• Childhood Kidney Diseases
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• 제19권2호
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• pp.148-153
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• 2015

Purpose: We investigated trends in antibiotic resistance for gram-negative bacteria in infants with a urinary tract infection (UTI) over 15 years at a single institution. Methods: A retrospective chart review was conducted for children younger than 24 months who visited the emergency room and were diagnosed with a UTI between January 2000 and December 2014. We selected urine culture data that grew Escherichia coli and Klebsiella pneumoniae. Baseline clinical information and results of antimicrobial susceptibility tests were analyzed by dividing the 15-year study time frame into three periods (A: 2000-2004, B: 2005-2009, and C: 2010-2014). Results: During the study period, 478 applicable children were identified (E. coli, 89.7% and K. pneumoniae, 10.3%). Antibiotic resistance to third-generation cephalosporins was increased from period A to period C (A, 2.1%; B, 8.3%; C, 8.8%; P=0.025). Resistance to quinolones also showed a steady pattern during periods A to C, although it was not statistically significant (A, 7.9%; B, 9.7%; C, 12.4%; P=0.221). The incidence of Extended-spectrum ${\beta}$-lactamase (ESBL)-producing gram-negative bacteria increased from period A to period C (A, 1.4%; B, 7.6%; C, 8.2%; P=0.012). Conclusion: This study revealed that the common uropathogens E. coli and K. pneumoniae experienced increasing resistance rates against third-generation cephalosporins and a constant antibiotic resistance to quinolones in children younger than 24 months. We also showed a recent increased incidence of ESBL-producing gram-negative bacteria in patients with community-acquired UTIs. Therefore, it is necessary to actively surveil resistance in order to properly select empirical antibiotics.

• Tuberculosis and Respiratory Diseases
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• 제52권3호
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• pp.207-218
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• 2002

배 경 : 중환자실은 병원 감염의 높은 발생률, 항생제 사용의 증가, 내성세균의 출현, 더욱 강력한 항생제의 사용으로 인해 감염증 치료 및 관리가 어렵다. 이에 중환자실 환자들의 감염증의 실태와 분리세균들의 항생제 감수성 동향에 대해서 기존의 여러 연구가 시행 된 바있다. 본 연구에서는 1995년 새로 개원하여 중환자실 시설에 병원 감염균이 없는, 한양대학교부속 구리병원의 중환자실 환자에서 중환자실 원내획득 폐렴 3 대균주로 알려져 있는 Pseudomonas aeruginosa, MRSA, A cinetobacter species를 선택하여 항생제 감수성 동향을 관찰하고, 주요 균주의 감염증에서 합리적인 항생제 요법에 도움을 주고자 하였다. 방 법 : 중환자에서 흔히 나타나는 중환자실 원내획득 폐렴의 3대 균주 (S. aureus, Pseudomonas aeruginosa, A cinetobacter species) 를 선택하여, 1995년 한양대학교 구리병원 개원이후 2000년 까지 중환자실에서 시행한 배양검사 상 흔히 사용하는 항생제의 개원 후 6년간의 연도별 내성율을 조사 하였다. 결 과 : S.aureus의 methicillin 내성율은 각각 1995년 15%, 1996년 21%, 1997년 20%, 1998년 23%, 1999년 22%, 2000년 55% 였다. Pseudomonas aeruginosa의 3세대 cephalosporin 내성율은 각각 1995년 50%, 1996년 50%, 1997년 78%, 1998년 40%, 1999년 77%,2000년 39%였다 lmipenam 내성율은 각각 1995년 0%, 1996년 27%, 1997년 65%, 1998년 12%, 1999년 16%, 2000년 12%였다. Ciprofloxacin 내성율은 각각 1996년 0%, 1997년 56%, 1998년 36%, 1999년 57%, 2000년 58%였다. Tobramycin 내성율은 각각 1995년 7%, 1996년 10%, 1997년 50%, 1998년 4%, 1999년 32, 2000년 15%였다. Gentamicin 내성율은 각각 1995년 14%, 1996년 36%, 1997년 67%, 1998년 36%, 1999년 65%,2000년 12%였다 Amikacin 내성율은 각각 1995년 14%, 1996년 30%, 1997년 61%, 1998년 16%, 1999년 39%,2000년 18%였다. Acinetobacter spp.의 3세대 cephalosporin 내성율은 각각 1996년 92%, 1997년 89%, 1998년 88%, 1999년 84%, 2000년 77%였다. imipenam 내성율은 각각 1996년 50%, 1997년 48%, 1998년 45%, 1999년 49%, 2000년 50%였다. Ciprofloxacin 내성율은 각각 1996년 0%, 1997년 48%, 1998년 33%, 1999년 27%, 2000년 71%였다. Tobramycin 내성율은 각각 1995년 67%, 1996년 100%, 1997년 93%, 1998년 95%, 1999년 89%, 2000년 77%였다. Gentamicin 내성율은 각각 1995년 67%, 1996년 100%, 1997년 89%, 1998년 95%, 1999년 87%, 2000년 83%였다. Amikacin 내성율은 각각 1995년 33%, 1996년 83%, 1997년 82%, 1998년 88%, 1999년 75%, 2000년 69% 였다. 결 론 : 개원 후 6 년간 S.aureus의 methicillin 내성율, Pseudomonas aeruginosa의 quinolone 내성율, A cinetobacter spp의 quinolone 내성율의 급격한 증가가 관찰되었다. 이후 이들 항생제들에 대한 사용시 주의가 필요할 것으로 생각된다. 또한, 이러한 결과는 새로 개원하는 병원 중환자실에서 감염증 환자의 배양검사 결과 전에 항생제 선택에 도움을 줄 수 있을 것으로 사료된다.

• Clinical and Experimental Pediatrics
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• 제51권10호
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• pp.1042-1046
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• 2008

The fluoroquinolones are an important group of antibiotics widely used in the treatment of various infectious diseases in adults, as a result of an excellent spectrum of activity, good tissue penetration and convenient ways of administration. In recent decades, there has been extensive development, clinical investigation, licensure and use of fluoroquinolone antibiotics. However, the use of fluoroquinolones in children has been limited because of their potential to induce arthropathy in juvenile animals. Despite class label warnings against use in children, prescriptions for quinolone antibiotics to treat infections in children have become increasingly prevalent. The main use of fluoroquinolones in pediatrics should be, understandably, in serious life-threatening infections for which other antibiotics therapies are not effective or available. While most of the published studies failed to detect an increased rate of articular adverse effects in children treated with fluoroquinolones, an increase in the use of these compounds, particularly in community-acquired lower respiratory infections, could accelerate the emergence of multidrug-resistant (including fluoroquinolone) pneumococcal strains. This review will discus the main issues related to the use of fluoroquinolones in children, the major problems of resistance developing among these compounds, with special emphasis on the potential side effects and skilled use of these alternative potent drugs in pediatric infection.

• 대한수의학회지
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• 제34권1호
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• pp.153-163
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• 1994

A study on quinolone antibacterial (pefloxacin methanesulfonate) was performed to use for the drug of fisheries. Petloxacin was proved excellent in antibacterial activity and resistance against fish pathogens when compared with the existing antibacterials. And any side effect was not observed during the period of indicated use. An outline of MIC(Minimal Inhibitory Concentration) was $1.6{\sim}6.4{\mu}g/ml$, $TLm_{48h}$ value were 380~420 ppm in Israeli carp(Cyprinus caprio) and 2100~2300 ppm in flounder(Paralichthys olivaceus). The residual time of fish body was less than 15 days. So we can treat some bacterial disease of fish by the dosage of 100 g/day/ton of fish body weight for 3 days and pefloxacin is thought to be used effectively and widely against most bacterial fish pathogens.

• Archives of Pharmacal Research
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• 제19권2호
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• pp.143-147
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• 1996

LB20304 is a novel fluoroquinolone that exhibits a potent broad spectrum antibacterial activity against both gram-positve and gram-negative bacteria. The MICs (Minimal Inhibitory Concentration) of LB20304 were determined against both gram-positve and gram-negative bacteria under various conditions including several media, pHs, and inoculum concentrations. The in vitro activity of LB20304 was not significantly affected by the changes in testing conditions such as components of media and inoculum concentrations, but it was slightly reduced by acid condition. The MICs and MBCs (Minimal Bactericidal Concentration) of LB20304 against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were hardly affected by the presence of 50 % human serum, mouse serum, guinea pig serum or horse serum, and the MBCs were equal to or at most four-times higher than the MiCs. The activities of LB20304 were decreased by the presence of high concentraion of $Mg^{++}$ or human urine (pH, 5.5) in the test media. The frequencies of mutants resistant to LB20304 were similar to or lower than those found in ciprofloxacin and sparfloxacin.

• 약학회지
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• 제43권6호
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• pp.716-728
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• 1999

Whole oil and ketonic fraction (KF) of Leptospermum scoparium have been tested for their antimicrobial activity and combination effect with several antibiotics against various bacterial strains and fungi by using microbiological assay methods. Antibacterial activities of KF against a number of test strains were 2-3 fold stronger than those of whole oil. MICs of the KF were $65~125{\;}{\mu\textrm{g}}/ml$ against seven gram positive bacterial strains, $65~250{\;}{\mu\textrm{g}}/ml$ against 19 methicillin resistance Staphylococcus aureus strains, and $65~50{\;}{\mu\textrm{g}}/ml$ against 14 quinolone resistance strains. However, KF showed little or no activity against gram negative bacteria. MICs of the KF were $16~250{\;}{\mu\textrm{g}}/ml$ against more than 50% of the anaerobic bacterial strains tested. KF showed the higher antibacterial activity than bacitracin against 10 strains of Bacteroids thetaiotaomicron, or three strains of Bacteroides ovatus, and the more active than ciprofloxacin against one strain of Bacteroides thetaiotaomicron and three strains of Bacteroids ovatus. The MICs of KF was 63 and $250{\;}{\mu\textrm{g}}/ml$ against Aspergillus niger and Candida albicans, respectively. Antibacterial activities of KF in combination with 19 antibiotics against 14 strains and with four antifungal agents against one fungal strain were determined by paper strip diffusion method. While most of combination showed additivity, KF showed synergism with bacitracin, exfadroxil, cephradin, and meropenem for 29~57% of the strains tested. However, ofloxacin, enoxacin, sparfloxacin showed antagonism with KF for 43~71% of the strains. KF alone and in combination with bacitracin, gentamycin, neomycin, itraconazole, fluconazole, terfinafine and ketoconazole against five bacterial strains or one fungus strain synergistic effect was demonstrated against 33% of strains examined with FIC index value below 0.5 by checkerboard study. Synergistic effect of KF with gentamicin against Staphylococcus epidermidis 329 (QRS) was found by time-kill study.

• 한국임상약학회지
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• 제22권1호
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• pp.55-64
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• 2012

The quinolones are broad-spectrum antibiotics and enhanced antimicrobial activity has extended the use of the quinolones beyond the traditional indications for quinolone antibiotics in the treatment of urinary tract infections. The quinolones are effective in a wider variety of infectious diseases, including skin and respiratory infections. Because of their excellent safety and tolerability, they have become popular alternatives to penicillin and cephalosporin derivatives in the treatment of various infections. A retrospective study was performed to evaluate efficacy and safety of IV quinolones for inpatient use. Total 117 patients who administerd quinolones for longer than 3 continuous days at community hospital from October 1st, 2008 to December 31st, 2008 were reviewed. The criterias for drug evaluation were included the validation of indication, outcome, dosage and side effects. In the results, ciprofloxacin 13 (total 93), levofloxacin 3 (total 59) and moxifloxacin 2 (total 19) cases were not met the criterias based on the culture results. Major indications were pneumonia (ciprofloxacin 16.3%, levofloxacin 67.8%, moxifloxacin 84.2%), urinary tract infection (ciprofloxacin 44.1%), skin infection (ciprofloxacin 7.5%, levofloxacin 20.3%, moxifloxacin 10.5%), intra-abdominal infection (ciprofloxacin 10.8%, moxifloxacin 5.3%), etc.. In the results of quinolone monotherapy, the frequencies were each ciprofloxacin 74.2%, levofloxacin 50.8% and moxifloxacin 47.4%. In the results of dosage validation, the validities were each ciprofloxacin 54.8%, levofloxacin 94.9% and moxifloxacin 100.0%. In the results of duration validation, the validities were each ciprofloxacin 59.1%, levofloxacin 78.0% and moxifloxacin 89.5%. Adverse drug reactions were reported for total 49 cases and those were gastrointestinal tract effects including nausea, vomiting, diarrhea and central nervous system effects including headache, dizziness. In summary, the quinolones appropriately used for hospitalized patients based on this study. A focused approach emphasizing "correct use of quinolones" may reduce development of antimicrobial resistance and maximize class efficacy. Consequently, correct use of antibiotics will contribute to decrease medical expenses for person and community.

• 대한미생물학회지
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• 제22권3호
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• pp.283-294
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• 1987

One hundred and fifty-seven strains of staphylococci isolated from various clinical specimens and 80 of Gram-negative bacilli from urine of patients with urological diseases were tested for resistance to antimicrobial drugs by microdilution broth method. Among staphylococci, 50 to 89% of the strains were resistant to gentamicin(Gm), kanamycin(Km), erythromycin(Em), nalidixic acid(Na), and tetracycline. Ninety per cent MIC was lowest in ciprofloxacin(Cp), followed by vancomycin(Vc), trimethoprim(Tp), enoxacin(Ex), and norfloxacin(Nf) with the values of two ${\mu}g/ml$ or lower. Twenty-seven strains were resistant to methicillin(MR), with 24 strains of Staphylococcus aureus and 3 of S. epidermidis. All strains of MR S. aureus were resistant to oxacillin, rifampin(Rf), Gm, Km, Em, Na, and Tc, and no strain was resistant to Vc and Tp. Almost all staphylococci isolated from urine were S. epidermidis and sensitive to most drugs tested without MR strain. Among Gram-negative bacilli from urine, Escherichia coli(43 strains) was most frequently isolated, and followed by Klebsiella spp.(11), Proteus spp.(10), Serratia spp.(10), and Pseudomonas aeruginosa(6) in the decreasing order. The majority of E. coli and Serratia spp. were resistant to chloramphenicol(Cm), Tc, streptomycin, sulfisomidine(Su), ampicillin(Ap), Km, and carbenicillin(Cb), and 50 and 90% MICs of these drugs were also high. In Klebsiella spp., 54% or more were resistant to Cm, Su, Ap, cephalothin, and Cb. Proteus spp. were susceptible to most drugs tested, but Pseudomonas were resistant to nearly all drugs tested except Rf, amikacin, and moxalactam(Mx). All Gram-negative bacilli tested were found to be susceptible to Mx. New quinolone carboxylic acid compounds, such as Nf, Ex, and Cp showed very high antimicrobial activities against the majority of organisms tested except Pseudomonas, and 50 and 90% MICs of Nf and Ex were always equal or 2 to 4 times higher than Cp. Organisms multiply resistant to drugs were noted in almost all isolates tested. Twenty-seven strains of staphylococci were multiply resistant to 11 or more drugs, and 6 of Klebsiella spp. to 8 to 11 drugs. The most frequent multiplicity of durg resistance were 7 and 8, 12, and 13 in E. coli, Serratia spp., and Pseudomonas, respectively. No strain was resistant to more than 5 drugs in Proteus spp..

• 대한임상검사과학회지
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• 제53권2호
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• pp.137-142
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• 2021

본 연구는 결핵환자의 초기 치료에서 모든 항결핵제에 감수성을 보이는 경우, 치료 과정 중 항결핵제에 대한 내성 전환을 조사하였다. 2010년 1월부터 2019년 12월까지 111개 의료기관에서 녹십자의료재단에 항결핵제감수성 검사를 의뢰한 760건의 환자를 대상으로 하였다. 항결핵제에 모두 감수성인 594명중 추적 기간에 감수성에서 내성으로 전환되는 56명을 분석한 결과 INH, RIF, SM, QUI 순으로 단독 내성 전환율이 가장 높게 나타났으며, INH, RIF에 동시에 복합 내성을 보인 경우는 56명중 17명(30.4%)으로 높은 내성 전환율을 보이고 있다. 전환 시기는 INH 항결핵제는 최소 98일부터 1,862일, 평균 435.6일이며, RIF 항결핵제는 최소 108일부터 1,673일, 평균 457.7일로 분석되었다. 이에 본 연구는 결핵 초기 치료 후 모든 항결핵제에 감수성을 보였다면 3개월이 지난 시점에서 반드시 항결핵제 감수성 검사를 통해 내성 전환 및 다제내성결핵을 확인해야만 한다고 사료되며, 국민보건향상과 국민건겅증진을 위한 국가결핵관리 사업에 도움이 되었으면 한다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제5권2호
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• pp.150-157
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• 2002

목 적: 비장티푸스성 살모넬라균은 세균성 위장관염 및 장열 등을 일으키는 중요한 원인균으로 전 세계적으로 발생률이 증가할 뿐 아니라 항생제에 대한 다제내성률도 증가하는 추세이다. 그러나 이에 대한 소아에서의 연구 보고는 많지 않아 저자들은 비장티푸스성 살모넬라 위장관염의 임상양상과 항생제 내성률 등에 대하여 알아보고자 하였다. 방 법: 2000년 1월부터 2002년 6월까지 서울대학교 어린이병원에 내원하여 비장티푸스성 살모넬라 위장관염으로 진단받은 환아를 대상으로 임상양상, 항생제 내성률 및 변역 상태에 따른 내성률과 다제내성률 등을 조사하였다. 결 과: 대변 검사상 비장티푸스성 살모넬라균이 분리된 99례 중, 남아가 66례 여아가 33례였다. 2세 이상 3세 미만이 23례로 가장 많았으며 5세 미만에서 발생한 경우가 전체의 71%에 해당하였고 평균 연령은 4.0세였다. 25례는 항암 화학요법이나 스테로이드 및 면역 억제제 치료 등으로 면역 기능이 저하된 환자였다. 혈청군 중 D군이 65례로 가장 많았고 B군이 16례, C군과 E군이 각각 8례였다. 3례에서 균혈증이 동반되었다. 항생제에 대한 내성률을 보면 ampicillin에 31%, chloramphenicol에 12%, TMP-SMX에 20%, cefotaxime에 11%, cefixime에 8%의 내성률을 보였으며 ciprofloxacin은 모든균주에서 감수성을 보였다. Cefotaxime과 cefixime에 대한 내성률은 변역가능이 저하된 환아군에서 각각 24%, 14.3%로 정상군에서의 6.8%, 5.6%보다 유의하게 높았다 (p<0.05). 연령별(5세 미만 vs 5세 이상), 혈청군별(D군 vs 비D군) 내성률의 차이는 없었다. 한편 3가지 이상의 항생제에 내성을 보이는 다제내성균은 11례에서 동정되었고, 변역가능이 저하된 환아군에서의 동정률이 24%로 정상군에서의 동정률인 6.8%보다 유의하게 높았다(p<0.05). 결 론: 비장티푸스성 살모넬라 위장관염인 소아환자에서 항생제 치료를 해야 하는 경우에, 소아에서 안정성이 확립되지 않은 quinolone을 제외한다면 3세대 cephalosporin을 1차 선택제로 고려할 수 있다. 그러나 본 연구에서처럼 변역 가능이 저하된 환자에서는 cefotaxime과 cefixime에 대한 내성률과 다제내성률이 유의하게 높으므로 적절한 항생제 선택에 주의해야 할 것이며 향후 이에 대한 연구가 더 필요하리라 생각된다.