병원감염 관리체계 및 미생물부의 역활

배직현 대한감염학회 1990 감염 Vol.22 No.4

그람양성균 감염에 대한 Teicoplanin의 임상적 효과

최강현,송재훈,조구영,유빈,김형호,서철원,배직현 대한감염학회 1993 감염 Vol.25 No.1

Backgrounds: Gram-positive cocci have been an increasing cause of nosocomial infections in recent years. Treatment of these infections is often difficult, particularly infections by methicillin-resistant Staphylococcus aureus (MRSA). Teicoplanin, a new glycopeptide antibiotic, has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. To evaluate the clinical efficacy of teicoplanin in the treatment of patients with gram-positive bacterial infection and to compare the in vitro susceptibility of teicoplanin with other antimicrobials, we performed a prospective open trial of teicoplanin. Methods: Twenty patients with infections by gram-positive organism were enrolled. The patients were received 400mg of teicoplanin followed by 200 mg from next day as maintenance dose. During the follow-up period, clinical features and laboratory parameters were ckecked to evaluate clinical efficacy and appropriate cultures were followed to determine the microbiologic efficacy. The adverse effects of teicoplanin were also observed. Results: The enrolled patients were 16 males and 4 females, whose mean age was 51±13 years. The categories of infections were bacteremia (5), skin and soft tissue infection (4), empyema (3), UTI (2), pneumonia (1), catheter associated infection (1) and infective endocarditis (1). The etiologic organisms isolated were MRSA (9), coagulase-negative Staphlycoccus (5), S. viridans (2), group D streptococcus (2), S. pneumoniae (1), and E. faecalis (1). All 20 patients treated with teicoplanin showed clinical cure (13/20) or clinical improvement (7/20), whereas 90% of isolated organisms were eradicated after teicoplanin therapy. The adverse effect of teicoplanin was minimal. Conclusion: Teicoplanin is safe and effective in the therapy of many different infections caused by gram-positive oragnisms.

원내감염과 원외감염에서 분리된 원인균의 항균제 감수성 비교

송재훈,김미나,정재심,김봉철,배직현 대한감염학회 1993 감염 Vol.25 No.4

The selective pressure of the widespread use of antimicrobials has resulted in an increasing spread of resistant genes. Thus it would be anticipated and, in fact, has been shown by several studies that organisms from nosocomial infections are more resistant to antimicrobial agents than the same species of organisms causing community-acquired infection in a particular geographic area or medical center. However, such data are not available from any medical center in Korea. We, therefore, examined the susceptibility data of the nosocomial versus community-acquired pathogens that were isolated in a large university hospital in Seoul. Major pathogenic organisms of 2,015 isolates, 545 nosocomial and 1,470 community acquired pathogens, recovered from clinical specimen in the microbiology laboratory in Asan Medical Center during 6-months period from June to November 1992 were tested for antimicrobiai susceptibility by the standard disk diffusion method or automated microdilution minimum inhibitory concentration method (Vitek??). The nosocomical or community origin of the isolates were determined by the Infection Control Office through the Nosocomial Infection Surveillance Program. Staphylococcus aureus and coagulase-negative Staphylococcus isolated from nosocomial infections were significantly less susceptible than those from community-acquired infection to oxacillin, cephalothin, ciprofloxacin, gentamicin, and erythromycin (p<0.01). Similar findings were obtained for Escherichia coli and Klebsiella pneumoniae to cephalothin, cefotaxime, tobramycin, and gentamicin, and for Pseudomonas aeruginosa to ceftazidime, ofloxacin, piperacillin, and tobramycin. Enterococcus faecalis isolated from nosocomial infections were significantly more resistant to penicillin and ampicillin (p<0.05). However, Acinetobacter calcoaceticus, Enterobacter cloacae, and Serratia marcescens did not show a significant difference between nosocomial and community acquired isolates. We conclude that the susceptibility patterns of nosocomial and community-acquired pathogens are sufficiently different to warrant separate reports of susceptibility data, which would be useful to improve empirical antimicrobial therapy of nosocomial infections.

우리나라 병원감염관리에서의 임상병리전문의의 역할: 새천년의 도전

배직현 대한임상병리학회 1999 대한임상병리학회지 Vol.19 No.6

Aminoglycosides 고도내성인 enterococci에 대한 항균제 병합요법의 in-vitro 효과

김미나,배직현 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.1

For serious enterococcal infections, synergistic combination of penicillin and aminoglycosides is recommended for bactericidal therapy. However, an optimal synergistic combination for infection caused by enterococcal strains demonstrating a high-level resistance to aminoglycosides has not been established. The present study ezamined the in-vitro effects of combinations of penicillin plus trimethoprim/sulfamethoxazole(Sxt), ciprofloxacin, teicoplanin, vancomycin, and fosfomycin and compared with single drug therapy of ampicillin of low(5㎍/mL) and high doses(10, 20㎍/mL) in strians of Enterococcus with high-level resistance to gentamicin, amilkacin, and streptomycin by time kill studies. The minimal bactericidal concentrations of these antibiotics were also determined. Sxt and ampicillin were most active single agents on both MIC/MBC test and time kill study, but not consistently bactericidal. Only penicillin-ciprofloxacin combination exhibited significant bactericidal synergy but the bactericidal effect was strain and inoculum-size dependent and not more significantly effective than high-dose ampicillin or Sxt only.

국내 분리 폐렴 구균의 항균제 내성 현황 및 분자역학 조사를 통한 내성 전파의 규명

양지원,이남용,백경란,김성민,송재훈,배직현 대한감염학회 1996 감염 Vol.28 No.5

목 적 : 최근 폐렴구균의 항균제 내성은 전 세계적인 문제가 되고 있다. 국내에서도 폐렴구균의 페니실린 내성율이 70%를 넘어 세계 최고 수준의 내성을 나타내고 있다. 본 연구는 국내 분리 폐렴 구균의 페니실린 내성 및 다제 내성 현황을 확인하고, 국내의 내성율이 외국에 비하여 지나치게 높은 원인으로서 내성 전파의 가능성을 규명하고자 항균제 감수성 검사 및 pulsed-field gel electrophoresis(PFGE)와 penicillin-binding protein(PBP) profile을 분석하였다. 대상 및 방법 : 국내 2개의 3차 병원에서 1989년부터 1995년까지 153명의 환자 검체에서 분리된 173균주의 폐렴 구균을 대상으로 하였다. 항균제 감수성 검사는 oxacillin disk로 페니실린 내성 여부를 검색한 후, 한천희석법을 이용하여 11개 항균제의 성장억제최소농도를 구하였다. 항균제 감수성 검사 결과 모든 β-lactam 제제에 동시 내성을 보인 다제 내성 균주 42 균주를 대상으로 PFGE 와 PBP profile 분석을 시행하였다. PFGE는 SmaI과 ApaI을 제한효소로 사용하였으며, CHEF DR-Ⅱ system을 이용하여 전기영동하였다. PBP profile은 ³H-benzylpeniclillin으로 균주를 label하여 분석하였다. 결 과 : 항균제 감수성 결과 전체의 67.8%가 중등도 이상의 내성을 보였으며 (중등도 8.2%, 내성 59.6%), 3가지 종류 이상의 항균제에 동시 내성을 보이는 다제 내성율은 25.4%였다. 페니실린에 내성을 보이는 균주는 대부분 다른 항균제 특히 cephalosporin 제제에 내성을 보였다. 시험 균주의 혈청균은 19와 23이 가장 많았다. PFGE의 결과 35개의 다제 내성 균주 및 29 균주 (83%)가 동일한 제한 절편 양상을 보였으며, 총 5가지의 PFGE pattern 을 나타내었다. PBP profile 분석에서도 PFGE상 동일한 양상을 보인 다제내성 균주들은 PBP profile이 동일하였다. 결 론 : 본 연구는 기존의 국내 보고와 마찬가지로 폐렴구균의 페니실린 내성율이 세계 최고 수준임을 확인하였고, 아울러 다제 내성율도 현저히 증가하여 있음을 확인하였다. PFGE를 통한 유전자 절편 분석과 PBP의 변화 양상 분석을 통하여 다제 내성 균주의 80% 이상이 유전적 상관성이 있음을 확인함으로써, 내성의 전파가 국내에서 일어나고 있으며, 이 현상이 비교적 단기간에 국내에서 폐렴구균의 내성율을 급증하게 한 원인의 일부일 것으로 생각하였다. 향후 내성전파의 기전 및 근원에 대한 후속 연구가 내성 문제에 대한 장기적인 대책 마련에 필수적일 것으로 사료된다. Background : During recent three decades, the resistance of Streptococcus pneumoniae to penicillin has been rapidly increasing in many parts of the world. To characterize the epidemiology of multidrug-resistant S. pneunoniae as well as to investigate the possible spread of multiresistant clones which could partly explain the unusually high resistance rate in Korea, we conducted the antimicrobial susceptibility tests of pneumococcal isolates and performed pulsed-field gel electrophoresis (PFGE) and penicillin-binding protein (PBP) profile analysis of multiresistant strains from Korea. Methods : A total of 174 pneumococcal isolates obtained from 153 patients who visited or were admitted to two tertiary care hospitals during the period from 1989 to 1995 were studied. Antimicrobial susceptibility tests for 173 isolates were performed using agar dilution method to determine minimal inhibitory concentrations of 11 antimicrobial agents. A total of 42 isolates with multidrug-resistance were subjected to PFGE and PBP profile analysis to investigate the genetic relatedness between multiresistant strains, SmaI and ApaI were used to digest the genomic DNAs in PFGE. For PBP profile analysis, 5 mCi³H-benzylpenicillin were used to label PBPs of pneumococci. Results : Antimicrobial susceptibility tests for 173 isolates showed that 67.8% of isolates were not susceptible to penicillin, exhibiting either intermediate (8.2%) of resistance (59.6%). Multidrug-resistance to three or more classes of antibiotics was observed in 25.4% of the isolates. Almost all isolates with resistance to penicillin were resistant to cephalosporins. PFGE showed that 29 of 35 Korean isolates with multidrug-resistance had an identical PFGE pattern. These strains also shared a common PBP profiles with decreased affinity of PBPs 1a, 2x, and 2b. Conclusion : These data demonstrated the extremely high rates of penicillin- and multidrug-resistance in pneumococcal isolates in Korea. Molecular epidemiologic studies suggest the spread of a single epidemic clone of resistant pneumococci within Korea, which could partly explain the unusually high rate of resistance in Korea. Future investigation with regards to source and mode of transmission is warranted.

임상미생물검사

배직현,김봉철,김의종,서진태,오홍백,이경원,이규만,최태열,홍석일 대한임상검사정도관리학회 1995 臨床檢査와 精度管理 Vol.17 No.1

항균제내성 추이 파악을 위한 병동별 집중감시조사

이성희,배직현 대한감염학회 1996 감염 Vol.28 No.3

목적: 일반적으로 항균제감수성 양상은 병원 전체환자에서 분리된 균들에 대한 통계를 기준으로 한다. 하지만 항균제감수성이 심각한 중환자실의 문제는 균수가 많은 전체를 기준으로 한 통계에서는 알아낼 수가 없다. 그러므로 본 연구에서는 중환자실(ICU)과 중환자실이 아닌 병동(nonICU)을 분리하여 집중감시조사 (focused microbiologic surveillance)를 실시하므로써 ICU에서의 심각한 내성을 알아내는 데 있어서 유용성을평가해 보고자 하였다. 방법: 1994년 10월부터 1995년 9월까지 서울중앙병원 임상병리과에 의뢰된 모든 임상검체에서 분리된균 중 숫자가 50이 넘는 병원균들을 대상으로 표준 디스크확산법과 자동화된 액체배지희석법을 이용하여 항균제감수성검사를 실시하였으며, 그 결과를 ICU에서 분리된 균과 nonICU에서 분리된 균들로 나누어 비교하였다. 결과: P. aeruginosa는 ICU와 nonICU에서의 항균제감수성이 서로 비슷하였으나, S. aureus, coagulase-negative staphylococci, Enterobacter species, Acinetobacter species등은 ICU에서의 항균제감수성이 nonICU 보다 유의하게 낮았다(p<0.05). 결론: 항균제의 사용이 빈번하며 내성이 높은 중환자실의 항균제 내성의 추이를 알기 위해서는 특정 unit만을 대상으로 하는 집중감시조사 (focused microbiologic surveillance)가 유용할 것으로 사료된다. Background: Traditionally, trends in antibiotic susceptibility are detected by hospital-based antimicrobial susceptibility derived from cumulative information generated from all clinical wards. However, these data may underestimate the bacterial resistance in high antibiotic-use wards such as the intensive care units(ICUs). To overcome this problem, focused surveillance techniques have been suggested to study the epidemiology of microorganisms, and guide for specific antimicrobial therapy. In present study, we attempted to evaluate the utility of focused surveillance in following the resistance patterns of isolates from the intensive care units. Methods: Major pathogenic organisms recovered from clinical specimen were tested for antimicrobial susceptibility by the standard disk diffusion method or automated microdilution method in the microbiologic laboratory in Asan Medical Center during 12 months period from October 1994 to September 1995. The susceptibility patterns of isolates from patients in ICU were compared with those of isolates from general wards(NonICU). Results: The patterns of susceptibility of Pseudomonas aeruginosa from ICU, were similar to those from nonICU. However, isolates of Staphylococcus aureus and coagulase-negative staphlococci from the ICU were significantly more resistant to cephalothin, ciprofloxacin, erythromycin, and oxacillin than those isolated from nonICU. Similarly, Enterobacter and Acinetobacter species were more resistant to ampicillin, cefotaxime, piperacillin, and aminoglycosides. Conclusion: We concluded that focused microbiologic surveillance by specific hospital unit provide a sensitive means to identify unit-specific antimicrobial resistance patterns and is a useful guide for the specific antimicrobial therapy in hospital.

임상미생물검사 신빙도조사 결과보고(1996)

배직현,김대근,김봉철,김의종,박정준,서진태,이경원 대한임상검사정도관리학회 1997 臨床檢査와 精度管理 Vol.19 No.1

병원감염 관리기구의 구성 및 기능

裵直炫 대한의학협회 1993 대한의학협회지 Vol.36 No.10