3개월 이하 영아기 열성 요로감염증에 대한 임상적 관찰

은병욱,정유미,강희경,하일수,정해일,이환종,최용,Eun, Byung Wook,Chung, Yoo Mi,Kang, Hee Gyung,Ha, Il Soo,Cheong, Hae Il,Lee, Hoan Jong,Choi, Yong 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.3

Purpose : To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis Methods : Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of ${\geq}10^5$ colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study. Results : The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%. Conclusion : Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.

임신전 여성의 감염관리 및 필수 예방접종

은병욱 한국모자보건학회 2009 한국모자보건학회 학술대회 연제집 Vol.2009 No.2

신생아중환자실 감염관리 국내 표준지침

은병욱 한국모자보건학회 2018 한국모자보건학회 학술대회 연제집 Vol.2018 No.2

The changing landscape of pediatric infectious diseases before, during, and after the COVID-19 pandemic

은병욱 한국아동간호학회 2025 Child Health Nursing Research Vol.31 No.2

장구균에 의한 소아 균혈증 : 50예에 대한 분석 A Review of Fifty Episodes in a Pediatric Hospital

은병욱,정은희,김영지,김제학,이환종 대한감염학회 2003 감염과 화학요법 Vol.35 No.3

목적 : 미국에서는 지난 15년간 장구균(enterococcus)에 의한 균혈증이 증가하고 있는 추세이지만, 국내에서 특히 소아 연령에서는 이에 대한 체계적인 연구가 미흡하다. 이에 본 연구에서는 장구균에 의한 소아 균혈증의 역학과 임상 경과 등을 분석하였다. 방법 : 서울대학교 어린이병원에서 1992년 11월부터 2001년 8월까지 9년간 진단된 장구균 균혈증 50예의 임상적, 미생물학적 자료를 후향적으로 분석하였다. 결과 : 기저 질환은 47예(94%)에서 관찰되었으며 심장 또는 복부 수술이 44%, 심질환이 30%, 만성 소화기계 질환이 16% 등이었다. 38예(76%)는 병원내 감염이었고 14예(28%)는 중복감염이었다. 균혈증의 원발병소가 16예(32%)에서 발견되었으며 중심정맥용 도관이 가장 많았다. 47예에서 장구균의 종을 밝혔으며 Enterococcus faecium이 20예, Enterococcus faecalis이 26예, Enterococcus avium이 1예 있었다. E. faecium의 72%가 ampicillin에 내성이었다. Gentamicin과 streptomycin에 고도내성을 보인 균주가 각각 36균주(80%)와 15균주(36%)였다. Vancomycin에 내성인 균주는 없었다. 임상경과를 세 가지로 분류할 수 잇었다. 자연 호전되는 균혈증 : 20%, 적절한 치료로 양호한 예후를 보인 경증의 패혈증 : 42%, 중증의 장기간의 감염 : 30%, 미분류군 : 8%, 전체 사망률은 10.8%였다. 결론 : 소아 장구균 균혈증은 병원내 감염에 의한 경우가 대부분이었으며, 대다수가 중증의 기저 질환을 갖고 있었고 임상 경과가 이질적인 군이 있었다. 그리고 균혈증을 일으킨 장구균은 높은 빈도에서 gentamicin에 고도내성을 보였다. Background: Episode of Enterococcal bacteremia has increasingly been reported for the past 15 years in USA, but there have been few systematic studies on its occurrence among Korean children. This study was carried out to determine the epidemiologic, clinical and laboratory characteristics of enterococcal bacteremia in Korean children. Methods: Fifty episodes of enterococcal bacteremia among Korean children were retrospectively analyzed. Clinical and microbiological data were collected for all episodes of enterococcal bacteremia which occurried during 9-year period between November, 1992, and August, 2001 at the Seoul National University Children's Hospital. Results: Significant underlying diseases were present in 47 (94%) episodes, including cardiac or abdominal surgery (44%), cardiac disease (30%), and chronic gastrointestinal disorders (16%). Thirty-eight (76%) episodes were nosocomial in origin, and 14 (28%) episodes were polymicrobial bacteremia. The source of bacteremia was identified in 16 (32%) episodes, intravascular device being the most common identifiable source. Of the 47 isolates identified at species level, 20 strains were Enterococcus faeciurn, 26 Enterococcus faecalis and one Enterococcus avium. Seventy-two percent of E. faecium cases were resistant to ampicillin. 36 cases (80%) had high-level resistance to gentamicin and sixteen cases (36%) to streptomycin. There was no strain resistant to vancomycin. Three clinical patterns were identified; self-limited bacteremia, 20%; low grade sepsis with favorable outcome after specific therapy, 42%; severe and prolonged infection, 30%; and unclassified, 8%. The overall mortality rate was 10.8%. Conclusion: Enterococcal bacteremia in children was usually nosocomial and comprised a heterogeneous group. The majority of cases occurred in children with serious underlying diseases. The frequency of high-level resistance to gentamicin in enterococcal isolates was high.

소아 및 청소년 결핵의 특징

은병욱 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.5

In childhood tuberculosis, it is possible to clearly distinguish among three basic stages: exposure, infection, and disease. The incidence of tuberculosis in children is low compared with that in adults, but latent infection is a major concern because children, who are exposed to Mycobacterium tuberculosis especially early in childhood, are at increased risk of developing the disease. Younger children particularly infants have a high relative risk of miliary or meningeal disease. The clinical manifestations of childhood tuberculosis differ noticeably from those of the disease seen in adults. Adolescents with tuberculosis have different demographic and clinical features from those of adults or children. Tuberculosis in adolescents has become relatively more important as the incidence of infection in childhood has decreased.

장구균에 의한 소아 균혈증 : 50예에 대한 분석

은병욱,정은희,김영지,김제학,이환종 대한감염학회 2003 Infection and Chemotherapy Vol.35 No.3

소아청소년 영역에서의 새로운 항미생물제

은병욱 대한소아감염학회 2009 Pediatric Infection and Vaccine Vol.16 No.1

There are relatively few novel antimicrobial agents despite the dramatic increase in antimicrobial resistance and multiple drug resistance of clinical isolates worldwide. Vancomycin is still the most widely used antibiotic for treating resistant Gram-positive coccal infections in children, especially for methicillin-resistant Staphylococcus aureus. For children with Gram-positive coccal infections where vancomycin is not effective or older therapeutic agents cannot be tolerated, linezolid, quinupristin-dalfopristin or daptomycin may be useful in the appropriate clinical setting. For Gram-negative bacterial infections, new carbapenems await clinical application. Tebipenem pivoxil is a novel oral carbapenem undergoing clinical trials for acute otitis media in pediatric patients. Antiviral drug development is now progressing at the pace of antibiotic development 30 years ago. Newer antiviral agents used for the treatment of herpes viruses and hepatitis C virus infections in children are included in this review.

소아에서 신이식후 발생한 Posttransplant Lymphoproliferative Disease(PTLD) 1례

은병욱,박은실,이성용,한혜원,장주영,박경미,김철우,강진한,고재성,하일수,이환종,정해일,서정기,Eun, Byung-Wook,Park, Eun-Sil,Lee, Seong-Yong,Hahn, Hye-Won,Jang, Ju-Young,Park, Kyung-Mi,Kim, Chul-Woo,Kang, Gin-Han,Ko, Jae-Seong,Ha, Il-Soo,Lee, 대한소아신장학회 2002 Childhood kidney diseases Vol.6 No.1

Posttransplant lymphoproliferative disease (PTLD) represents a diverse lymphoproliferative disorder ranging front nonspecific reactive hyperplasia to malignant immunoblastic sarcoma developed in a setting of immunosuppression following organ or cellular transplantation. It is often associated with Epstein-Barr virus (EBV) infection and high dose immunosuppression. PTLD after renal transplantation was reported at first in adult in Korea in 1997. In children there have been several cases of PTLD after liver transplantation but PTLD after renal transplantation has not been reported. This is a case report of PTLD developed 4 months after renal transplantation in a 9-year-old boy. The major clinical manifestations were fever, multiple lymph nodes enlargement and blood-tinged stool. EBV was detected by in-situ hybridization in the enlarged cervical lymph node and the colonic tissue. Histological examination revealed B-cell lineage. Use of ganciclovir and reduction of the immunosuppression level resulted in complete remission of PTLD. This is the first pediatric case report of PTLD following renal transplantation in Korea. (J Korean Soc Pediatr Nephrol 2002 ; 6 : 123-30)

가와사끼병과 급성 호흡기 바이러스 감염증의 연관성에 관한 연구

조은영,은병욱,김남희,이진아,이환종,최정연,최은화 대한소아청소년과학회 2009 Clinical and Experimental Pediatrics (CEP) Vol.52 No.11

Purpose:The etiology of Kawasaki disease (KD) is still unknown. Recently, an association between human coronavirus NL63 (HCoV-NL63) and KD was implicated. Hence, we attempted to determine the association between KD and acute respiratory viral infections. Methods:Nasopharyngeal aspirate samples were obtained from 54 patients diagnosed with KD at the Seoul National University (SNU) Children’s Hospital and SNU-Bundang Hospital between October 2003 and September 2006. Viral diagnoses of 11 respiratory viruses were made using multiplex reverse transcriptase-polymerase chain reaction (RT-PCR): respiratory syncytial virus (RSV), adenovirus, rhinovirus (RV), parainfluenza viruses (PIVs) 1 and 3, influenza viruses (IFVs) A and B, human metapneumovirus (HMPV), human bocavirus (HBoV), HCoV OC43/229E, and HCoV-NL63. Clinical data were reviewed retrospectively. Results:The median age was 32 months (6 months-10.4 years). Respiratory symptoms were observed in 37 patients (69%). The following respiratory viruses were identified in 12 patients (22%): RV (n=4), PIV-3 (n=2), HBoV (n=2), and adenovirus, RSV, PIV-1, IFV-A, and HCoV-NL63 (n=1). Co-infection with PIV-3 and RV was observed in one patient. Respiratory symptoms were observed in 7 (58.3%) and 30 (71.4%) patients of the virus-positive and virus-negative groups (P> 0.05). Response rate to intravenous immunoglobulin administration was 67% (n=8) and 86% (n=36) in the virus- positive and virus-negative groups (P>0.05). Conclusion:Respiratory symptoms were commonly observed in KD patients but the association between respiratory viruses and KD were not found. Large multicenter-based investigations are required to confirm the association between acute respiratory viral infections and KD. 목 적:가와사끼병은 소아의 후천성 심질환의 가장 흔한 원인이나, 그 원인은 아직 밝혀지지 않았다. 최근 급성 호흡기 감염증의 원인 중 하나인 코로나바이러스(human coronavirus NL63)와 가와사끼병 발병과의 연관성이 제기된 바 있다. 이에 저자들은 급성 호흡기 바이러스 감염증과 가와사끼병의 발병 및 임상적 특징과의 연관성을 연구하고자 하였다. 방 법:2003년 10월부터 2006년 9월까지 서울대학교병원과 분당서울대학교병원에서 가와사끼병으로 진단받은 환자 54명으로부터 비인두 흡인물을 채취하여 총 11가지 호흡기 바이러스(호흡기 세포융합 바이러스, 아데노바이러스, 라이노바이러스, 파라인플루엔자 바이러스 1형 및 3형, 인플루엔자 바이러스 A형 및 B형, 메타뉴모바이러스, 보카바이러스, 코로나바이러스 OC43/229E 및 NL63)를 바이러스 배양검사 혹은 다중 역전사 중합 효소 반응(multiplex RT-PCR)로 검출하였다. 대상 환자들의 임상 양상은 후향적으로 검토하였다. 결 과:대상 환자들의 중앙 연령은 32개월(범위 6개월-10.4세)이었으며, 37례(69%)에서 발병 전에 호흡기 증상이 동반되었다. 호흡기 바이러스는 12례(22%)에서 검출되었으며, 라이노바이러스 4례, 파라인플루엔자 바이러스 3형 2례, 보카바이러스 2례, 그리고 아데노바이러스, 호흡기 세포융합 바이러스, 파라인플루엔자 바이러스 1형, 인플루엔자바이러스 A형, 코로나바이러스 NL63 각각 1례씩 검출되었다. 이 중 파라인플루엔자 바이러스 3형과 라이노바이러스가 중복 검출된 경우가 1례 있었다. 발병 전 호흡기 증상이 동반된 경우는 바이러스 양성군이 7례(58.3%), 음성군이 30례(71.4%)이었고, 정맥내 면역글로불린 1회 치료 후 해열된 경우는 바이러스 양성군이 8례(67%), 음성군이 36례(86%)로 나타났으며, 관상동맥 병변이 2개월 이상 지속된 경우는 바이러스 양성군이 2례(17%), 음성군이 4례(9.5%)이었으나, 모두 통계적으로 유의한 차이는 없었다. 결 론:본 연구에서는 가와사끼병 환자에서 호흡기 증상이 동반되는 경우가 흔하였으나, 특정 호흡기 바이러스와의 인과적 관계는 규명되지 않았다. 본 연구는 소규모 단일기관 연구로서, 향후 대규모 다기관 연구를 통하여 호흡기 바이러스 감염증과 가와사끼병의 연관성 및 예후에 미치는 영향이 검토되어야 할 것으로 보인다.