• 제목/요약/키워드: glycopeptide antibiotics

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감염증 환자에서 vancomycin, teicoplanin 투여례에 대한 연구 - 항균제 투여의 적응증 평가 - (Study on patients of infectious diseases administered with vancomycin or teicoplanin - Assessment of fitness of antimicrobial administration -)

  • 장철훈;손한철;황규연;박광옥;양웅석
    • 한국의료질향상학회지
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    • 제3권2호
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    • pp.26-35
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    • 1997
  • Background : Glycopeptide antibiotics are the only drugs for treatment of infections due to beta-lactam-resistant Gram-positive bacteria. As the incidence of infection and colonization with vancomycin-resistant enterococci(VRE) rapidly increases, the hospital infection control practices advisory committee(HICPAC) recommends prudent vancomycin use to detect, prevent and control infection and colonization with VRE. Methods : The inpatients admitted from September to December, 1996 in Pusan National University Hospital, with Gram-positive bacterial infections were evaluated retrospectively to see whether the administrations of glycopeptide antibiotics were appropriate or not, upon comparison with the recommendations for preventing the spread of vancomycin resistance by HICPAC. Results : Teicoplanin has been chosen more frequently than vancomycin of the glycopeptide antibiotics. The indications of administration of glycopeptides in patients with pneumonia, wound infections, sepsis, and in febrile or neutropenic patients with malignancies were appropriate, but the use of glycopeptides for elimination of merely colonized bacteria in the oral cavity could not be excluded. Inappropriate use of glycopeptides was 10.6%, and inappropriately long-term use without positive culture for beta-lactam-resistant Gram-positive organisms was about 40% of total days of drug use. Conclusion : It seems essential for the quality assurance committee to make a plan in teaching the HICPAC recommendations to the medical practitioners who prescribed the glycopeptides inappropriately or used for irrelevantly long to his patient, monitor and survey their use of glycopeptides prospectively and periodically, and if there are repeated inappropriate prescriptions, a certain penalty would be given to the practitioners.

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Novel Vancomycin Resistance System in Streptomyces coelicolor

  • Hong, Hee-Jeon
    • 한국미생물학회:학술대회논문집
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    • 한국미생물학회 2005년도 International Meeting of the Microbiological Society of Korea
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    • pp.143-147
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    • 2005
  • The non-pathogenic, non-glycopeptide-producing actinomycete Streptomyces coelicolor carries a cluster of seven genes (vanSRJKHAX) that confers inducible, high-level resistance to vancomycin. The van genes are organised into four transcription units, vanRS, vanJ, vanK and vanHAX, and these transcripts are induced by vancomycin in a vanR-dependent manner. vanHAX are orthologuous to genes found in vancomycin resistant enterococci that encode enzymes predicted to reprogramme peptidoglycan biosynthesis such that cell wall precursors terminate in D-Ala-D-Lac, rather than D-Ala-D-Ala. vanR and vanS encode a two-component signal transduction system that mediates transcriptional induction of the seven van genes. vanJ and vanK are novel genes that have no counterpart in previously characterised vancomycin-resistance clusters from pathogens. VanK is essential for vancomycin resistance in S. coelicolor and it is required for adding Gly branch to stem peptides terminating D-Ala-D-Lac. Because VanK can recognise D-Lac-containing precursors but the constitutively expressed femX enzyme, encoded elsewhere on the chromosome, cannot recognize D-Lac-containing precursors as a substrate, vancomycin-induced expression of VanHAX in a vanK mutant is lethal. Further, femX null mutants are viable in the presence of glycopeptide antibiotics but die in their absence. Bioassay using vanJp-neo fusion reporter system also showed that all identified inducers for van genes expression were glycopeptide antibiotics, but teicoplanin, a membrane-anchored glycopeptide, failed to act as an inducer.

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Vaneomycin-Resistant Enteroeocci (VRE) 약물치료방법 (Vaneomycin-Resistant Enteroeocci (VRE) Treatment Options)

  • 김묘경
    • 한국임상약학회지
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    • 제9권1호
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    • pp.1-14
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    • 1999
  • Vancomycin-resistant Enterococci (VRE) have recently emerged in Korean hospitals, as well as in those of other countries. VRE have been partially attributed to the overuse and misuse of vancomycin. The mecbanisms of VRE resistance are related to VanA, VanB, and VanC. Both VanA and VanB produce abnormal ligase enzymes to form D-ala-D-lactate termini in E. faecium and E. faecalis, instead of D-ala-D-ala termini. Meanwhile, Van C produces D-ser-D-ala termini in E. gallinarum and E. casseliflavus. These abnormal termini have a low affinity to vancomycin. As a result, VRE avoid the activity of vancomycin by these mechanisms. Unfortunately, there is no approved therapy for the treatment of VRE. Thus, available but uncommonly prescribed antibiotics (due to their toxicity or unproven efficacy) may become possible options. They include chloramphenicol, novobiocin, fosfomycin, and bacitracin. The combination therapy of available agents may also be the other options. They include high doses of a penicillin- or ampicillin-aminoglycoside combination, high doses of an ampicillin/sulbactam and aminoglyoosidcs combination, an ampicillin and vancomycin combination, and a ciprofloxacin, aminoglycosides, and rifampin combination. With respect to the near future, many types of investigational agents will most likely expand their treatment options for VRE. Teicoplanin, a glycopeptide, can be used for VanB- and VanC-related VRE. LY333328, a new generation of glycopeptide, is effective in treating VanA as well as VanB and VanC. RP59500 (quinupristin/dalfopristin), a streptogramin, is effective in treating vancomycin-resistant E. faecium. New generation quinolones (especially clinatloxacin) are potential options for the treatment of VRE, even though they cannot work as effectively against VRE as they can against Staphylococci. Both glycylcyclines (a new generation of tetracyclines) and ketolides (a new generation of macrolides) show good activity against Enterococci, regardless of vancomycin susceptibility. Oxazolidinones (i. e. eperezolid and 1inezolid) and everninomicins (i. e. SCH27899) are new groups of antibiotics, which also demonstrate good activity against VRE. It is imperative that clinical pharmacists take the responsibility of investigating new treatment options for VRE in order to combat this growing problem throughout the world.

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신경외과 병동에 적용한 Vancomycin 내성 장구균의 감염관리 전략효과 및 균집락의 위험인자 분석 (Effects of Infection Control Strategies & Analysis of Risk Factors for Vancomycin Resistant Enterococci)

  • 홍혜경;이꽃실;박성춘;정은경;박미라;김세철
    • 한국의료질향상학회지
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    • 제19권1호
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    • pp.30-42
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    • 2013
  • Objectives: This study was intended to check if the "Creating Clean Wards" project, which is an innovative reinforced campaign activity targeting infection control strategies and active surveillance cultures for VRE (vancomycin resistant enterococci) high-risk patients to be admitted in the NS (neuro-surgery) wards, would be reduced the incidence rates of VRE acquisition, transmission rates. Methods: 75 subjects of the VRE high-risk patients were surveyed by carrying out active surveillance cultures of VRE colonization 11 times from January to March, 2012. And the retrospective study was conducted dividing them into two groups. Results: The incidence rates of VRE acquisition was reduced to 3.67 cases per 1,000 patients day in the control group and to 2.88 cases in experimental group, which was not statistically significant (p = .753). VRE transmission rates of 0.0015 per day before the project tended to increase to 0.0019, although not statistically significant (p = .650). As a result of multivariate analysis with regard to using glycopeptide antibiotics in order to find out risk factors of VRE colonization, the patients who had been treated with glycopeptide until VRE colonization showed 274.41 times higher rate. Conclusion : For effective VRE infection control in NS wards, We should carry out active surveillance culture regularly, especially patient of using glycopeptide. And block the spread of VRE by strengthening infection control through the strict isolation and the changed mind-set of members motivated by the "Creating Clean Wards" campaign.

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Development of a Competitive Direct Enzyme-Linked Immunosorbent Assay for Teicoplanin

  • Lee, Hyang-Burm;Kwak, Bo-Yeon;Lee, Jae-Chan;Kim, Chang-Jin;Shon, Dong-Hwa
    • Journal of Microbiology and Biotechnology
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    • 제14권3호
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    • pp.612-619
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    • 2004
  • A competitive direct enzyme-linked immunosorbent assay (cdELISA) was developed for selective and rapid detection of a glycopeptide antibiotic, teicoplanin (TP). TP was conjugated to bovine serum albumin (BSA) for use as an immunogen. Repeated subcutaneous injections of 0.5 mg of the conjugate was effective in generating specific polyclonal antibody (PAb) toward TP in rabbits, as determined by cdELISA. TP-horseradish peroxidase conjugate (TP-HRP) was used as an enzyme marker. The cdELISA was developed based on a competition reaction between TP-BSA PAb and TP-HRP conjugate. The TP-BSA PAb was highly sensitive (detection limit, 0.3 ng/ml and specific toward teicoplanin, showing no cross-reactivity to other glycopeptide antibiotics including vancomycin. There were good correlations ($r^2$=0.84 and 0.76, respectively) between cdELISA and microbiological assay, and high-performance liquid chromatography. The cdELISA system developed in this work is expected to be useful not only for selective and rapid monitoring of TP but also for study of TP pharmacokinetics.

소수성 Diaion HP-20및 친화성 Concannvalin A 크로마토그래피를 이용한 Glycopeptide계 항생제 Teicoplanin의 분리 및 정제 (Separation and Purification of Teicoplanin by Diaion HP-20 and Conacnavalin A Chromatography)

  • 김창진;이재찬;박해룡;박동진;김영배
    • 한국미생물·생명공학회지
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    • 제31권2호
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    • pp.201-204
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    • 2003
  • Glycopeptide antibiotics, teicoplanin was purified from a mutant strain of Actinoplanes teichomyceticus ATCC31121, A. teichomyceticus MSL2211. We developed a simple procedure to separate and purify the teicoplanin from the fermentation broth. Teicoplanin was purified by two-step purification system, hydrophobic adsorption and sugar affinity chromatography in combination with HPLC analysis based on the properties of hydrophobic acyl chain and sugar moiety in teicoplanin. Teicoplanin was separated from the culture broth by Diaion HP-20 and further purified by concanavalin A affinity column chromatography. As an adsorbent resin, Diaion HP-20 in broth eliminated toxic effects on growth, reduced feedback repression of teicoplanin production, and assisted In rapid recovery of teicoplanin. The teicoplanin displayed the final yield of 80% and 95% of purity.

신생아 패혈증에서 발현시기에 따른 원인균 분석과 항생제 선택 (Analysis of causative microorganisms and choice of antibiotics according to the onset of neonatal sepsis)

  • 성준승;김동연;김선희;변형석;황태주;최영륜
    • Clinical and Experimental Pediatrics
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    • 제49권6호
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    • pp.623-629
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    • 2006
  • 목 적 : 신생아 의료의 발전으로 신생아 사망률은 감소하였으나 여러 가지 침습적 시술의 증가로 신생아 패혈증의 발생은 줄어들지 않고 있으며, 아직도 신생아 이환과 사망의 상당한 비중을 차지하고 있다. 전남대학교병원 신생아중환자실에서 신생아 패혈증의 발생시기에 따른 흔한 원인균 및 항생제 감수성 결과를 분석하여 가장 적절한 항생제 선택의 지침을 정하고자 하였다. 방 법 : 2000년 1월 1일부터 2004년 12월 31일까지 전남대학교병원 신생아중환자실에 입원한 환아 중 혈액배양 검사에서 1회(피부 상재균인 경우 2회) 이상 동정된 경우는 89명이었다. 이 중 74명은 패혈증에서 회복된 후 재발하지 않았으며(74례), 12명은 임상증상 재출현과 함께 혈액배양 검사상 균이 1회 더 동정되었고(24례), 3명은 2회 더 동정되어(9례) 총 107례에 대한 입원기록지를 후향적으로 조사하였다. 재태연령, 출생체중, 성별, 주산기 위험인자와 임상증상, 원인균 및 항생제 감수성, 사망률 등을 조사하였다. 결 과 : 신생아 패혈증의 발생빈도는 1.7%였으며, 30주 미만, 출생체중 1,500 g 미만에서 빈발하였다(P<0.05). 조발형의 거의 대부분(92.9%) gram-양성균이 원인이었으나, 지발형에서는 약 2/3(67.4%)가 gram-양성균이고 나머지 1/3은 gram-음성균(20.0%)과 칸디다(12.6%)가 차지하였다. Gram-음성균과 칸디다 감염은 중심정맥 카테테르가 있는 경우에서 많았다. 항생제 감수성 검사상 gram-양성균은 vancomycin, teicoplanin, chloramphenicol 순이었고, gram-음성균은 ciprofloxacin, imipenem, cefotaxime, ceftazidime 순이었다. 결 론 : 신생아 패혈증은 저출생체중 미숙아에서 흔하고, coagulase-negative staphylococci, Candida, S. aureus가 가장 흔한 원인균이었다. 항생제 감수성 검사상 1차 항생제 선택에 조발형은 3세대 cephalosporin 계열과 clindamycin, 지발형은 3세대 cephalosporin 계열과 glycopeptide 계열의 병용이 추천되며, 지발형에서 충분한 항생제 치료에도 반응이 없다면 칸디다 패혈증을 의심하고 예방적 항진균제 사용이 필요할 것으로 사료되었다.

대학병원에서의 Teicoplanin의 사용 현황 조사 및 실태 평가 (The Evaluation of Teicoplanin Usage in a University Hospital)

  • 김은아;오정미
    • 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.

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Teicoplanin 생산성이 우수한 Actinoplanes teichomyceticus ATCC31121 변이주 선별 및 배양학적 특성 (Screening and Characteristics of a Mutant of Actinoplanes teichomyceticus ATCC31121 Highly Producing Teicoplanin)

  • 노용택
    • 미생물학회지
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    • 제37권4호
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    • pp.299-304
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    • 2001
  • Teicoplanin은 Actinoplanes teichomyceticus가 생산하는 밴코마이신과 유사한 글리코펩티드계 항생제의 일종으로 메티실린 내성 황색포도상구균에 대해서도 효과가 우수한 치료제이다. 공시균주인 Actinoplanes teichomyceticus ATCC31121에 자외선을 조사하여 teicoplanin 생산성이 우수한 균주를 얻었다. 본 연구에서 우수 변이주 획득을 위한 UV 조사에 대한 균주의 치사곡선을 구하고 변이 유도 최적 조건을 확립하였다. 또한 한천 확산법을 사용하여 모균주와 변이주들의 teicoplanin 생산성 분포를 비교하였다. 변이주 가운데 가장 생산성이 높은 T1014-1를 최종적으로 획득하였으며 효소 활성도, 항생제 내성, 자가내성 및 teicoplanin 생산성을 조사하였으며 발효조에서 발효특성을 조사하였다.

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전북대학교병원 입원환자에서의 항생제 사용 실태 (Use of Antimicrobial Agents for the Treatment of Inpatients in Chonbuk National University Hospital)

  • 송재호;김정수
    • Pediatric Infection and Vaccine
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    • 제7권2호
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    • pp.225-232
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    • 2000
  • 목 적 : 올바른 항생제의 사용을 위해서는 우선 항생제 사용 실태의 파악과 함께 검사실의 확충, 의료진의 협조 등 다양한 노력과 보완이 요구된다. 본 연구는 적절한 항생제 사용의 기반을 마련하고자 현재 시행되고 있는 항생제 사용 실태를 조사하였다. 방 법 : 전북대학교병원에 입원한 환자 총 1,833명을 대상으로 의무기록을 통하여 항생제의 사용 여부, 종류, 사용 기간, 용량, 항생제의 투약 시작 시기 및 투여 목적을 조사하였다. 결 과 : 전체 조사 대상 환자 1,833명 중 입원 기간 중 항생제를 사용한 환자는 1,231명으로 67.2%였으며, 계별로 살펴보면 내과계는 전체 1,014명 중 497명(49.0%)이 항생제를 사용하였고, 외과계는 819명 중 734명(89.6%)에서 항생제를 사용하였다. 전체 항생제를 사용한 환자 1,231명 중 706명(57.4%)에서 예방 목적으로 사용하였고, 525명(42.6%)에서 치료 목적으로 사용하였다. 항생제를 사용한 환자의 경우 사용된 항생제의 갯수를 살펴보면 총 1,231명 중 1가지 항생제를 사용한 경우는 125명(10.2%)이었으며, 2가지를 사용한 경우는 311명(25.3%), 3가지를 사용한 경우는 562명(45.6%), 4가지 이상을 사용한 경우는 233명(18.9%)으로, 70% 이상의 환자에서 3가지 이상의 항생제가 사용하였다. 사용 항생제의 종류는 ${\beta}$-lactam, aminoglycoside, quinolone, macrolide, 항진균제, metronidazole, clindamycin, trimethoprim-sulfamethoxazole, glycopeptide, 그리고 fosfomycin 등으로 아주 다양하였다. 전체적인 그룹별 사용률을 보면 ${\beta}$-lactam은 57.0%, aminoglycoside는 34.5%, quinolone은 3.6% 그리고 기타 그룹은 4.9%로, ${\beta}$-lactam과 aminoglycoside가 가장 많이 사용되었다. 결 론 : 대부분의 환자에서 2가지 이상의 항생제의 병합요법이 보편화되어 있다는 점은 진지하게 검토되어야 할 것으로 생각된다. 아울러 임상적으로 전신 세균 감염이 확실한 경우에도 원인 병원체를 찾아내기 위한 적극적인 노력이 부족한 경우도 상당수 있어 이에 대해서도 검사실과 함께 적극적인 개선의 노력이 필요할 것으로 생각된다. 수술 환자의 예방적 화학 요법에 대해서도 개선이 필요할 것으로 생각된다.

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