• Pediatric Infection and Vaccine
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• 제24권2호
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• pp.71-78
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• 2017

목적: 2011년부터 2015년까지 최근 5년간 서울대학교 어린이병원 소아 혈액종양 환자에게 발생한 균혈증의 원인균 분포와 이들의 항생제감수성을 분석하여 경험적 항생제 선택에 실제적인 도움을 얻고자 하였으며 원인균의 분포와 항생제감수성에서 이전 연구와 경향성을 비교하고자 하였다. 방법: 2011년부터 2015년 12월까지 서울대학교 어린이병원에서 입원 치료를 받은 소아 혈액종양 환자들에게 발생한 균혈증에 대하여 의무기록을 후향적으로 분석하였다. 결과: 총 167명의 소아 종양 환자에게 221예의 균혈증이 발생하였고, 229 균주가 분리되었다. 이 중 그람음성균, 그람양성균, 진균이 각각 69.0% (2002-2005년 64.0%, 2006-2010년 63.4%), 28.8%(2002-2005년 31.3%, 2006-2010년 34.6%), 2.2% (2002-2005년 4.7%, 2006-2010년 2.0%)의 분포를 보였다. 그람음성균 중에는 Klebsiella species (53.2%, 84/158), Escherichia coli (19.6%, 31/158), 그람양성균 중에는 Staphylococcus aureus (48.5%, 32/66), viridans streptococci (21.2%, 14/66)가 높은 비율로 분리되었다. 그람양성균의 페니실린, 옥사실린, 반코마이신 감수성률은 각각 13.8%, 54.8%, 96.9% (2002-2005년 16.7%, 51.5%, 95.5%; 2006-2010년 14.3%, 34.1%, 90.5%)이었고, 그람음성균의 세포탁심(cefotaxime), 피페라실린/타조박탐(piperacillin/tazobactam), 이미페넴(imipenem), 겐타마이신(gentamicin), 아미카신(amikacin) 감수성률은 각각 73.2%, 77.2%, 92.6%, 71.0%, 95.2% (2002-2005년 75.9%, 82.8%, 93.4%, 78.4%, 85.8%; 2006-2010년 62.8%, 82.9%, 93.8%, 67.8%, 86.3%)이었다. 본 연구의 원인균 분포 및 항생제감수성률은 과거 연구와 비교하여 차이가 없었다. 전체 환자에서 치사율은 13.1%이었다. 결론: 그람음성균은 소아 혈액종양 환자의 균혈증의 가장 흔한 원인균이다. 균혈증의 원인균과 항생제감수성은 이전 연구들과 다르지 않았다. 연구 결과에 따라 본 연구 기관에서는 예년과 같이 발열을 동반하는 소아 혈액종양 환자에서의 경험적 항생제를 피페라실린/타조박탐으로 투여할 수 있을 것이다.

• 미생물학회지
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• 제46권3호
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• pp.303-307
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• 2010

임상분리 균주인 A. baumannii 1625는 imipenem (carbapenem 계열)을 포함한 대부분의 ${\beta}$-lactam계열의 항생제들과 kanamycin, gentamicin, tobramycin 및 제 3세대와 4세대 cephalosporin 계열의 항생제들에 광범위한 내성을 나타내었고, 한국에서는 드문 IMP-1형 metallo-${\beta}$-lactamase (MBL)를 생성하는 균주임이 확인되었다. A. baumannii 1625는 약 2.5 kb 크기의 class 1 integron을 갖고 있었으며, 이 integron내에 aminoglycoside계열 내성 유전자인 accA4, carbapenem 계열 내성 유전자인 $bla_{IMP-1}$, 광범위한 ${\beta}$-lactam 내성 유전자인 $bla_{OXA-2}$ 유전자 cassette들이 차례대로 위치해 있음을 확인하였는데, 이것은 IMP-1형과 OXA-2형 ${\beta}$-lactamase의 유전자를 같은 integron내에 동시에 갖는 새로운 배열 및 구조로서 이전에 국내에서 보고된 바 없는 것이다. 이 2.5 kb 크기의 integron을 항생제 내성이 없는 E. coli에 형질전환 시켰을 때, imipenem, ampicillin, piperacillin, cefazolin, cefoperazone, aztreonam 등의 항생제들에 대하여 8배 이상 증가된 내성정도를 보였다. 이는 A. baumannii 1625의 integron이 다제내성을 부여하는 기능을 하고 있음을 보여준다.

• 미생물학회지
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• 제44권4호
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• pp.339-345
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• 2008

국내 대학병원에서 분리되어 imipenem 에 대한 최소억제농도가 $8{\mu}g/ml$ 이상인 51개의 포도당비발효 그람음성 간균들 중 metallo-${\beta}$-lactamase (MBL)을 생성하는 균주들을 분리하고, 그들 중에서 내성이 강한 Pseudomonas aeruginosa에 대한 항균제 병합요법의 효과를 알아보기 위하여 상승효과를 보이는 항균제 조합을 찾아보았다. 9개의 균주(Pseudomonas aeruginosa 2주 및 Achromobacter xylosoxidans subsp. xylosoxidans 7주)가 MBL 양성을 나타냈으며, PCR 결과 9주 모두에서 $bla_{VIM-2}$ 유전자가 관찰되었다. 이들 중에서 P. aeruginosa DK569는 aztreonam (MIC; $8{\mu}g/ml$)을 제외하고 실험한 모든 ${\beta}$-lactam 항균제, aminoglycoside, ciprofloxacin에 내성을 보여 aztreonam 함유 배지를 이용하여 상승효과률 보이는 항균제를 찾고자 하였다. One disk synergy test 에서 선별된 항균제 조합을 이용하여 생존률 검사 실험을 한 결과, aztreonam (AZT)와 piperacillin-tazobactam (TZP)의 병합은 항균제 노출 6시간 후에 AZT 또는 TZP의 단독 항균제 노출시 보다 균수가 1/18.7로 감소하였다. 그리고 AZT와 amikacin (AN)의 병합에서도 항균제 노출 6 시간 후에 AZT 또는 AN의 단독항균제의 투여보다 균수가 1/17.1 로 감소하였다. 결국 위 두 조합은 의미있는 상승효과를 보이지 못하여 위 세 항균제를 조합하여 실험하였다. 위의 세 항균제를 병합하였을 때 항균제 노출 8시간 후에 AZT, TZP 및 AN의 단독 투여에 비하여 병합요법에 의해 균수가 1/183.3 로 감소하여 의미있는 상승효과를 보였다. 이 결과는 치료가 쉽지 앓은 MBL 생성균에 의한 감염에 대한 치료에 AZT, TZP 및 AN의 세 가지 항균제 병합요법이 유용할 것이라는 것을 의미한다.

• 한국임상수의학회지
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• 제19권3호
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• pp.303-311
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• 2002

질병을 유발하는 세균의 분리와 동정, 그리고 그 세균에 대한 항생제 감수성 검사는 치료에 효과적인 항생제를 선택하는 데에 있어서 중요하다 본 연구의 목적은 항생제 감수성의 경향을 알아보고 치료를 위한 효과적인 항생제 선택을 위해 세균을 동정하는 것이었다. 1999년 7월부터 2000년 9월 사이에 서울대학교 수의과대학 부속동물병원에 내원한 개로부터 실험재료를 채취하여 호기배양을 실시하였다. 피부(63개), 뇨(45개), 외이도(31개), 안결막(18개)으로부터 채취한 총 157개 시료를 이용하였다 내원한 환자의 피부, 외이도, 결막에서 가장 많이 분리된 세균은 S. intermedius였다. 내원한 환자의 뇨에서 가장 많이 분리된 세균은 E. coli 였다. 분리된 그람 양성 세균의 대부분은 ampicillin(80.6%), erythromycin(68.8%), penicillin(86.2%), tetracycline(89.2%) 에 대해 저항성을 나타내었다. 반면, 분리된 그람 음성 세균의 대부분은 ampicillin(73.4%), trimethoprim-sulfa(53.3%) 에 대해 저항성을 나타내었다 E. coli는 ciprofloxacin(6l.5%), piperacillin(69.2%) 에 대해 저항성을 나타내었다 분리 동정된 세균의 채취부위에 따른 항생제 감수성의 차이는 뇨중의 S. aureus를 제외하고는 특이할 만한 사항이 없었다.

• 병원약사회지
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• 제35권4호
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• pp.391-399
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• 2018

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians'antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

• Clinical and Experimental Pediatrics
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• 제56권8호
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• pp.332-337
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• 2013

Purpose: To identify the frequency of bacterial isolates in early-onset neonatal sepsis (EONS) and their antimicrobial resistance pattern. Methods: A retrospective study of EONS was conducted at the Beni Suef University Hospital from September 2008 to September 2012. A case of EONS was defined as an infant who had clinical signs of infection or who was born to a mother with risk factors for infection, and in whom blood culture obtained within 72 hours of life grew a bacterial pathogen. Results: Of 673 neonates screened, there were 138 positive blood cultures (20.5%) (confirmed EONS). Of the recovered isolates, 86.2% were gram-negative pathogens. Klebsiella pneumoniae (42.8%), Enterobacter cloacae (22.5%), and Escherichia coli (13.8%) were the commonest isolated organisms. The most common gram-positive microorganism was Staphylococcus aureus accounting for only 12 isolates (8.7%). All Klebsiella isolates and 93% of Enterobacter isolates were resistant to ampicillin. Gram-negative pathogens had the maximum overall sensitivity to imipenem, cefepime, and ciprofloxacin; whereas, gram-positive isolates were most susceptible to vancomycin, imipenem, and piperacillin. Conclusion: K. pneumoniae was the predominant causative bacteria of EONS followed by E. cloacae and E. coli. There was a high resistance to ampicillin. Imipenem had the maximum overall activity against the causative bacteria. Continuous surveillance is needed to monitor the changing epidemiology of pathogens and antibiotic sensitivity.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.330-334
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• 2006

Polymicrobial nature of diabetic foot infection has been well documented in the literature. Initial antibiotic therapy of diabetic foot infection is usually empiric until reliable culture data is shown. This study was carried out to determine the common bacteriological flora of diabetic foot infection and antimicrobial sensitivity pattern in order to enhance possible empiric treatment. The specimens were obtained from wounds of 207 cases of diabetic foot ulcer, and the bacteriological isolation, and antimicrobial susceptibility tests of the isolates were carried out by standard microbiological methods. Staphylococcus aureus was the most common isolate, with 46.2% of recover rate among total bacterial isolated cases. Among gram-negative organisms, Pseudomonas aeruginosa was most common. Gram-positive organisms showed significant susceptibility to clindamycin, trimethoprim/sulfamethoxazole, and levofloxacin, besides vancomycin. Cefoperazone, piperacillin/tazobactam, and amikacin in addition to imipenem were most effective agents compared to gram-negative organisms. Diabetic foot infection requires use of combined antimicrobial therapy for initial management. Our results indicate that the most effective antibiotic combination for diabetic foot infection of Korean patients is clindamycin plus cefoperazone.

• 한국임상수의학회지
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• 제3권1호
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• pp.243-253
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• 1986

In recent years much attention has been paid to swine respiratory infection caused by Haemophilus(H.) Pleuropneumoniae with rapid expansion of pork industry in Korea. The organism may cause an acute respiratory infection with high morbidity and mortality, or it may also cause chronic persistent infection, resulting in loss of body weight. The present study was performed to observe the etiologic situation of H. Pleuropneumoniae infection by evaluating bacteriological, serological examinations with the lungs and sera collected from slaughtered pigs in Daegu city, respectively. In addition, antibiotic susceptibility test was carried out against the isolated strains of H. Pleuropneumoniae. The results obtained are summarized as follows : 1. Only 10 strains of H. Pleuropneumoniae were isolated from the 120 cases of swine lungs examined, and biological and biochemical characteristics of the isolates were identical with that of standard strains(serovar 1 to 6). 2. Out of 336 swine sera examined, 108(32.1%) were shown to be positive against H. Pleuropneumoniae by latex agglutination test. 3. Antibiotic susceptibility test revealed that 10 isolates of H. Pleuropneumoniae were sensitive to 16 kinds of antibiotic such as ampicillin, benzylpenicillin, piperacillin, cephalothin, cefazolin, cefamandol, cefoperagon, lactomoxycefa, tetracycline, minocycline, chloramphenicol, gentamicin, kanamycin, amikacin, colistin and nalidixic acid, whereas cloxacillin, erythromycin, kitasamycin, lincomycin, oleand-amycin, and bacitracin were resistent.

• 대한미생물학회지
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• 제19권1호
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• pp.25-33
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• 1984

One hundred and forty strains of Shigella cultures isolated from the twelve hygiene laboratories of cities and provincial level and general hospital laboratories in 1983, and were tested for their resistance to 13 antimicrobial drugs and their R-Plasmid transfer. One hundred and forty (100%) of isolates were susceptible to amikacin, gentamicin, tobramycin, a total of 94.3% of all shigella isolates were resistant to 1 or more of the 13 antimicrobial agents tested. The most commonly found resistance was to chloramphenicol (94%), followed by streptomycin (93%), tetracycline (92%), piperacillin (90%), ampicillin (83%), cefoperazone (42%), nalidixic acid (14%), cephalothin (17%), rifampicin (22%), and kanamycin (6%). Sixty percent of strains among 140 were resistant to ampicillin, chloramphenicol, streptomycin, tetracycline at same time. The transfer of drug resistance by conjugation was tested and 94 strains (94.3%) which were resistant to one or more drugs were found to transfer their drug resistance to E. coli.

• 한국동물위생학회지
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• 제37권4호
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• pp.225-231
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• 2014

In this study, 185 cefotaxime-resistant Escherichia coli were isolated from different stages of a wastewater treatment plant (WWTP) in Daegu in Korea. Among them, 99.5% (184 isolates) originated from raw sewage and 0.5% (1 isolates) from the final effluent. Cefotaxime-resistant E. coli were high resistant to ampicillin, piperacillin, cefazolin, cephalothin, cefachlor and cefamandole (99.5~100%). About 93% of the cefotaxime-resistant E. coli were extended-spectrum ${\beta}$-lactamases (ESBL)-producing E. coli. The $bla_{TEM+CTX}$ gene was the most predominant of the ESBL genes (72.5%), followed by $bla_{CTX-M}$ (16.2%), $bla_{TEM}$ (8.7%), $bla_{TEM+CTX+SHV}$ (1.1%), $bla_{TEM+SHV}$, $bla_{TEM+OXA}$, and $bla_{TEM+CTX+SHV}$ (respectvely 0.5%). Class 1 and 2 integron were found in 49.7% and class 3 integron was not found. All of integron positive isolates were multiresistant (i.e. resistant to four or more antibiotics). Our findings showed WWTP is contaminated with antibiotic resistant bacteria with resistance genes.