• 미생물학회지
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• 제40권4호
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• pp.295-301
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• 2004

최근 extended-spectrum $\beta-lactamase$ 생산 임상 균주의 급속한 증가와 확산은 매우 심각한 문제를 야기하고 있다. 이에 국내에서 extended-spectrum $\beta-lactamase$ 생산 임상 균주의 발생율을 파악하고자 국내 한 대학병원에 입원한 환자로부터 대장균을 분리하여 항생제 감수성 검사를 실시하였다. 충 233균주 중 184균주 $(78.9\%)$가 ampicillin에 대해 내성을 나타냈으며, 80균주$(34.3\%)$가 cephalothin에, 93균주$(39.9\%)$가 gentamicin에, 64균주$(27.5\%)$가 norfloxacin에 대해 내성을 나타내었다. 이중 17균주$(7.3\%)$가 double disk synergy test에 의해 양성반응을 나타낸 것으로 확인되었고, 이들에 대해서 6가지 항생제에 대한 최소 억제 농도를 추가적으로 시험한 결과, 13 균주가 4가지 이상의 다른 계열의 항생제에 대한 다중 약제 내성인 것으로 나타났다. Isoelectric focusing gel electrophoresis에 의한 pI값과 DNA 염기서열을 분석한 결과 5균주가 TEM-1,1균주가 TEM-15,1 균주가 TEM-20,4균주가 TEM-52,2균주가 TEM-1과 AmpC, 1균주가 TEM-1과 OXA-30,1 균주가 TEM-1과 OXA-33,1 균주가 TEM-1, CTX-M-3, AmpC, 그리 고 1 균주가 AmpC를 생산하는 것으로 나타났으며, SHV를 생산하는 균주는 없었다. 이들의 항생제내성 유전자가 전달되는지 확인한 결과 동물로부터 분리된 대장균 (CCARM No.1203)에 extended-spectrum $\beta-lactamase$생산 유전자가 전달되는 것을 확인하였다. Random amplified polymorphic DNA와 pulsed field gel electrophoresis분석을 사용하여 genomic DNA에 대한 유전형을 분석한 결과 균주간의 유전적 연관성은 매우 낮은 것으로 나타나 한 병원에서 발견되는 균주는 clonal spread에 의한 것이라는 일반적인 보고와 다른 결과를 얻었다.

• 대한의생명과학회지
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• 제11권3호
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• pp.389-396
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• 2005

Resent studies have reported increased isolation of extended-spectrum $\beta-lactamase$ (ESBL) producing strains at several hospital in Korea. We studied to investigate the isolation rates of ESBL strains from clinical isolates of Klebsiella pneumoniae and to characterize differences in types using analyses of genotyping and antibiotic susceptibility test. Antibiotic susceptibility test with confirmation of ESBL by double disk synergy test was performed on the 54 ESBL strains of Klebsiella pneumoniae from a hospital in Busan. Transfer of resistant gene in ESBL strains resistant to 3rd generated antibiotics was confirmed by transconjugation test using E. coli $RG176^{nal(r)}$. blaTEM, blaSHV, blaCTX-M genes were detected by PCR. ESBL producing strains had 100% of resistant rate to ampicillin, azteronam, cefazolin, cefepime and ceftriaxone ($\beta-lactam$ antibiotics). Forty strains of bla TEM$(74\%)$, 41 strains of bla SHV $(76\%)$, 23 strains of bla CTX-M $(43\%)$ were found, respectively. The strains had one or more genes. They had high resistant rates to $\beta-lactam$ antibiotics including cephalosporin. The resistant rates of strains with multiple resistant genes were higher than those of strains with single resistant gene.

• Childhood Kidney Diseases
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• 제25권1호
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• pp.22-28
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• 2021

Purpose: The purpose of this study was to investigate the clinical outcomes of non-carbapenem treatment for urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) in young children. Methods: We retrospectively reviewed the medical records of children under 2 years of age who were diagnosed and treated for UTIs caused by ESBL-producing E. coli from September 2014 to March 2020. Results: Forty-three children under 2 years of age were treated with non-carbapenem antimicrobials for UTIs caused by ESBL-producing E. coli without bloodstream infections. The overall clinical and microbiological success rates for empirical antimicrobial treatment were 90.7% and 97.7%. Three of the patients (7.0%) experienced a relapse of UTI within a month. An in vitro susceptibility test showed that two patients were sensitive and one was resistant to the antimicrobial treatments. Furthermore, there were no significant differences in the time to defervescence, clinical success, microbiological success, and relapse rate between the susceptible (n=13) and non-susceptible groups (n=30). Conclusion: In this study, the overall relapse rate of patients treated with non-carbapenem antimicrobials was 7.0%. The patients showed high success rates in the clinical and microbiological responses to the non-carbapenems regardless of the results of the in vitro antimicrobial susceptibility test. These results provide evidence that non-carbapenems may be viable alternative treatments for UTIs caused by ESBL-producing E. coli.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권1호
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• pp.49-57
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• 2020

Objectives: This study aimed to understand the nationwide patterns of antibiotic prescription after tooth extraction in adult patients. Materials and Methods: This study analyzed dental records from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database on 503,725 tooth extractions performed in adults (≥19 years) during 2011-2015. Patient sex, age, household income, systemic disease (diabetes mellitus and hypertension), type of dental institution, region of dental institution, year of prescription, and type of tooth extraction procedure were considered. The antibiotic prescription rate and broad-spectrum antibiotic prescription frequency were analyzed using chi-squared tests. Factors affecting the prescription of broad-spectrum antibiotics were evaluated using multivariate logistic regression analysis. Results: The rate of antibiotic prescription after tooth extraction was 81.85%. Penicillin was most commonly prescribed (45.25%), followed by penicillin with beta-lactamase inhibitors (18.76%), metronidazole (12.29%), and second- to fourth-generation cephalosporins (11.52%). The proportion of broad-spectrum antibiotics used among all prescribed antibiotics was 45.88%. Conclusion: The findings of this study demonstrate that the rate of antibiotic prescription after tooth extraction is higher in Korea than in other countries. Furthermore, broad-spectrum antibiotics are used more frequently, which may indicate unnecessary drug prescription, an important contributor to antibiotic resistance.

• Clinical and Experimental Pediatrics
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• 제58권1호
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• pp.8-14
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• 2015

In patients with a language developmental delay, it is necessary to make a differential diagnosis for autism spectrum disorders (ASDs), specific language impairment, and mental retardation. It is important that pediatricians recognize the signs and symptoms of ASDs, as many patients with language developmental delays are ultimately diagnosed with ASDs. Pediatricians play an important role in the early recognition of ASDs, because they are usually the first point of contact for children with ASDs. A revision of the diagnostic criteria of ASDs was proposed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) that was released in May 2013. The autism spectrum describes a range of conditions classified as neurodevelopmental disorders in the fifth edition of the DSM. The new diagnostic criteria encompasses previous elements from the diagnosis of autistic disorder, Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder-not otherwise specified. An additional change to the DSM includes synthesizing the section on social and communication deficits into one domain. In ASD patients, the appropriate behavioral therapies and rehabilitation treatments significantly affect the prognosis. Therefore, this makes early diagnosis and treatment very important. In conclusion, pediatricians need to be able to recognize the signs and symptoms of ASDs and be attentive to them in order to make an early diagnosis and provide treatment.

• Clinical Endoscopy
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• 제55권4호
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• pp.540-548
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• 2022

Background/Aims: Colorectal polyps are removed to prevent progression to colorectal cancer. Polyp size is an important factor for risk stratification of malignant transformation. Endoscopic size estimation correlates poorly with pathological reports and several factors have been suggested to influence size estimation. We aimed to gain insight into the factors influencing endoscopic polyp size estimation. Methods: Images of polyps in an artificial model were obtained at 1, 3, and 5 cm from the colonoscope's tip. Participants were asked to estimate the diameter and volume of each polyp. Results: Fifteen endoscopists from three large-volume centers participated in this study. With an intraclass correlation coefficient of 0.66 (95% confidence interval [CI], 0.62-0.71) for diameter and 0.56 (95% CI, 0.50-0.62) for volume. Polyp size estimated at 3 cm from the colonoscope's tip yielded the best results. A lower distance between the tip and the polyp was associated with a larger estimated polyp size. Conclusions: Correct endoscopic estimation of polyp size remains challenging. This finding can affect size estimation skills and future training programs for endoscopists.

• 한국응용과학기술학회지
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• 제40권6호
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• pp.1413-1424
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• 2023

Virtual reality (VR) simulation in nursing education, especially in the teaching of VR simulations just prior to clinical practice, has the potential to enhance the effectiveness of clinical practice and better prepare nursing students for patient care. The aim of this study was to evaluate the effect of a preclinical VR simulation education program on the development of critical thinking, self-efficacy, problem-solving ability, and perceived clinical competency among undergraduate nursing students. The study was conducted between May and June 2021 using a pretest-posttest design with a control group. A total of 42 nursing students were recruited through convenience sampling from two separate classes. The intervention group participated in VR simulation education, while the control group engaged in lecture-based education, before beginning clinical practice. Assessments were conducted before preclinical education and after completing clinical practice using structured questionnaires. The data was analyzed using chi-square tests, independent t-tests, and ANCOVA. The findings indicated that the intervention group had a significantly higher score in perceived clinical competency compared to the control group (F = 5.25, p = 0.029) after controlling for pretest scores. However, there were no statistically significant differences in critical thinking, self-efficacy, or problem-solving abilities between the two groups. These findings suggest that preclinical VR simulation education is partially effective in preparing nursing students for their clinical practice, underscoring the need for a balanced educational approach that integrates VR with clinical practice to develop a full spectrum of nursing skills and knowledge.

• 한국임상약학회지
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• 제23권1호
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• pp.26-32
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• 2013

Objective: This study was to define the clinical effect on the clinical decision support system (CDSS) for prescribing antibiotics integrated with the order communication system in a National Hospital. Method: We extracted data collected before integrating the CDSS of 4,406 adult patients in 2007 and data collected after integrating the CDSS of 4,278 adult patients in 2009. These patients were 50.4% and 45.2% of all patients admitted in 2007 and 2009, respectively. The clinical effect was defined as the proportion of prescribed antibiotics, the length of antibiotics use, and the DDDs (defined daily doses) of antibiotics per 1,000 patient-days using these retrospective data. Results: There were a significant change in the proportion of patient prescribed penicillins with extended spectrum (OR=0.55, p=001), penicillins included beta-lactamase inhibitors (OR=0.75, p<.001), 3rd cephalosporin (OR=1.47, p<.001). The mean of the length of antibiotics use was decreased statistically from $6.09{\pm}5.48$ to $5.85{\pm}5.51$ days (p=.003). The DDD of glycopeptides was decreased from 24.43 DDD to 19.55 DDD per 1000 patient-days. The DDD of 3rd cephalosporins was also decreased from 15.88 to 11.65. Conclusion: Therefore, the clinical decision support system for prescribing antibiotics was effective for the clinical outcomes.

• 생명과학회지
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• 제19권12호
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• pp.1718-1723
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• 2009

Chromosomal 인 SHV-11 $\beta$-lactamase가 plasmid를 매개로 다른 균주로 전달 되는 현상은 흔하지 않다. 본 연구에서는 플라스미드성 SHV-11 $\beta$-lactamase를 동시에 가지고 있는 ESBL생성 두 균주를 검출하였다. 따라서 이들 균주에 대한 유전적 특성과 임상적 의의에 대해 알아보고자 하였다. Vitek system과 이중디스크확산법을 이용하여 ESBL생성균주를 검출하였고, PCR과 DNA 염기서열분석을 이용하여 SHV-11 $\beta$-lactamase를 가지고 있는 ESBL생성균주를 확인 하였다. 이들 균주를 교차접합실험과 형질전환실험을 이용하여 유전자전이를 확인하고 액체배지 희석법으로 3세대 cephalosphorin 항생제에 대한 최소억제농도를 측정하였다. 이들 균주의 유전형 분석결과는 SHV-11 $\beta$-lactamase 유전자와 CTX-M-15 ESBL 유전자를 동시에 가지고 있었다. 3세대 cephalosphorin 항생제에 대한 최소억제농도는 SHV-11 $\beta$-lactamase와 CTX-M-15 ESBL 유전자를 동시에 가지고 있는 균주에서 $64{\mu}g/ml$ 이상이었고, SHV-11 $\beta$-lactamase 만을 가지고 재조합 한 균주에서 $0.5{\mu}g/ml$ 이하로 나타났다.

• Annals of Clinical Neurophysiology
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• 제4권1호
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• pp.60-62
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• 2002

Two separate cranial nerve variants of Guillain-Barre syndrome(GBS) have been reported. One is Miller-Fisher syndrome, the other is polyneuritis cranialis. Involvement of the extraocular muscles in variants of GBS is well recognized, but complete external and internal opthalmoplegia is rare. Optic neuritis remains the only consistent, albeit very uncommon, evidence of inflammation of central nervous system myelin in GBS. This propose that GBS is part of a spectrum of central and peripheral inflammation. This case is an unusual clinical variant who had ptosis, opthalmoplegia, areflexia, ataxia, optic neurritis, marked oropharyngeal, and neck and shoulder weakness. This combined regional from is able to misdiagnose initially as botulism or diphtheria and less so, myasthenia. So if we were consider variant from of GBS, it is possible for make a correct diagnosis more easily and treatment without delay.