장구균 균혈증에서의 예후 인자

천신혜,정현,손경목,김연숙 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

배경: 최근 고령 인구 및 신생물 질환, 장기 이식이 증가함에 따라 장알균 균혈증의 빈도 및 그로 인한 사망률이 증가하고 있다. 하만 장알균은 혈액에서 다른 세균과 함께 동정되거나 기저질환이 위중한 경우에 발병하는 경우가 많아 사망에 영향을 미치는 원인병원체로서의 중요성에 대해 논란이 있다. 이전의 연구들과 달리 본 연구에서는 혈액에서 장알균 외에 다른 균이 동정되지 않은 균혈증 만을 대상으로 하여장알균의 원인병원체로서의 중요성과 사망에 미치는 영향에 대해서 알아보고자 하였다. 방법: 2007년 1월부터 2010년 12월까지 충남학교병원에 내원하거나 입원한 18세 이상의 성인을 대상으로 하였다. 전신염증반응증후군(Systemic inflammatory response syndrome)이 으면서 혈액 배양 검사상 최소 한쌍 이상에서 장구균만이 동정된 105명을 대상으로 후향적으로 의무기록을 검토하였다. 결과: 적절한 항생제치료가 시행된 경우는 91건 중 40건으로 44%이며, 부적절한 항생제 치료가 시행된 경우도 50건으로 56%이었다. 병원감염에 의한 균혈증은 5건으로 전체의 63.7%를 차지하였으며, 지역 사회 감염은 19건으로 20.9%이었다. 환자의 기저 질환으로는 고형암 (solid tumor)이 가장 았으며, 원발 병소는 복강 내 감염과 원발성 균혈증이 각각 28건(30.8%)으로 가장 빈도가 높았다. 단변량 분석에서 병원내 감염 여부, 이전 생제치료여부, 이전 ICU입원여부, ampicillin과 gentamicin에 대한 high-level resistance 여부가 장알균 균혈증에 따른 사망에 영향을 치는 의미있는 인자였고, 다변량 분석에서 이전 항생제 치료여부와 ICU 입원여부가 통계적으로 의미 있는 사망에 영향을 미치는 인자였다. 결론: 장알균 균혈증의 원인병소는 복강내 감염과 원발성 균혈증이 가장 많았다. 기저 질환으로는 고형암이 가장 많았고, 2/3 정도가 병원 획득감염이었다. 혈액에서 장알균만 단독으로 배양된 경우 항생제 사용의 적절성 보다는 이전 항생제 치료여부와 중환자실 입원 여부가 의미는 예후인자였다.

장구균 균혈증에서의 예후 인자

천신혜,정현,손경목,김연숙 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

증례 : 감염 ; 귀밑샘 양성 림프상피낭으로 발현한 사람면역결핍바이러스 감염 1예

천신혜 ( Shin Hye Cheon ),나선희 ( Sun Hee Na ),남은영 ( Eun Young Nam ),이명진 ( Myoung Jin Lee ),정영희 ( Young Hee Jung ),김문석 ( Moon Suk Kim ),김남중 ( Nam Joong Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1

저자들은 귀밑샘의 양성 림프상피낭이 단서가 되어 HIV 감염을 확정 진단한 환자를 경험하여 이를 보고한다. Benign lymphoepithelial cysts are rare, and are associated with swelling of the salivary glands (usually the parotid gland). The cytopathological features include lymphoid hyperplasia with an epithelial component, exhibiting cystic and proliferative changes. Development of a benign lymphoepithelial cyst commonly precedes acquisition of acquired immunodeficiency syndrome, but may also be the initial clinical manifestation of human immunodeficiency virus (HIV) infection. A 43 year-old male presented with a slowly growing multilocular cystic mass in his right cheek. Computed tomography of the neck revealed a well-circumscribed cystic lesion in the bilateral parotid glands. A provisional diagnosis of a benign lymphoepithelial cyst associated with HIV infection was made, and Western blotting confirmed the HIV infection. Three months after initiation of antiretroviral therapy, the parotid swelling was completely resolved. We report this case to suggest that clinicians should consider the possibility of HIV infection when patients present with benign lymphoepithelial cysts of the parotid gland. (Korean J Med 2015;88:106-109)

증례 : 위험인자가 없는 환자에서 발생한 Serratia grimesii에 의한 감염성 척추염 1예

천신혜 ( Shin Hye Cheon ),손경목 ( Kyung Mok Sohn ),김연숙 ( Yeon Sook Kim ),정현 ( Hyeon Jung ),은혁수 ( Hyuk Soo Eun ),최승원 ( Seung Won Choi ),구선회 ( Sun Hoe Koo ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1

Serratia에 의한 감염은 대부분 병원 시술이나 수술 혹은 면역 저하와 관련되어 있다. 인간 감염을 일으키는 것으로 S. marcescens가 가장 흔하고 S. liquefaciens도 종종 문제가 된다. 그러나 S. gimesii에 의한 감염 혹은 지역사회 획득 Serratia 척추염은 보고된 적이 없다. 저자들은 고혈압 외에는 건강하게 지내던 환자에서 발생한 경막외 고름을 동반한 S. grimesii에 의한 척추 골수염을 경험하였다. 고름 제거 후 항생제 치료로 호전되어 문헌고찰과 함께 보고하는 바이다. Vertebral osteomyelitis or paraspinal abscess caused by Serratia species is rare and has been reported only in certain groups of people, such as intravenous drug users, immunocompromised hosts, and patients who have undergone invasive procedures. However, we report here that Serratia was recovered from a patient with vertebral osteomyelitis and epidural abscess without predisposing factors. The organism was initially identified as Serratia liquefaciens by a Vitek II-based assessment. It was finally identified as Serratia grimesii by 16S rRNA gene sequence analysis. We present the first case of vertebral osteomyelitis caused by S. grimesii in a patient without risk factors and who was managed successfully.

당뇨병 환자에서 건강 문해력, 당뇨병 지식과 혈당조절의 상관관계

천신혜 ( Shin Hye Cheon ),나상규 ( Sang Kyu Na ),김하윤 ( Ha Yoon Kim ),임희경 ( Hee Kyung Lim ),최민규 ( Min Kyu Choi ),노용균 ( Yong Kyun Roh ) 대한의료커뮤니케이션학회 2015 의료커뮤니케이션 Vol.10 No.2

Purpose: Patients with limited health literacy usually have less disease-related knowledge, and consequently have poor health status. On the other hand, diabetes care requires complex course of strict medication and lifestyle changes to maintain appropriate glycemic levels and to prevent diabetic complications. We evaluated the association between health literacy, diabetes knowledge and glycemic control among diabetic patients. Methods: A cross-sectional study of 84 enrollees who were older than 30 years and had type 2 diabetes was conducted in a university hospital. Health literacy was measured using the short form of Newest Vital Sign (NVS), and diabetes knowledge measured using one of the two parallel diabetes knowledge tests. Participants were interviewed to determine participants’ characteristics, and HbA1c levels were identified from the clinical database of Hallym University Kang Nam Sacred Heart Hospital to assess glycemic control. Results: The mean score of health literacy was 1.8 (±1.9) and mean score of diabetes knowledge was 12.0 (±4.1). Only 23.8% of participants had adequate literacy. After adjusting sociodemographic characteristics, duration of diabetes, and treatment regimen, diabetes knowledge and health literacy were not independently associated with HbA1c levels. Only significant factor of glycemic control was duration of diabetes (r=0.489, p<0.001). Conclusion: Among patients with type 2 diabetes, health literacy and diabetes knowldege were not independently associated with glycemic control. Better strategies are needed to improve glycemic control.

복부비만과 저녁식사 및 야식의 비율과의 관계

나상규,천신혜,최예진,이해정,노용균,최민규 대한비만학회 2016 The Korean journal of obesity Vol.25 No.2

배경: 비만은 각종 성인병의 위험요인이다. 최근 칼로리의 절대 양뿐만이 아니라 세 끼 식사의 비율에 따른 비만도를 알아보고자 하는 연구들이 많이 발표되고 있는 추세이다. 본 연구는 한국인 일반인구 집단에서 저녁식사 및 야식의 비율에 따른 복부비만의 차이를 봄으로써 저녁식사 및 야식의 비율과 비만과의 관계를 알아보고자 한다. 방법: 분석 대상 인원은 총 15,757명(평균나이 44.6세)이었다. 허리둘레에 의한 복부비만의 기준은 남자 90 cm 이상, 여자 85 cm 이상으로 정의하였다. 저녁식사 및 야식은 오후 6시부터 새벽 2시까지 식사를 한 경우로 정의하였다. 저녁식사 및 야식의 칼로리를 하루 중 섭취한 총 칼로리로 나누어 5분위수로 구분하였다. 비만에 영향을 줄 수 있는 각종 사회인구학적 변수와 건강 생활습관 변수를 보정하여 로지스틱 회귀분석모델로 저녁식사 및 야식과 복부비만과의 관련성을 확인하였다. 결과: 전체 인원에서 하루 섭취한 전체 칼로리 중에서 저녁식사 및 야식의 칼로리 비율에 따른 1분위수와 2, 3, 5분위수를 비교했을 때 통계적으로 의미 있는 복부비만도 차이가 있었다(Odds ratio: 1.19, 1.25, 1.21). 평소 아침식사를 하지 않는 군과 하는 군 각각에서 비교를 했을 때 아침식사를 하지 않는 군에서는 통계적으로 의미 있는 차이를 얻을 수 없었다. 아침식사를 하는 군에서는 모두 통계적으로 의미 있는 복부비만도 차이를 얻을 수 있었다(Odds ratio: 1.28, 1.30, 1.22, 1.21). 결론: 전체 하루 섭취 칼로리 중 저녁식사 및 야식의 칼로리 비율을 권장 칼로리의 1/2 수준으로 낮추면 복부비만의 위험이 감소한다.

지역 사회에서 발생한 ESBL 생성 E. coli에 의한 치골결합 골수염 1예

손경목,김연숙,천신혜,정현,구선회,황득수 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.3

Osteomyelitis of the pubic symphysis or pubic osteomyelitis is a rare disease entity. Predisposing factors include trauma, pelvic or urologic surgery, intravenous drug abuse, pelvic malignancy, parturition and cardiac catheterization. Pathogens vary depending on the risk factors. The most frequent causative organism is Staphylococcus aureus . Gram-negative bacteria such as Pseudomonas aeruginosa and Escherichia coli are also common pathogens. However, pubic osteomyelitis due to community-onset extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has not previously been described. We present a patient with pubic osteomyelitis caused by ESBL-producing Escherichia coli without known predisposing factors except for diabetes.

Higher Risk for All-cause Mortality of Staphylococcus aureus Bacteremia in Patients with Non-Dialysis Dependent Chronic Kidney Disease

김연숙,김정옥,천신혜,손경목 대한감염학회 2020 Infection and Chemotherapy Vol.52 No.1

Background: Staphylococcus aureus bacteremia (SAB) is a common and serious infection with a high mortality. Patients with chronic kidney disease (CKD) are vulnerable to SAB, but there have been few studies performed on the clinical characteristics and outcomes of SAB in CKD patients stratified by dialysis. We aimed to estimate the all-cause mortality and identify its predictors in patients with CKD. Materials and Methods: We conducted a retrospective study on the patients with SAB hospitalized in a tertiary care center in Korea between March 2014 and December 2018. Kaplan-Meier analysis was performed to compare all-cause mortality following SAB among patients with non-dialysis dependent CKD (ND-CKD), those receiving dialysis, and those without CKD (non-CKD). The predictors of mortality among CKD patients were analyzed by Cox proportional hazards regression. Results: As a total, 278 SAB of 43 ND-CKD (31 males), 58 dialysis (39 males), and 177 nonCKD (112 males) patients were included. The 30-day mortality was 39.5% in ND-CKD, 27.6% in dialysis, and 7.9% in non-CKD patients. The hazard ratio of all-cause mortality following SAB in ND-CKD was 2.335 (95% confidence interval, 1.203 – 4.531; P = 0.003), compared to non-CKD patients. For methicillin-resistant S. aureus bacteremia (MRSAB), the hazard ratio of all-cause mortality in ND-CKD was 2.628 (95% CI, 1.074 – 6.435; P = 0.011), compared to dialysis patients. Appropriate antibiotics <48 h was independently related to improved survival following SAB among ND-CKD (adjusted HR, 0.304; 95% CI, 0,108 – 0.857; P = 0.024) and dialysis (adjusted HR, 0.323; 95% CI, 0,116 – 0.897; P = 0.030) patients. Conclusion: ND-CKD patients demonstrated poor outcome following SAB and administration of appropriate antibiotics within 48 h could reduce the risk for mortality.

고령의 정상면역 환자에서 척추성형술 후에 발생한 Mycobacterium intracellulare에 의한 척추골수염

김민성,박찬걸,손경목,송창헌,천신혜,김연숙 대한노인병학회 2016 Annals of geriatric medicine and research Vol.20 No.1

Mycobacterium avium complex (MAC) comprises M. intracellulare and M. avium. MAC usually causes pulmonary diseases in individuals with intact immunity, disseminated disease in patients with acquired immunodeficiency syndrome, and cervical lymphadenitis. It can also cause cutaneous disease, but musculoskeletal infection is rare. Herein, we present a case of vertebral osteomyelitis due to M. intracellulare in an elderly immunocompetent patient who underwent vertebroplasty. The patient was successfully treated with antimycobacterial drugs without surgical intervention. MAC should be considered as a causative pathogen of vertebral osteomyelitis when the patient has a history of vertebroplasty.

Experimental and Mathematical Optimization of a Pooling Test for Detection of SARS-CoV-2 in a Population with Low Viral Load

Jeong Hyeongseok,Lee Jooyeon,천신혜,손경목,김정옥,Kym Sungmin,김연숙 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.1

Background: A pooling test is a useful tool for mass screening of coronavirus disease 2019 (COVID-19) in the pandemic era. We aimed to optimize a simple two-step pooling test by estimating the optimal pool size using experimental and mathematical validation. Materials and Methods: Experimental pools were created by mixing one positive respiratory sample with various numbers of negative samples. We selected positive samples with cycle threshold (Ct) values greater than 32 to validate the efficiency of the pooling test assuming a high likelihood of false-negative results due to low viral loads. The positivities of the experimental pools were investigated with a single reverse-transcription polymerase chain reaction (RT-PCR) using the U-TOP™ COVID-19 Detection Kit Plus (Seasun Biomaterials, Daejeon, Korea). We used the Dorfman equation to calculate the optimal size of a pooling test mathematically. Results: Viral RNA could be detected in a pool with a size up to 11, even if the Ct value of a positive sample was about 35. The Dorfman equation showed that the optimal number of samples in a pool was 11 when the prevalence was assumed to be 0.66% based on the test positivity in Daejeon, Korea from April 1, 2020 to November 10, 2020. The efficiency of the pooling test was 6.2, which can save 83.9 of 100 individual tests. Conclusion: Eleven samples in a pool were validated optimal experimentally assuming a prevalence of 0.66%. The pool size needs modification as the pandemic progresses; thus, the prevalence should be carefully estimated before pooling tests are conducted.