조군보다 설사 횟수와 설사 기간이 의미 있게 줄어들어 치료에 도움이 되었고 향후 더 많은 연구가 필요할 것으로 사료된다.

• 한국동물위생학회지
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• 제35권4호
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• pp.343-346
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• 2012

This study was investigated the effects of feeding the combination with Lactobacillus plantarum and Bacillus subtilis on the diarrhea incidence and fecal microflora of weaned calves. A total of 12 newly weaned calves were allocated to two dietary treatments in a randomized design based on body weight. The dietary treatments included a commercial basal diet supplemented with: 1) no microbial inoculants (Control); 2) a mixture of Lactobacillus plantarum and Bacillus subtilis (LB). Calves were fed diets for a 4-week period. At the end of the experiment, the counts of fecal lactic acid bacteria and Enterobacteriaceae in LB were significantly improved compared to control (P<0.05). Over the 4-week period, fecal scores and duration of diarrhea in LB were significantly decreased compared with those in control (P<0.05). The present results suggest that LB is a potential feed additive which could be used for the balance of intestinal microflora and the prevention of diarrhea in Korean native calves.

• Asian-Australasian Journal of Animal Sciences
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• 제24권11호
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• pp.1601-1606
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• 2011

32 sows (Landrace${\times}$Yorkshire) and their litters were used to evaluate the effects of varying creep feed duration on pre-weaning, post-weaning performance of piglets and sows. Sows were randomly assigned with 1, 2 or 3+ parities into 1 of 4 treatments. Creep feeding was initiated at day 5, 10 and 15 from birth for treatment 1 (TRT1), 2 (TRT2) and (TRT3), respectively, with a control group provided no creep feed. In this study, TRT1 and TRT2 diets had reduced (p<0.05) the post-weaning diarrhea scores in piglets and the weaning-to-estrus interval and cortisol concentration in sows at weaning time compared with other treatments. Dietary TRT1 led to a higher (p<0.05) epinephrine and norepinephrine concentrations than other treatments. No differences (p>0.05) were noted in suckling, sleeping, fighting frequency and mortality in piglet and eating, standing times, backfat and body weight loss in sows. In conclusion, creep feed initiated from day 5 and 10 reduce diarrhea scores in piglets and benefit the estrus interval in sows compared with those initiated from day 15 and no-creep feeding diets, indicating creep feeding could improve the pigs and sows performance, especially those initiated from day 5 and 10.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권5호
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• pp.464-471
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• 2020

Purpose: Some probiotic strains reduce the duration of acute diarrhea. Because of strain and product specificity, each product needs to be supported by clinical data. This study aimed to test the efficacy of the synbiotic food supplement Probiotical (Streptococcus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium infantis, fructo-oligosaccharides) in children with acute gastroenteritis of likely infectious origin. The primary endpoint was the number of children with normal stool consistency during the treatment duration. Methods: A total of 46 children (aged 3.6 months to 12 years) with acute gastroenteritis that started less than 48 hours prior to their visit at a hospital-based emergency department were included in this prospective, randomized, placebo-controlled trial. All children were treated with oral rehydration solution and placebo (n=20) or the test product (n=26). Results: Significantly more children had a normal stool consistency on days 1 and 2 in the probiotic group: 5 children (20%) on day 1 in the probiotic group compared with none in the placebo group (p=0.046). On day 2, 11 children in the probiotic group (46%) and 3 (16%) in the placebo group (p=0.024) had a normal stool consistency. The mean duration of diarrhea was shorter in the probiotic group compared with that in the placebo group (3.04±1.36 vs. 4.20±1.34 days) (p=0.018). Conclusion: The test product was shown to normalize stool consistency significantly more rapidly than the placebo. These data confirm the findings from a previous study in a larger group of children performed in a primary healthcare setting.

• Clinical and Experimental Pediatrics
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• 제52권4호
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• pp.453-457
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• 2009

목 적 : 본 연구에서는 장염증상으로 입원한 소아 중 노로바이러스에 의한 급성 위장관염의 임상양상을 알아보고자 하였다. 방 법 : 2006년 7월부터 2008년 6월까지 분당차병원 소아과에 급성 위장관염 증상으로 입원한 환아 중 대변 RT-PCR을 통해 노로바이러스 감염으로 진단되었던 22명의 임상 기록지를 후향적으로 분석하였다. 비교군은 로타바이러스 감염으로 진단되었던 45명의 환자로 하였다. 결 과 : 구토와 설사는 노로바이러스 군에서는 각각 19명(86.4 %), 21명(95.5%)에서 보였고, 로타바이러스 군 환아 모두에서 관찰되었다. 구토의 지속기간은 두 군간에 차이가 없었으나, 평균 구토횟수는 노로바이러스 군에서 더 많았다. 평균 설사횟수와 지속기간은 로타바이러스 군에서 더 높았다. Vesikari Scale은 두 군간에 차이가 없었으며, 발열 빈도와 지속기간 또한 두 군간 유의한 차이는 없었다. 두 군 모두 2세 미만의 소아가 대다수를 차지하였다. 결 론 : 노로바이러스 장염 증상의 전반적인 양상은 로타바이러스 감염과 비슷하였으나, 노로바이러스 감염에서 구토 증상이 더 심했고 로타바이러스 감염에서 설사가 더 심하고 오래 지속되었다. 앞으로 노로바이러스 감염에 대한 광범위한 역학조사 및 예방적 노력이 필요할 것이다.

• 대한한방내과학회지
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• 제31권2호
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• pp.298-307
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• 2010

Objectives : This study was designed to investigate the effectiveness of adjunctive herbal therapy combined with conventional therapy on antibiotic-associated diarrhea (AAD) treatment. Methods : The medical records of 25 patients admitted to the Intensive Care Unit at Kyunghee Oriental Medical Center between January 1, 2009 and January 30, 2010 were reviewed. The charts were analyzed for the general characteristics, site of infection, predominant bacteria, antibiotic treatment, herbal medicine treatment, effect on liver and kidney functions, and the effect of therapy on diarrheal duration. Results : 48% of the 25 patients were male while 52% were female. The average age was 67.2 years old. The most commonly used antibiotic was fluoroquinolone (40.0%) and the most commonly used herbal medicine was Samchulkunbi-tang (24.0%). The average diarrheal duration was 8.9 days. No significant change in hepatic and renal function was discovered before and after treatment with herbal medicine. Conclusions : The results suggest that herbal therapy would be a safe and effective treatment for AAD. Further study investigating the usage of herbal medicine in AAD treatment is anticipated.

• Clinical and Experimental Pediatrics
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• 제59권9호
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• pp.368-373
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• 2016

Purpose: This study examined the risk factors of a delayed diagnosis of acute appendicitis in children undergoing an appendectomy. Methods: This retrospective study involved children aged below 18 years, who underwent an appendectomy. After dividing them into a delayed diagnosis group and nondelayed diagnosis group according to the time interval between the initial hospital visit and final diagnosis, the risk factors of delayed diagnosis were identified using logistic regression analysis. Results: Among 712 patients, 105 patients (14.7%) were classified in the delayed diagnosis group; 92 patients (12.9%) were diagnosed using ultrasonography (US), and both US and computed tomography were performed in 38 patients (5.3%). More patients in the delayed diagnosis group underwent US (P=0.03). Spring season and prior local clinic visit were significantly associated with a delayed diagnosis. Fever and diarrhea were more common in the delayed diagnosis group (fever: odds ratio [OR], 1.37; 95% confidence interval [CI], 1.05-1.81; diarrhea: OR, 1.94; 95% CI, 1.08-3.46; P<0.05). These patients showed symptoms for a longer duration (OR, 2.59; 95% CI, 1.78-3.78; P<0.05), and the admission course (OR, 1.26; 95% CI, 1.11-1.44; P<0.05) and C-reactive protein (CRP) levels (OR, 1.47; 95% CI, 1.19-1.82; P<0.05) were associated with the delayed diagnosis. Conclusion: To decrease the rate of delayed diagnoses of acute appendicitis, symptoms such as fever and diarrhea, seasonal variations, admission course, and CRP levels should be considered and children with a longer duration of symptoms should be closely monitored.

• Clinical and Experimental Pediatrics
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• 제56권9호
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• pp.383-388
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• 2013

Purpose: Viral etiology is common in cases of children with acute diarrhea, and antibiotic therapy is usually not required. Therefore, it is important to determine the distribution of common viruses among children hospitalized with acute diarrhea. Methods: We included 186 children who suffered from acute diarrhea and were hospitalized at the Wonkwang University Hospital Pediatric ward from December 1, 2010 to June 30, 2011 in this study. Stool samples were collected and multiplex reverse transcriptase polymerase chain reaction (multiplex RT-PCR) was used to simultaneously determine the viral etiology such as rotavirus, norovirus, astrovirus, or adenovirus. Results: Causative viruses were detected in 72 of the 186 cases (38.7%). The mean age of the virus-positive cases was 1 year and 9 months (range, 1 month to 11 years). Rotavirus was detected in 50/186 (26.9%); norovirus, in 18/186 (9.7%); and astrovirus, in 3/186 cases (1.6%). Adenovirus was not detected in any of the cases. Proportions of norovirus genogroups I and II were 21.1% and 78.9%, respectively. Four of the 51 rotavirus-positive cases (7.8%) had received rotavirus vaccination at least once. The mean duration of diarrhea was 2.8 days (range, 1 to 10 days) and vomiting occurred in 39 of the 72 cases (54.2%). Conclusion: Viral etiology was confirmed in about one-third of the children with acute diarrhea, and the most common viral agent was rotavirus, followed by norovirus.

• Pediatric Infection and Vaccine
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• 제19권1호
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• pp.12-18
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• 2012

목 적 : 본 연구는 발열성 요로감염으로 입원한 영아에서 항생제 연관 설사(Antibiotic-associated Diarrhea, 이하 AAD)의 양상 및 연관인자를 조사하였다. 이 연구는 영아 AAD의 예방과 치료에 사용되는 생균제에 대한 기초 연구이다. 방 법 : 가천의대길병원에서 2008년 1월부터 2010년 9월 사이에 급성 발열성 요로감염으로 입원한 생후 3-6개월의 영아들의 의무기록을 후향적으로 조사하여 AAD를 보인 환자(AAD군)와 보이지 않은 환자(non-AAD군)를 비교하였다. AAD군 내에서 사용한 항생제 요법과 용량, 설사의 양상을 비교하였다. 결 과 : 총 147명 중 AAD군은 54명(36.7%)이었고, 이 중 3세대 세팔로스포린($3^{rd}$ CS) 단일요법군, $3^{rd}$ CS과 비세팔로스포린 혼합요법군, 비세팔로스포린 혼합요법군 간의 설사의 발현 시점, 지속기간 및 횟수의 유의한 차이가 없었다(P>0.05). AAD군과 non-AAD군과의 cefotaxime 사용량의 유의한 차이는 없었다. 결 론 : 생후 3-6개월 영아의 발열성 요로감염 환자에서 AAD는 항생제의 요법과 평상적 투여량 범위내에서 용량에 관계없이 흔하게 발생하였다. 영아 AAD의 예방과 치료에 사용되는 생균제의 효과에 대한 추가적인 연구가 필요하다.