• Pediatric Infection and Vaccine
• /
• 제29권1호
• /
• pp.46-53
• /
• 2022

뇌실염은 일반적으로 정맥 내 항생제를 통하여 치료하나, 불응성 뇌실염의 치료는 정맥 내 항생제 치료와 뇌실 내 항생제 치료의 병행이 요구되기도 한다. 이론적으로 항생제의 뇌실 내 투여는 정맥 내 단독 투여보다 뇌척수액에서 더 높은 항생제 농도에 도달할 수 있게 한다. 본 증례 보고는 기존의 전신 항생제 치료에 불응하는 폐렴 간균과 메티실린 내성 표피 포도상 구균에 각각 뇌실 내 겐타마이신과 반코마이신 투여를 통하여 뇌실염을 치료한 2례로서 이후에도 주요 합병증 등이 없어 이를 보고하는 바이다.

• Pediatric Infection and Vaccine
• /
• 제28권3호
• /
• pp.133-143
• /
• 2021

목적: 본 연구는 신생아중환자실에서 중심정맥관 관련 혈류감염 발생률을 확인하고, 이러한 환자들의 임상적 특성 및 원인균에 대해 분석하여 향후 신생아중환자실 내 혈류감염 예방 및 치료 지침의 기초 자료로 활용하고자 수행되었다. 방법: 2016년 1월부터 2020년 12월까지 분당서울대학교병원 신생아중환자실에 입원한 환자 중 중심정맥관 관련 혈류감염이 발생한 환자들을 대상으로 후향적 의무기록 분석을 하였다. 결과: 5년의 연구 기간동안 총 45명의 환자에게서 53례의 중심정맥관 관련 혈류감염이 확인되었고, 18,622 카테터-일 동안 발생률은 1,000 카테터-일 당 2.85건이었다. 가장 흔한 중심정맥관 종류는 말초 혈관 삽입형 중심정맥관이었다. 총 57균주가 분리되었고, 이 중 그람 양성균, 그람 음성균, 진균이 각각 57.9% (n=33), 36.8% (n=21), 5.3% (n=3)이었다. 가장 흔한 균은 Staphylococcus aureus (n=12, 21%) 와 coagulase-negative staphylococci (n=12, 21%)였고, 그 다음으로는 Klebsiella aerogenes (n=8, 14%)였다. 균혈증 평균 지속시간은 2일이었고, 19건에서는 3일 이상 균혈증이 지속되었다. 균혈증 발생으로부터 14일 이내에 사망한 사례는 총 6건(13.3%)이었다. 결론: 본 연구에서는 신생아중환자실 내 중심정맥관 관련 혈류감염의 발생률과 원인균 분포에 대해 분석하였다. 중심정맥관 관련 혈류감염에 대한 지속적인 모니터링은 경험적 항생제 사용 지침을 수립하기 위한 중요한 기반이 될 수 있으며, 감염예방 지침 실행의 필요성 및 이에 따른 영향을 평가하는 데에 도움이 될 것으로 생각된다.

• Journal of Microbiology and Biotechnology
• /
• 제24권5호
• /
• pp.648-660
• /
• 2014

Doenjang, a traditional Korean fermented soybean paste, is made by mixing and ripening meju with high salt brine (approximately 18%). Meju is a naturally fermented soybean block prepared by soaking, steaming, and molding soybean. To understand living bacterial community migration and the roles of bacteria in the manufacturing process of doenjang, the diversity of culturable bacteria in meju and doenjang was examined using media supplemented with NaCl, and some physiological activities of predominant isolates were determined. Bacilli were the major bacteria involved throughout the entire manufacturing process from meju to doenjang; some of these bacteria might be present as spores during the doenjang ripening process. Bacillus siamensis was the most populous species of the genus, and Bacillus licheniformis exhibited sufficient salt tolerance to maintain its growth during doenjang ripening. Enterococcus faecalis and Enterococcus faecium, the major lactic acid bacteria (LAB) identified in this study, did not continue to grow under high NaCl conditions in doenjang. Enterococci and certain species of coagulase-negative staphylococci (CNS) were the predominant acid-producing bacteria in meju fermentation, whereas Tetragenococcus halophilus and CNS were the major acid-producing bacteria in doenjang fermentation. We conclude that bacilli, LAB, and CNS may be the major bacterial groups involved in meju fermentation and that these bacterial communities undergo a shift toward salt-tolerant bacilli, CNS, and T. halophilus during the doenjang fermentation process.

• 대한의생명과학회지
• /
• 제20권2호
• /
• pp.77-84
• /
• 2014

Periodic analysis of local epidemiologic data of prevalent pathogens of blood culture can provide clinicians with relevant information to guide empirical antibiotic therapy. In this study, we analyzed a pattern of change of causative microorganisms and antimicrobial resistance at a tertiary medical center in Chungcheong province from 2003 to 2012, retrospectively. Of 70,258 blood specimens cultured, 6,063 (8.6%) were positive. Among the positive isolates, 95.9% were aerobic or facultative anaerobic bacteria, 0.1% were anaerobes, and 3.9% were fungi. Coagulase-negative Staphylococci (CoNS) (32.9%), Escherichia coli (16.7%), Staphylococcus aureus (9.1%), Klebsiella pneumoniae (6.4%), and ${\alpha}$-hemolytic Streptococcus (5.9%) were commonly isolated bacteria, and Candida albicans (1.4%) was the most commonly isolated fungi. Enterococcus faecium progressively increased but Streptococcus pneumoniae, Acinetobacter baumannii and Proteus species gradually decreased over a period of 10 years. The multidrug-resistant microorganisms such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), cefotaxime-resistant E. coli, imipenem-resistant Pseudomonas aeruginosa (IRPA) and imipenem-resistant A. baumannii (IRAB), were significantly increased. Therefore, there is a need for a more strict control of antibiotics and a more updated guideline for the treatment of bloodstream infection.

• 대한수의학회지
• /
• 제38권1호
• /
• pp.71-76
• /
• 1998

The effects of chitosan on mastitis in lactating holstein cows were evaluated. Fifty six cows with intramammary infection(IMI) from nine farms were selected and the cows were fed with diets which contained 15~20g chitosan per day for 5~7 days. The milk samples were obtained from cows at 7 days and 14 days after administration to determine effect of the curing of mastitis and the reduction of somatic cell counts(SCC). The average value of SCC levels in quarter milk from the cows administrated with chitosan significantly decreased up to 31.8% and 47.7% at 7 and 14 days, respectively(P<0.05). The cure rates of chitosan for Stapylococcus aureus, coagulase-negative Staphylococci, Streptococci spp, other gram positive bacteria and coliforms were 30.4, 42.8, 33.3, 66.6 and 54.5 % respectively. Twenty three out of 64 cases were cured by feeding with chitosan. The results showed that administration of chitosan could reduce SCC in milk and improve cure rates of bovine mastitis caused by microorganisms. The further studies will be pursued to study on the mechanism of chitosan in the immune responses of cows with mastitis.

• Archives of Plastic Surgery
• /
• 제46권2호
• /
• pp.160-166
• /
• 2019

Background Implant-related deformities in aesthetic rhinoplasty are a major problem for rhinoplasty surgeons. Capsular contracture is believed to be the pathological cause of delayed contour deformities, comparable to breast implant-related contracture. This study investigated the prevalence of bacterial biofilms and other epidemiological factors related to capsular contracture in cases of silicone augmentation rhinoplasty. Methods Thirty-three patients who underwent corrective rhinoplasty due to a delayed contour deformity or aesthetic revision after implant rhinoplasty were studied from December 2014 to December 2016. All recruited patients received surgical correction by the authors. The patients were categorized by clinical severity into four grades. Demographic data and related confounding factors were recorded. Samples of capsular tissue and silicone removed from each patient were analyzed for the presence of a biofilm by ultrasonication with bacterial culture and scanning electron microscopy. Results Thirty-three paired samples of capsular tissue and silicone implants from the study group were analyzed. Biofilms were detected in one of 10 subjects (10%) with grade 1 contracture, two of four (50%) with grade 2 contracture, 10 of 14 (71.40%) with grade 3 contracture, and four of five (80%) with grade 4 contracture (P<0.05). The organisms found were Staphylococcus epidermidis (47.10%), coagulase-negative staphylococci (35.30%), and Staphylococcus aureus (17.60%). Conclusions As with breast implant-related capsular contracture, silicone nasal augmentation deformities likely result from bacterial biofilms. We demonstrated the prevalence of biofilms in patients with various degrees of contracture. Implant type and operative technique seemed to have only vague correlations with biofilm presence.

• Clinical and Experimental Pediatrics
• /
• 제45권6호
• /
• pp.719-726
• /
• 2002

목 적: 신생아 집중 치료술의 발달로 고위험 신생아의 생존율이 많이 개선되었지만 적극적인 침습적 시술의 증가로 신생아 사망과 이환의 주요한 원인이 되는 신생아 감염의 발생은 오히려 높아졌다. 본 연구는 신생아 중환자실에서 원내 감염의 분포 양상, 원인균, 발생 빈도 및 변화 양상 등 5년간의 추이를 알아보기 위해 실시하였다. 방 법: 1995년 1월부터 1999년 12월까지 전남대학교병원 신생아 중환자실에 입원하여 혈액, 피부, 기관내 튜우브, 카테테르, 눈, 소변, 대변, 뇌 척수액에서 시행한 균 배양 검사 상 양성으로 나온 환아들 중 선천성 감염을 제외하고 임상 증상으로 원내 감염이 의심되었던 환아들에서 원내 감염의 분포 양상과 원인균 및 혈중 감염의 빈도, 원인균, 사망률 추이에 대하여 조사하였다. 결 과 : 5년 동안 신생아 중환자실에 입원한 환아의 원내 감염률은 입원 환아 100명당 9.0례이었고, 감염소로는 혈중 감염이 32.3%로 가장 많았으며, 피부(18.4%), 기관내 튜우브(17.2%), 카테테르(10.6%), 눈(10.0%), 소변(6.1%), 대변(3.0%), 뇌 척수액(2.4%) 순이었다. 원인균은 S. aureus가 29.9%로 가장 많았고 coagulase-negative staphylococci(CONS), Enterobacter,Candida 순이었다. 감염소별 원인균은 혈중과 카테테르는 S. aureus와 CONS, 피부와 눈은 S. aureus, 기관내 튜우브는 Enterobacter, 소변은 Candida와 enterococci, 그리고 대변은 Pseudomonas와 S. aureus가 흔하였고, 다병소 감염율은 26.1%이었다. 원내 감염률은 입원 환아 100명당 1995년 9.5례에서 1999년 11.6례로 증가하였으며, 원인균으로 S. aureus 는 감소하고 CONS, Candida, Klebsiella, Acinetobacter baumannii는 증가하는 추이를 보였다. 동기간 동안 혈중 감염률은 입원 환아 100명당 3.6례였으며, CONS와 S. aureus가 가장 많았다. 혈중 감염률은 입원 환아 100명당 1995년 2.1례에서 1999년 5.2례로 증가하였는데 원인균으로 S. aureus는 감소하고 CONS, Candida, Klebsiella, Acinetobacter baumannii는 증가하는 추이를 보였고, 패혈증에 의한 사망률은 11.9%이었다. 결 론 : 신생아 원내 감염의 가장 흔한 감염소는 혈중 감염이고 원인균으로는 S. aureus가 가장 흔하며, CONS, Candida, Klebsiella, Acinetobacter baumannii에 의한 감염은 증가하는 추이이므로, 이에 대한 예방 및 치료를 위한 노력이 필요할 것으로 사료된다.

• 한국임상약학회지
• /
• 제11권1호
• /
• pp.19-29
• /
• 2001

Teicoplanin, a glycopeptide antibiotic, has potential for use as an alternative to vancomycin in the treatment of gram-positive bacterial infections. However, unlike vancomycin, there is a lack of study on teicoplanin's efficacy and safety and the guideline for its use is not available, yet. The objective of this study was to investigate and evaluate the pattern of teicoplanin usage in a university hospital. A retrospective study was performed on 72 adult patients, who took teicoplanin for 3 continuous days at D. University hospital from 1 January 1999 to 30 June 2000. The microorganisms treated with teicoplanin were methicillin-resistant Staphylocorcus aureus $(69\%)$, coagulase-negative Staphylococci $(12\%)$, Enterococcus $(4\%)$, vancomycin-resistant Enterococci $(2\%)$, Streptococci $(2\%)$, and Bacillus $(1\%)$. The types of infection treated with teicoplanin were surgical wound infection $(58\%)$, lower respiratory infection $(11\%)$, bactremia $(7\%)$, urinary tract infection $(5\%)$, pleural fluid infection $(4\%)$, and peritoneal fluid infection $(2\%)$. The mean duration of teicoplanin usage was 16.5 days and teicoplanin was used with 1.4 other antibiotics, which were aminoglycosides (isepamicin, amikacin, netilmicin, astromicin) or quinolones (ciprofloxacin, tosufloxacin) or the third generation cephalosporin (ceftazidime). Only 24 cases $(28.6\%)$ met with the criteria for the justification of use, and the rest of 60 cases $(71.4\%)$ did not meet the criteria. In 84 cases $(100\%)$, blood culture tests were performed prior to the initial dose of teicoplanin. In 83 cases $(99\%)$, serum creatinine were conducted before the initial doses. In 45 cases $(53.6\%)$, serum creatinine was monitored at least twice weekly. In 55 cases $(65.5\%)$, WBC was tested at least twice weekly. In 84 cases $(100\%)$, body temperature was monitored at least once per nursing shift. In 15 cases out of 56 cases, maximum temperature decreased at least 1 degree within 3 days of teicoplanin use. In 15 case out of 35 cases, WBC values were within the normal range after treatment. In 23 cases $(27.4\%)$, dosage regimen was appropriate. Drug-related adverse effects were reported in 13 cases. Nephrotoxicity (progressively increasing SCr. or sustained SCr increase of $\geq$0.5 mg/dl from baseline) was noted in five cases. Neutropenia (absolute neutrophil count <1,500 $cells/mm^3$) was noted in one case and eosinophilia (total eosinophil count >350 $cells/mm^3$) was noted in seven cases. A more strict control on use of teicoplanin is required, considering that teicoplanin is categorized as one of restricted antibiotics.

• Archives of Plastic Surgery
• /
• 제41권3호
• /
• pp.253-257
• /
• 2014

Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to $33.6kg/m^2$ (mean, $23.1{\pm}3.74kg/m^2$). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.

• Clinical and Experimental Pediatrics
• /
• 제50권1호
• /
• pp.56-64
• /
• 2007

목 적 : 소아 종양 환자에서 발열이 있는 경우, 즉각적인 경험적 항생제 치료가 필요하기 때문에, 지역이나 병원 내에서 발생한 균혈증의 흔한 원인균과 항생제 감수성에 대한 최근 경향에 대한 정보가 필요하다. 본 연구에서는 4년간 소아 종양 환자에서 분리된 균혈증의 원인균 분포와 이들의 항생제 감수성에 대하여 분석하고자 하였다. 방 법 : 2002년 1월부터 2005년 12월까지 서울대학교 어린이병원 소아 종양 환자 128명 환아에서 발생한 197례의 균혈증과 이들에서 분리된 214균주에 대하여 분석하였다. 결 과 : 총 214균주 중 그람음성균이 64.0%, 그람양성균이 31.3%였으며 진균은 4.7%이었다. 균혈증을 일으킨 가장 흔한 균은 Klebsiella species(21%)와 E. coli(16.8%)였으며, CNS와 viridans streptococci도 7.9%와 7.5%로 분리율이 높았다. 호중구 감소증이 있는 환자군에서 그람음성균이 차지하는 비율이 감소증이 없는 환자군에 비해 높았고(67.5% vs. 51.1%, P=0.018), 균혈증 발생 당시 중심 정맥관을 가진 경우에 CNS(12.7% vs. 2.1%, P=0.004)와 viridans streptococci(11.0% vs. 3.1%, P=0.036)가 차지하는 비율이 더 높았다. 항생제 감수성 검사에서 그람양성균에서는 penicillin, oxacillin 및 vancomycin 내성률이 각각 83.3%, 48.5% 및 0.5%였으며, 그람음성균에서는 cefotaxime, piperacillin/tazobactam, imipenem, gentamicin 및 amikacin 내성률이 24.1%, 17.2%. 6.6%, 21.6% 및 14.2%이었다. 균혈증의 경과를 알 수 있었던 179례 중 42례(23.5%)가 중환자실 치료를 받았으며, 20례(11.2%)가 사망하였으며, 그람 음성균 감염의 경우 그람 양성균 감염에 비해 중환자실 치료율이 높았으며(26.5% vs. 10.3%, P=0.016), 중심 정맥관을 가진 경우에 중환자실 치료 빈도(34.4% vs. 10.8%, P<0.001)와 사망률(16.7 % vs. 4.8%, P=0.012)이 높았다. 결 론 : 최근 4년간 소아 종양 환자에서의 균혈증 분석 결과, 아직 그람음성균이 차지하는 빈도가 높으며 특히 호중구 감소증이 동반되었을 때 그람음성균에 대한 적절한 치료가 우선 시행되어야 하겠다. 하지만 그람양성균이 차지하는 비율이 증가하고 있는 것도 경험적 항생제 결정시 고려하여야 할 것으로 판단된다.