• 기본간호학회지
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• 제19권2호
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• pp.212-222
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• 2012

Purpose: The purpose of this study was to examine the effects of infection control education for families of patients infected with vancomycin resistant enterococcus (VRE). Method: Forty family members of VRE patients were chosen from a university hospital and assigned to the experimental or control group. The experimental group was provided infection control education that consisted of one-on-one instruction using an information booklet, hand-washing video, and demonstration of hand washing practice. Dependent variables were self-reported knowledge and performance of VRE infection control measures, and the number of hand washings when entering and leaving patients' rooms. Results: Knowledge and performance scores were significantly higher for the experimental group compared to the control group. The experimental group washed their hands significantly more often when entering and leaving patients' rooms than the control group. Conclusion: Infection control education for family members of VRE patients was effective in improving knowledge and performance of infection control measures as well as improving the practice of hand washing. Further investigation is needed on the effects of infection control education for families on the actual VRE colonization and/or infection rate.

• 약학회지
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• 제43권2호
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• pp.160-168
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• 1999

The purpose of this study was to determine pharmacokinetic parameters of vancomycin using peak and trough plasma level (PTL) and Bayesian analysis in 20 Korean normal volunteers, 16 gastric cancer and 12 lymphoma patients and also using the compartment model dependent (nonlinear least squares regression: NLSR) and compartment model independent (Lagrange) analysis in 10 ovarian cancer patients. Nonparametric expected maximum (NPEM) algorithm for calculation of the population pharmacokinetic parameters was used, and these parameters were applied for clinical pharmacokinetic parameters by Bayesian analysis. Vancomycin was administered as dose of 1.0 g every 12 hrs for 3 days by IV infusion over 60 minutes in normal volunteers, gastric cancer and lymphoma patients. Population pharmacokinetic parameters, K and Vd in gastric cancer and lymphoma patients using NPEM algorithm were $0.158{\pm}0.014{\;}hr^{-1},{\;}0.630{\pm}0.043{\;}L/kg{\;}and{\;}0.131{\pm}0.0261{\;}hr^{-1},{\;}0.631{\pm}0.089{\;}L/kg$ respectively. The K and Vd in gastric cancer and lymphoma patients using Bayesian analysis were $0.151{\pm}0.027,{\;}0.126{\pm}0.056{\;}hr^{-1}{\;}and{\;}0.62{\pm}0.105,{\;}0.63{\pm}0.095{\;}L/kg$. The K and Vd in ovarian cancer patient using the NLSR and Lagrange analysis were $0.109{\pm}0.008,{\;}0.126{\pm}0.012{\;}hr^{-1}{\;}and{\;} 0.76{\pm}0.08,{\;}0.69{\pm}0.19{\;}L/kg$, respectively. It is necessary for effective dosage regimen of vancomycin in cancer patients to use these population parameters.

• 한국임상약학회지
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• 제6권2호
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• pp.1-6
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• 1996

Carcadian rhythm dependence of vancomycin pharmacokinetics was evaluated in 5 normal volunteers receiving a single intravenous 1.0 g dose of vancomycin at 8 o'clock in the morning and another occasion at 8 o'clock in the evening in a crossover manner. The serum data were subjected to simultaneous computer nonlinear least squares regression analysis using a two-compartment pbarmacokinetic model. The mean half-life of vancomycin was $4.78\pm0.81$ hr in the morning and $4.25\pm0.51$ hr in the evening. The mean total body clearance of vancomycin was $1.29\pm0.58$ hr in the morning and $5.58\pm0.48$ hr in the evening. No circadian rhythm was found to be apparent in normal volunteers. The mean in intrasubject difference in the half-life between 8 A.M. and 8 P.M. was $15.4\%$ with fluctuations ranging from $10.4\sim33.8\%$, It is reasonable to consider individual circadian rhythm for effective dosage regimen of vancomycin in clinical chronotherapeutics.

• 한국임상약학회지
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• 제9권2호
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• pp.88-91
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• 1999

The purpose of this study was to compare the pkarmacokinetic parameters of vancomycin using a 2-compartment model in 8 Korean healthy volunteers and 8 lymphoma patients. Vancomycin (1.0 g) was administered by IV infusion over 60 minutes. The $\beta-phase$ rate constant $(\beta)$, apparent volume of distribution at steady srate $(V_{ss})$, total body clearance (CL) and area under the plasma level-time curve (AUC) of vancomycin in healthy volunteers were $0.15\pm0.02\;hr^{-1},\;33.8\pm4.12\;L/kg,\;5.36\pm0.61\;L/hr\;and\;185.8\pm20.5\;{\mu}g/ml{\cdot}hr$, respectively. The corresponding values in lymphoma patients ere $0.09\pm0.02\;hr^{-1},\;38.2\pm5.11\;L/kg,\;4.58\pm0.52\;L/hr\;and\;218.3\pm22.9\;{\mu}g/ml{\cdot}hr$. There were significant differences (p<0.05) in ${\beta}$ and CL between healthy volunteers and lymphoma patients.

• 약학회지
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• 제57권1호
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• pp.32-36
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• 2013

The purpose of this study was to determine the influence of assay error for improved pharmacokinetic modeling and simulation of vancomycin on the Bayesian and nonlinear least squares regression analysis in 24 Korean gastric cancer patients. Vancomycin 1.0 g was administered intravenously over 1 hr every 12 hr. Three specimens were collected at 72 hr after the first dose from all patients at the following times, at 0.5 hr before regularly scheduled infusion, at 0.5 hr and 2 hr after the end of 1 hr infusion. Serum vancomycin levels were analyzed by fluorescence polarization immunoassay technique with TDX-FLX. The standard deviation (SD) of the assay over its working range had been determined at the serum vancomycin concentrations of 0, 20, 40, 60, 80 and $120{\mu}g/ml$ in quadruplicate. The polynomial equation of vancomycin assay error was found to be SD $({\mu}g/ml)=0.0224+0.0540C+0.00173C^2$ ($R^2=0.935$). There were differences in the influence of weight with vancomycin assay error on pharmacokinetic parameters of vancomycin using the nonlinear least squares regression analysis but there were no differences on the Bayesian analysis. This polynomial equation can be used to improve the precision of fitting of pharmacokinetic models to optimize the process of model simulation both for population and for individualized pharmacokinetic models. The result suggests the improvement of dosage regimens for the better and safer care of patients receiving vancomycin.

• 한국임상약학회지
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• 제11권1호
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• pp.1-6
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• 2001

This research is conducted to evaluate the clinical and economic benefits from therapeutic drug monitoring(TDM) service on vancomycin in a tertiary general hospital. Total 99 pairs of steady state peak and trough concentrations of vancomycin were obtained from 73 patients. To see the clinical benefits, the appropriateness of vancomycin dosing before TDM was evaluated. In 72 pairs of vancomycin blood concentrations obtained prior to TDM consultation, $47.2\%$ of the cases had reached within therapeutic range. Serum vancomycin levels in patients with $40{\leq}CLcr<60$ (ml/min) were higher and than the levels in patients with 40>CLcr and $60{\leq}CLcr$ (ml/min). Dose reduction rate in patients with creatinine clearance $40{\leq}CLcr<60$ (ml/min) were also significantly higher than those of compared groups ($61.5\%$, p=0.0138). Serum vancomycin concentrations were re-obtained from 21 patients who received modified dose through TDM service. Ninety percent (19/21cases) of them were within the target therapeutic range. For the evaluation of economic benefits from TDM consultation, estimated cost savings were calculated in those patients. The total drug saving were 586 vials in 21 patients. The calculated mean cost saving from the drugs was 314,570 won (range: $11,273\sim473,466)$ per patient. The study revealed that TDM service for vancomycin is necessary because empirical dosing is not effective for obtaining therapeutic drug level, especially patients with mild renal insufficiencies. The cost saving from TDM is also beneficial for the patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권6호
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• pp.672-676
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• 2000

One of the current treatment methods for chronic osteomyelitis is removal of the infected and necrotic tissue to reduce the bacterial concentration as much as possible. This is performed concomitantly with antibiotic therapy. Chronic osteomyelitis(C.O.) implies chronic ischemia of the diseased bone. Thus, the treatment for C.O. requires high systemic level of antibiotics. In some cases, however, inherent undesirable adverse effects(for example, nephrotoxicity, ototoxicity, and others) may render this course of treatment difficult. Knowing that residual monomers are released from hardened bone cement, installation of antibiotic-impregnated PMMA(polymethyl-methacrylate) beads in situ have been one of treatment methods of C.O. When introduced into the wound, they established an exceedingly high level of local antibiotics for prolonged period without high systemic level of antibiotics. We experienced favorable results with vancomycin-impregnated PMMA beads for the treatment of C.O. of the mandible. So, we report it with literature reviews.

• 약학회지
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• 제41권2호
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• pp.195-202
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• 1997

The purpose of this study was to determine pharmacokinetic parameters of vancomycin using two point calculation(TPC) and Bayesian methods in 16 Korean normal volunteers and 15 g astric cancer patients. Nonparametric expected maximum(NPEM) algorithm for calculation of population pharmacokinetic parameter was used, and these parameters were applied for clinical pharmacokinetic parameters by Bayesian analysis. Vancomycin was administered 1.0g every 12 hrs for 3 days by IV infusion over 60 minutes. The volume of distribution(Vd), elimination rate constant(Kel) and total body clearance(CLt) of vancomycin in normal volunteers using TPC method were $0.34{\pm}0.06 L/kg,\; 0.19{\pm}0.01 hr^{-1}$ and $4.08 {\pm} 0.93 L/hr$, respectively, The Vd, Kel and CLt of vancomycin in gastric cancer patients using TPC method were $0.46 {\pm} 0.06 L/kg, 0.17{\pm}0.02 hr^{-1}$ and $4.84 {\pm} 0.57 L/hr$ respectively. There were significant differences(p<0.05) in Vd. Kel and CLt between normal volunteers and gastric cancer patients. Polpulation pharmacokinetic parameter, the slope(KS) of the relationship beetween Kel versus creatinine Clearance, and the Vd were $0.00157{\pm}0.00029(hr{\cdot}mL/min/1.73m^2)^{-1},\; 0.631 {\pm} 0.0036 L/kg$ in gastric cancer patients using NPEM algorithm respectively. The Vd and Kel were $0.63{\pm}0.005 L/kg, 0.15 {\pm}0.027 hr^{-1}$ for gastric cancer patients using Bayesian method. There were significant differences(p<0.05) in vancomycin pharmacokinetics between Bayesian and TPC methods. It is considered that the population parameter in the patient population is necessary for effective Bayesian method in clinical pharmacy practise.

• Pediatric Infection and Vaccine
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• 제17권1호
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• pp.1-8
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• 2010

목 적:부산대학교병원 신생아 중환자실에서 2006년 3월 VRE 유행이 나타나 입원 환아를 대상으로 대변VRE 감시 배양을 시행하였다. 본 연구는 VRE 감염의 정착정도를 파악하고, 위험인자를 분석하여 향후 VRE의 출현을 예방하고자 본 연구를 시행하였다. 방 법: 2006년 3월부터 2007년 3월까지 본원 신생아 중환자실 환아 192명을 대상으로 주 1회 대변 감시배양 검사를 시행하였다. VRE가 분리된 환아의 위험인자를 규명하고자 성별, 재태 기간, 기저 질환, 이전 치료에 사용된 항생제의 종류, 침습적 처치의 유무 등을 의무기록을 바탕으로 후향적으로 조사하였다. 결 과:총 192명의 환아 중 VRE 양성군은 48명(25%), VRE 음성군은 189명(75%)이었다. VRE 양성 환아 중 본원 출생아는 12명(25.0%), 타병원 출생아는 36명(75.0%)이었다. VRE 양성 환아의 기저 질환으로는 선천성 심질환이 25명(52.1%)으로 VRE 양성 빈도가 유의하게 높았다(P =0.005). 항생제 중 VRE 양성군에 서 3세대 cephalosporin 사용(45.8% vs. 15.3%, P < 0.001)과 vancomycin 사용(95.8% vs. 40.9%, P < 0.05)의 기왕력이 통계적으로 유의하게 높음을 알 수 있었다. 또한 VRE 양성군에서 중심 정맥 도관(41.7% vs. 15.3%, P <0.001)이나 인공 호흡기(41.7% vs 25.0%, P =0.017)를 사용한 예가 많았고, 수술 여부(41.7% vs 16.7%, P =0.001)나 흉관 삽입의 기왕력(10.4% vs 2.7%, P =0.021)이 통계적으로 유의하게 높았다. VRE양성군 48명 중 11명(22.9%)에서 VRE 음전을 확인 하였고 VRE의 음전기간의 중앙값은 101일 이었다. 결 론: VRE 감염은 신생아 중환자실에서 중요한 원내 감염으로 부각되고 있다. 이러한 VRE 집락을 차단하기 위해서는 철저한 감염 관리와 격리를 해야 하며 침습적인 기구의 사용 및 불필요한 항생제의 사용을 줄이려는 노력이 필요하다.

• Clinical and Experimental Pediatrics
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• 제53권2호
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• pp.173-177
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• 2010

목 적 : MRSA는 대부분의 항생제에 강한 내성을 가지고 있어 감염시 극히 제한된 항생제로만 치료가 가능하며 종종 합병증을 동반한다. 저자들은 신생아에서 합병증이 동반된 MRSA 균혈증의 위험요소들을 알아보고자 하였다. 방 법 : 2002년 1월부터 2007년 12월까지 6년간 부산대학교 병원 신생아 중환자실에 입원한 환아들 중 MRSA 균혈증으로 확인된 44명을 대상으로 후향적 연구를 실시하였다. 합병증은 수막염, 감염 심내막염, 폐렴, 폐공기낭종, 패혈성 관절염, 지속성 균혈증으로 정의하였다. 결 과 : 1) 총 44명의 환아 중 남자는 31명(70.5%), 여자는 13명(29.5%) 이었으며, 평균 재태 주수는 $33.2{\pm}4.9$주, 평균 출생체중은 $1,919{\pm}962.2g$, 인공호흡기 치료를 받은 환아는 21명(47%), 평균 치료기간은 $8.8{\pm}13.8$일이었다. 2) 합병증이 생긴 환아는 13명(29.5%), 합병증이 생기지 않은 환아는 31명(70.5%) 이었다. 3) 두 군간의 재태 주수, 출생 시 체중, 첫 수유시작 날짜, 인공호흡기 치료 유무와, 제대혈관도관 유무, 중심 정맥도관 유무, 기저 질환 유무, 반코마이신의 초기사용 여부, 수혈유무를 변수로 하여 합병증 발생과의 연관성을 조사하였고 기저질환이 있는 경우와 수혈을 한 경우에서 합병증 발생이 유의하게 증가함을 보였다(P <0.05). 결 론 : 합병증이 동반된 MRSA 균혈증은 기저질환이 동반된 경우와 수혈을 한 경우 유의하게 증가하였다. 균 배양검사와 항생제 감수성 결과가 나오기 전 반코마이신을 초기에 사용한 경우 합병증을 동반한 MRSA 균혈증의 발생빈도와는 관계가 없었으며 더 정확한 결과를 위해서 대규모의 전향적 연구가 필요할 것으로 생각된다.