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소아의 요로감염증 환아에서 분리된 Escherichia coli의 ribotyping에 관한 연구
임애연,김순겸 고려대학교 의과대학 1996 고려대 의대 잡지 Vol.33 No.1
Urinary tract infections in childhood are very common and usually asymptomatic but can cause serious renal damage with relapses. It is important to recognize whether relapses are caused by bacterial persistence of the same strain in the urinary tract or not. Classical typing techniques using serotyping, antibiotic susceptibility patterns, and plasmid profiles have been used for strain differentiation in relapses, but the utility of these methods is notably limited because they may not be stably expressed under certain environmental or culture conditions. Recently, analysis of DNA polymorphism in the chromosomal regions containing the highly conserved rRNA genes, and referred to as ribotyping, has been widely used as a tool for epidemiological typing of various species of bacteria. To evaluate the utility of ribotyping analysis in strain differentiation of E. coli urinary isolates, the author analyzed ribotyping patterns, plasmid profiles, and antimicrobial susceptibility patterns of 34 E coli isolates from 32 children with urinary tract infections. The results are summarized as follows: 1. Twelve patterns were observed in antimicrobial susceptibility testing. 2. Plasmid were found in 7 of 34 subjects(21%). 3. EcoRI- and HindⅢ-digested ribotyping analysis demonstrated 21 and 14 ribotypes, respectively. 4. Three isolates collected at 7 and 34 day intervals from the same patient with vesicoureteral reflux showed identical EcoRI- and HindⅢ-digested ribotypes, respectively. The results indicate that ribotyping is a highly discriminatory and reproducible method for distinguishing E. coli strains isolated from children with urinary tract infections compared to plasmid profiles and antimicrobial susceptibility patterns. Thus, ribotyping analysis is clinically useful for the effective treatment of urinary tract infections in children.
중합 효소 연쇄반응을 이용한 Methicillin-내성 포도상구균의 검출에 관한 연구
심필섭,임애연,김순겸,이주원 고려대학교 의과대학 1996 고려대 의대 잡지 Vol.33 No.2
Recently, newly occurring, highly beta-lactam resistant strains of staphylococcus aureus. called methicillin-resistant staphylococcus aureus (MRSA) strains, have become common pathogens of nosocomial infections worldwide. Unfortunately, variable expressions of resistance and marked difference of resistance expression upon test conditions make routine susceptibility test methods are unreliable. A rapid and reliable test for the identification of methicillin-resistant staphylococci would be desirable so that appropriate therapy could be begun early, and expensive, toxic therapy could be avoided. Available data suggest that methicillin-resistant staphylococci of different species have mecA gene, the structural gene of resistance, in the 533-bp region. Recent progress in molecular biology, PCR, make it possible to amplify a specific target gene. In this study, we are trying to demon- strate that detection of mecA gene by PCR is useful for identifying MRSA, and applicate it clinically for early detection of MRSA. The results are summarized as follows; 1. Detection of mecA gene by PCR are 76 over 78 strains of methicillin-resistance and 1 over 33 strains of methicillin-susceptible staphyloicocci. 2. The result gave sensitivity, specificity, positive predictive value, and negative predictive value as 99%, 97, %, 98.7%, and 84.1% respectively. 3. Detection of mecA gene by PCR are 17 over 18 strains of methicillin- resistance and 4 over 16 strains of methicillin-sensitive coagulase negative staphylococci. 4. The result gave sensitivity, specificity, positive predictive value and negative predictive value as 94.4%, 75%, 81%, and 92.3% respectively. Detection of mecA gene by PCR for determining methicillin-resistance staphylococci was rapid, easily interpretable and accurate method.
소아 신질환 환자의 신기능 평가에 있어서 Cimetidine 효과에 대한 연구
이주원,김순겸,유기환,임애연,피대훈 대한신장학회 1994 Kidney Research and Clinical Practice Vol.13 No.3
To investigate whether the creatinine clearances using cimetidine approximate to true glomerular filtration rate, serum ceatinine concentration, creatinine clearance were analyzed in 33 children with renal diseases except acute diseases influencing on glomerular filtration rate, before and after cimetidine administration. Also, we evaluated that the ratios of the creatinine clearance (C ) to the glomerular filtration rate using Tc-DTPA scan (D+) approximate to unity. All patients had stable renal function and were received cimetidine 20 mg/kg p.o. four times daily for six days. The results were as follows. 1) Administration of cimetidine resulted in a significant increase (p$lt;0.01) in mean serum creatinine con centration and a significant reduction (p$lt;0.05) In mean creatinine clearance. 2) The mean ratio of C to Dpvp after ingestion of cimetidine approximated to unity significantly (p$lt;0.05). In conclusion, the cimetidine-aided creatinine clearance can be used as a reliable technique to evaluate renal function in children with various renal diseases.