• 한국임상약학회지
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• 제11권1호
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• pp.19-29
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• 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.

• 대한의생명과학회지
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• 제6권3호
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• pp.201-208
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• 2000

Vancomycin은 세포벽의 합성을 억제하여 세균에 대한 항균효과를 나타내는 glycopeptide 계 항생물질로서 그람양성세균으로 인한 감염치료에 광범위하게 사용되며, 특히 methicillin 내성 포도상구균의 선택적 치료제로 쓰이고 있다. 그러나 최근 임상검체에서도 중등도의 내성을 가지는 포도상구균 (Mu50: MIC 8 $\mu\textrm{g}$/ml)이 나타나기 시작하였고 여러 가지 여건상 국내에서도 내성균주가 분리될 가능성이 높다고 사료되어 임상검체 중 methcillin 내성 포도상구균을 대상으로 vancomycin 감수성 및 내성빈도 조사를 실시하고 이에 따른 내성기전을 알아보고자 하였다. 본 실험 결과 107주 (株)의 methicillin 내성균주 중 23.3%가 vancomycin에 대하여 내성을 보였으며 vancomycin 내성을 나타내는 표준균주인 Mu50과 Mu3의 중간 정도의 내성빈도를 보였다. 중합효소 연쇄반응을 통해 장구균의 vancomycin 내성에 관여하는 vanA, vanB, vanC1, vanC2, vanH 특이 유전자는 증폭되지 않았다. SDS-PAGE를 실시하여 81 kDa, 58 kDa, 33 kDa, 28 kDa 등의 주요 단백 분획을 확인하였고, Mu50에서 45 kDa의 특징적인 단백 분획을 관찰하였다. LDH enzyme assay에서는 한 개의 검체가 Mu50과 함께 높은 LDH 활성을 보였다.

• 한국의료질향상학회지
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• 제8권1호
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• pp.10-21
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• 2001

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

• Pediatric Infection and Vaccine
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• 제22권1호
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• pp.16-22
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• 2015

목적: 소아에서 VRE의 자발적 소실 기간에 대한 영향인자들을 밝히는 것이다. 방법: 2005년 1월부터 2010년 11월까지 VRE 양성인 환자의 의무기록을 후향적으로 분석하였다. 집락소실 기간의 평균 325일을 기준으로 하여 조기소실군과 만기소실군을 나누어 임상특징을 비교하였다. 결과: VRE가 확인된 환자 중 관찰기간이 1년 이상이 되었거나 VRE 집락 소실이 확인된 수는 151명이었다. 조기소실군(41명)에서 처음 VRE 집락이 되었을 때 나이는 만기소실군(110명)에 비하여 많았다(44.9개월 vs 40.9개월, P=0.040). 그리고 조기소실군보다 만기소실군에서 VRE 집락 후 반코마이신 치료를 한 경우가 더 많았다(7% vs 27.2%, P=0.008). 결론: VRE 집락기간에 있어, 처음 VRE를 획득하였을 당시의 나이와 항생제의 사용여부가 중요하다. 감염질환을 치료하고 항생제 저항성 세균의 집락을 억제하기 위하여 적절하고 신중한 항생제 사용이 필요하다.

• 대한미생물학회지
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• 제13권1호
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• pp.7-16
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• 1978

환자(患者)로부터 분리(分離)한 103주(株)의 장구균(腸球菌)을 대상(對象)으로 항생제감수성검사(抗生劑感受性檢査)와 더불어 R plasmid에 의(依)한 약제내성전달(藥劑耐性傳達)을 실험(實驗)하였다. 전(全) 균주(菌株)에 대(對)한 MIC는 ampicillin이 $4{\mu}g/ml$로 가장 낮았으며 rifampin이 $16{\mu}g/ml$, amikacin과 chloramphenicol이 공(共)히 $125{\mu}g/ml$, tetracyclin이 $250{\mu}g/ml$이었고 분리균주(分離菌株) 중(中) $2,000{\mu}g/ml$ 고농도(高濃度)의 GM, KM 및 SM에 내성(耐性)을 보인 균주(菌株)는 각각(各各) 19주(株)(18.5.%), 27주(株)(26.2%) 그리고 22주(株)(21.4%)이었다. 가검물별(可檢物別) 분리균주(分離菌株)의 약제내성도(藥劑耐性度)는 뇨(尿)에서 분리(分離)된 균(菌)의 내성도(耐性度)가 가장 높았으며 각(各) 항생제(抗生劑)에 대(對)한 균종(菌種)의 약제내성도(藥劑耐性度)는 S. zymogenes의 내성도(耐性度)가 ampicillin과 rifampin을 제외(除外)한 기타(其他) 약제(藥劑)에 대(對)해 가장 높았다. 다제약제내성(多劑藥劑耐性)을 보인 28주중(株中) 17주(株)(61%)가 내성유형(耐性類型)의 일부(一部) 또는 전부(全部)를 전달(傳達)하였으며 이 중(中) 2주(株)만이 그 유형(類型)의 전부(全部)를 전달(傳達)하였고 내성전달빈도(耐性傳達頻度)는 $2{\times}10^{-4}-2{\times}10^{-6}%$이었다. 이상(以上)의 실험결과(實驗結果) 저자(著者)들은 우리나라에서 분리(分離)된 장구균(腸球菌)이 수종(數種)의 항생제(抗生劑)에 내성(耐性)이며 장구균(腸球菌)에 있어서도 약제내성전달(藥劑耐性傳達)이 R plasmid에 의(依)해 이루어짐을 결론(結論)지을 수 있었다.

• 한국미생물생명공학회:학술대회논문집
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• 한국미생물생명공학회 2000년도 Proceedings of 2000 KSAM International Symposium and Spring Meeting
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• pp.3-6
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• 2000

Antimicrobial resistance has been a well-recognized problem ever since the introduction of penicillin into clinical use. History of antimicrobial development can be categorized based on the major antibiotics that had been developed against emerging resistant $pathogens^1$. In the first period from 1940 to 1960, penicillin was a dominating antibiotic called as a "magic bullet", although S.aureus armed with penicillinase led antimicrobial era to the second period in 1960s and 1970s. The second stage was characterized by broad-spectrum penicillins and early generation cephalosporins. During this period, nosocomial infections due to gram-negative bacilli became more prevalent, while those caused by S.aureus declined. A variety of new antimicrobial agents with distinct mechanism of action including new generation cephalosporins, monobactams, carbapenems, ${\beta}$-lactamase inhibitors, and quinolones characterized the third period from 1980s to 1990s. However, extensive use of wide variety of antibiotics in the community and hospitals has fueled the crisis in emerging antimicrobial resistance. Newly appeared drug-resistant Streptococcus pneumoniae (DRSP), vancomycin-resistant enterococci (VRE), extended-spectrum ${\beta}$-lactamase-producing Klebsiella, and VRSA have posed a serious threat in many parts of the world. Given the recent epidemiology of antimicrobial resistance and its clinical impact, there is no greater challenge related to emerging infections than the emergence of antibiotic resistance. Problems of antimicrobial resistance can be amplified by the fact that resistant clones or genes can spread within or between the species as well as to geographically distant areas which leads to a global concern$^2$. Antimicrobial resistance is primarily generated and promoted by increased use of antimicrobial agents. Unfortunately, as many as 50 % of prescriptions for antibiotics are reported to be inappropriate$^3$. Injudicious use of antibiotics even for viral upper respiratory infections is a universal phenomenon in every part of the world. The use of large quantities of antibiotics in the animal health industry and farming is another major factor contributing to selection of antibiotic resistance. In addition to these background factors, the tremendous increase in the immunocompromised hosts, popular use of invasive medical interventions, and increase in travel and mixing of human populations are contributing to the resurgence and spread of antimicrobial resistance$^4$. Antimicrobial resistance has critical impact on modem medicine both in clinical and economic aspect. Patients with previously treatable infections may have fatal outcome due to therapeutic failure that is unusual event no more. The potential economic impact of antimicrobial resistance is actually uncountable. With the increase in the problems of resistant organisms in the 21st century, however, additional health care costs for this problem must be enormously increasing.

• 대한간호학회지
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• 제11권1호
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• pp.19-27
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• 1981

This Study was conducted at Intensive Care Unit of H & S Hospitals from Jan 4 to April 7, 1981 on 14mail & 26female adult patients. Each patient was screened and found to have nonbacteriuria in clean catch specimen before catheterization. Clean catch apecimen through Foley catheter were obtained after 24hours, 48hours and 72hours from catheterization. The result of this study is reviewed in a statistical analysis of percentage ＆ Chi Square test to obtain the following findings. 1) The occurenc of bacteriuria in patients according to duration of indwelling catheter. a. 9.1％ of the patient showed evidence of bacteriuria 24hours post catheterization specimen and 60％ showed 48hours post cathetreization, while 68.4％ of the patient showed evidence of bacteriuria 72hours post catheterization specimen. The occurence of bacteriuria in patients were significant differences at 1％ level between duration of indwelling catheter. b. Mail patients had no infection 24hours post catheterization, 50％ displayed bacteriuria 48hours post catheterization ＆ 62.5％ displayed bacteriuria 71hours post catheterization. 11.1％ of femail patients displayed infection 24hours post catheterization 66.7％ displayed infection 48hours post catheterization and 72.7％ displayed infection 72hours post catheterization. There were significant differences at 1％ level between bacteriuria occurence of mail ＆ femail patients and the duration of insertion. 2) 56％ of those patient who have altered mental state developed bacteriuria, while 40％ of those patient who have alear mental state developed bacteriuria. But there was without statistically any significant difference between patient's mental status. 3) The occurence of bacteriuria with the administration of antibiotics in 36 patient was in 50％. The occurence of bacteriuria without the administration of antibiotics in 4 patients was in 50％. But there was without statistically any significant difference between the administration of antibiotics. 4) The occurence of bacteriuria in patients according to frequency of bladder irrigation. 50％ of those patient who irrigated twice a day developed bacteriuria, 63.6％ of those patient who irrigated once a day developed bacteriuria. The occurence of bacteriuria in patients were significant differences at 1％ level between frequency of bladder irrigation. 5) The occurence of bacteriuria in patients who did perineal care once a day was 58.1％, 22.6％ of those patient who did perineal care twice a day developed bacteriuria. But there was without statistically any signiticant differences between frequency of perineal care. 6) Most frequent bacteria of all bacterial strains isolated by culture of the urine was E. coli(45％). Enterococci & Staphylococcus were 15％ respectively.

• 한국해양학회지
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• 제7권1호
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• pp.24-45
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• 1972

The Han River is an important water source in Seoul and neighbouring districts, for public and industrial supply, and for agriculture and fishery. Nowadays, more than six million inhabitants are supplied withe water from this river. The total length of the river is 470km, and has 17 10$\^$9/㎥ an average annual flow. The hydrographic characteristics at Seoul are 653㎥/sec in an average flow, 4,608㎥/sec in the maximum average flow, and 201㎥/sec in the minimum average flow. These are influenced in some degree by snowmelt in early spring, and greatly by the flood during summer. For the pollution problems, the periods of low flow are critical ones. As a rule they occur around the months November through June. Nowadays, most of the sewage from towns and industries is discharged untreated. Apart from domestic and industrial sewages, there are some discharges of mineral matter by mines in the upriver region. In general, water quality of the Han River is kept very clean and healthy until Kwangnaru of the upper region of Seoul. A large pollution, however, is received in the downstream by the domestic and industrial sewages of Seoul. It can be seen that dissolved oxygen, COD and BOD$\sub$5/ diminish markedly, and the intensity of almost every water parameter of the river continues to increase. Comparison of the figures for 1971 derived from a sampling point 40km downstream of Kwangnaru leads to the conclusion that hardness, Ca and Mg were no changed; alkalinity, Si and soluble- Fe were slightly increased; CO$\sub$2/, acidity, Cl, NO$\sub$2/-N, Cu, Zn and Al were increased in 2 and 3 times; total residue, total ignitious residue, COD, BOD$\sub$5/, NH$\sub$4/-N, PO$\sub$4/-P, Mn, Pb and total-Fe were increased in 4 to 7 times; and SO$\sub$4/, particulate-Fe and Cd were increased in 10 to 11 times. On the other hand, coliforms were increased in 650 times; fecal coliforms in 365 times; enterococci and total plate counts in 30 times, respectively. In view points of water quality standards, the down Han River water is now leveling out in Cd, coliforms and fecal coliforms for the agricultural use; in dissolved oxygen and some trace elements (Cu, Zn, Pb and Cd) for the fishery use; in ammonia, COD, BOD$\sub$5/, and Cd for the drinking use.

• 한국식품위생안전성학회지
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• 제32권2호
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• pp.135-140
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• 2017

본 연구는 서울시내에서 시판중인 식육에서 E. faecalis를 분리하고 이 균들의 항생제 내성 패턴, 항생제 유출 펌프 유전자 및 병독성 유전자의 분포를 분석하였다. 총 277개의 식육시료에서 93균주의 E. faecalis 를 분리하였다. 이 균주들의 항생제 내성비율은 ampicillin에는 35.5%, chloramphenicol에 6.4%, ciprofloxacin에 4.3%, eryhtromycin에 18.3%, quinupristin-dalfopristin에 76.3%, tetracycline에 45.2%의 내성이었으며 levofloxacin, teiconplanin 및 vancomycin에는 모든 균이 감수성이었다. 약물 유출펌프인 MFS 타입의 eme(A)와 ABC 타입의 efr(A)유전자는 모든 균주(100%)에서 확인되었으며 efr(B)는 98.9%, lsa는 91.4%의 균주에서 확인되었다. 병독성 인자인 gel(E)는 68.8%, ace는 90.3%, asa1는 47.3%, efaA는 91.4%, esp는 12.9%의 균주에서 확인되었다. 본 연구는 시판 식육에서 분리한 지표 미생물의 하나인 E. faecalis의 항생제 내성, 약물유출 펌프 및 병독서 유전자의 분포를 분석한 연구로 지속적인 모니터링을 하여야 할 것으로 사료된다.

• Journal of Yeungnam Medical Science
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• 제37권2호
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• pp.112-121
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• 2020

Background: Vancomycin-resistant Enterococcus (VRE) has become more common in nosocomial infections, especially in urine samples. However, until now, no treatment regimen has been proven to effectively eradicate urine VRE colonization. Therefore, to evaluate the efficacy of doxycycline in eradicating urine VRE and shortening VRE isolation period, we compared VRE colony detection period between doxycycline-treated and untreated patients. Methods: A retrospective cohort study of 83 patients with VRE colonization in urine cultures was conducted at a tertiary academic hospital from January 2011 to February 2018. Kaplan-Meier survival analysis was used to evaluate eradication rates in the treatment and non-treatment groups. Factors affecting urine VRE colonization persistence were analyzed by multiple logistic regression analysis. Results: The overall rate of VRE eradication during the entire hospital stay was higher in the doxycycline treatment group (90.5%) than in the non-treatment group (58.1%, p=0.014). Survival analysis showed that the 5-, 10-, and 20-day cumulative eradication rates were 78.3%, 100%, and 100% in the doxycycline treatment group, and 18.5%, 45.7%, and 67.8% in the non-treatment group, respectively, thereby indicating that eradication rates were higher in the doxycycline treatment group than in the non-treatment group (p<0.001). Only doxycycline treatment was shown to affect urine VRE colonization persistence in multivariate logistic regression analysis. Conclusion: Doxycycline treatment enhanced the eradication rate of urine VRE colonization and appeared to be useful in shortening VRE isolation period.