• Journal of Oral Medicine and Pain
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• 제46권3호
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• pp.88-92
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• 2021

Acute osteomyelitis caused by Klebsiella pneumoniae is rare in the oral and maxillofacial region. Klebsiella pneumoniae is a Gram-negative bacillus and the normal flora of the human body, but it can cause pneumonia, urinary tract infection, meningitis, and osteomyelitis in patient with compromised immune systems. These infections are mainly caused by nosocomial infection. Microbacterial osteomyelitis was developed by clinical cause such as tooth extraction, fracture, and surgical history, which requires long-term antibiotic administration and surgical treatment. This report describes that a 56-year-old male patient with acute osteomyelitis caused by Klebsiella pneumoniae infection after implant placement was treated with intravenous administration of ertapenem without open surgery treatment. Through this case, we report that antibiotic susceptibility test is essential for the treatment of acute osteomyelitis caused by a bacterial infection resistant to empirical antibiotics, and early administration of appropriate antibiotics can reduce the possibility of extensive bone destruction or additional open surgery.

• 한국산학기술학회:학술대회논문집
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• 한국산학기술학회 2011년도 추계학술논문집 1부
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• pp.326-329
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• 2011

Mortality associated with maxillofacial infection is relatively low due to the development of antibiotics, and improved oral care. However, inappropriate treatment, delayed treatment, old age, underlying systemic disease, and drug-resistant micro-organisms can potentially result in life threatening situations such as cavernous sinus thrombosis, mediastinitis, and sepsis. Sepsis is the most dangerous state with high mortality, ranging from 20~60%. The treatment of sepsis involves properly monitoring vital functions, fluid resuscitation, surgical drainage, and empirical use of high doses of antibiotics until culture results are available. Ventilatory support maybe be required as well. We encountered a 64-year-old patient who died from sepsis that developed as the result of an odontogenic infection. The initial diagnosis was right temporal, infraorbital, buccal, pterygomandibular space abscess. Despite surgical and medical supportive care, the condition progressed to sepsis and after four days the patient died due to multiple organ failure.

• Childhood Kidney Diseases
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• 제21권2호
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• pp.128-135
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• 2017

Purpose: Extended-spectrum ${\beta}$-lactamase-producing bacteria-induced urinary tract infections are increasing and require more potent antibiotics such as carbapenems. We evaluated the clinical significance of extended-spectrum ${\beta}$-lactamase -urinary tract infection in children younger than 5 years to select proper antibiotics and determine prognostic factors. Differences were compared between age groups. Methods: We retrospectively studied 288 patients with their first febrile urinary tract infection when they were younger than 5 years. Patients were divided into extended-spectrum ${\beta}$-lactamase-positive and extended-spectrum ${\beta}$-lactamasenegative urinary tract infection groups. Clinical characteristics and outcomes were compared between the groups; an infant group was separately analyzed (onset age younger than 3 months). Results: Extended-spectrum ${\beta}$-lactamase urinary tract infection occurred in 11 % patients who had more frequent previous hospitalization (P=0.02) and higher recurrence rate (P=0.045). During the antimicrobial susceptibility test, the extended-spectrum ${\beta}$-lactamase-positive urinary tract infection group showed resistance to third-generation cephalosporins; however, 98% patients responded clinically. In the infant group, extended-spectrum ${\beta}$-lactamase-positive urinary tract infection occurred in 13% patients and was associated with a longer pre-onset hospitalization history (P=0.002), higher C-reactive protein level (P=0.04), and higher recurrence rate (P=0.02) than that in the older group. Conclusion: Extended-spectrum ${\beta}$-lactamase urinary tract infection requires more attention because of its higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins, but they can be used as first-line empirical antibiotics because of their high clinical response rate. Aminoglycosides can be second-line antibiotics before starting carbapenems when third-generation cephalosporins do not show bactericidal effects for extended-spectrum ${\beta}$-lactamase urinary tract infection.

• 보건행정학회지
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• 제21권2호
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• pp.179-194
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• 2011

Although there have been studies regarding the separating policy of dispensary and medical practice, little study have provided a concrete empirical evidence to what extent the policy objectives are achieved. In this paper, we try to provide empirical evidence whether the policy separating dispensary from medical practice achieved the policy objectives, which representatively are reducing the mis-use or over-use of anti-biotic prescriptions and medicines, and decreasing the government spending for the cost of pharmaceutical support. By comparing the average of the rate of change of the number of medicines prescribed, the rate of anti-biotics prescribed, and the government spending for the cost of pharmaceutical support between the areas where the separation policy was implemented and the exceptional areas, we concluded that it is difficult to conclude that the policy separating dispensary and medical practice achieved its policy objects, as it first announced to achieve in the introduction of the policy in 2000. However, the limitation of this study is that the data, that can thoroughly analyze the effect of separating policy of dispensary from medical practice, cannot be collected as expected. Hence, we could not use a parsimonious empirical model to evaluate the effect of the policy introduced in 2000. Rather we used a simple statistical method to extract enough empirical evidence fro m the data available. In the near future, we would expect to see more research that analyze the exact effect of policy separating dispensary and medical practice with concrete empirical model using more sophisticated dataset.

• Archives of Plastic Surgery
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• 제48권2호
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• pp.165-174
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• 2021

Background In recent years, implant-based breast reconstruction has been performed because of its simplicity, short operation time, and rapid recovery of patients. Several studies have reported treatment methods for implant surgery-related infection, which is a serious complication. The aim of this study was to introduce our strategy for salvaging infected implants and to evaluate its effectiveness. Methods The authors performed a retrospective study of 145 cases from 132 patients who underwent implant-based breast reconstruction from January 2012 to December 2018. Empirical antibiotics were immediately administered to patients with suspected infections. The patients then underwent salvage treatment including appropriate antibiotics, ultrasonography-guided aspiration, debridement, antibiotic lavage, and implant exchange through a multidisciplinary approach. Patient demographics, operative data, duration until drain removal, adjuvant treatment, and complications were analyzed. Results The total infection rate was 5.5% (8/145). A longer indwelling catheter period and adjuvant treatment were significantly associated with infection. The salvage treatment showed a success rate of 87.5% (7/8). Seven patients who received early aggressive salvage treatment recovered from infection. One patient with methicillin-resistant Staphylococcus aureus, who received salvage treatment 11 days after symptom onset, did not respond to drainage and antibiotic treatment. That patient subsequently underwent explantation. Conclusions In implant-based breast reconstruction, prevention of infection is of the utmost importance. However, if an infection is suspected, proactive empirical antibiotic therapy and collaboration with the necessary departments are required. Through a multidisciplinary approach and proactive early management, swift and appropriate salvage should be performed.

• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.777-783
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• 2006

목 적 : 최근 소아 요로감염의 가장 흔한 원인균인 E. coli에 대한 항생제 내성 문제가 점차 대두되고 있다. 본 연구에서는 소아 원외 요로감염 환아에서 분리된 E. coli에 대한 cefixime을 포함하여 흔히 사용되고 있는 경구용 항생제의 시험관 내 감수성 연구를 시행하여 적합한 치료 항생제 선택의 기초 자료를 얻고자 하였다. 방 법 : 2004년 10월부터 2005년 9월까지 연구 참여 병원 소아과 외래에서 요로감염으로 진단된 206명 환아의 요 배양검사에서 동정된 211개 균주 중 188개 E. coli를 대상으로 경구용 항생제(ampicillin, amoxillin, ampicillin-sulbactam, cefaclor, TMP-SMX, cefixime)에 대한 시험관 내 감수성 검사를 실시하였다. 결 과 : 분리된 E. coli 균주에 대한 항생제별 감수성 결과에서 내성률은 각각 ampicillin 81.4%, amoxicillin 85.6%, ampicillin-Sulbactam 77.2%, cefaclor 93.6%, TMP-SMX 50.5%, cefixime 13.3%이었다. ESBL 생성 E. coli는 7.0%이었다. 결 론 : Aminopenicillins계, cefaclor, sulfa약제들은 E. coli에 대한 내성률이 매우 높아 소아 요로감염의 일차 선택 항생제로 유용하지 못한 것으로 추정할 수 있었다. 그러나 cefixime과 같은 3세대 cephalosporin은 일차 치료 실패할 경우 이차 선택항생제로 유용할 수 있으며, 일차 선택 항생제로도 사용될 수 있을 것으로 추정되었다. E. coli의 항생제 내성 양상에 대한 광범위한 연구와 지속적 감시를 통하여 소아 원외 요로감염 치료에서 1차적으로 선택될 수 있는 경구용 항생제에 대한 지침 자료가 요구된다.

• 대한치과의사협회지
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• 제52권7호
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• pp.425-431
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• 2014

Objectives : The purpose of our study was to evaluate penicillin as a still drug of choice for severe endodontic infection, by analyzing the antimicrobial susceptibilities from endodontic infections with swelling to figure out appropriate antibiotics as empirical treatment. Materials and methods : This study involved 18 patients who attended for emergency treatment because of facial or periapical swelling associated with root canal infections. Identification and antimicrobial susceptibility test of each pathogen were performed by Vitek2 Systems (bioM$\acute{e}$rieux, Marcy l'Etoile, France). Results : The most frequent bacteria was Streptococcus spp.(77%), and the resistance against penicillin was 35% in overall patients, followed by clindamycin and erythromycin (17%), which was much higher than previous studies. Conclusions : In our study, the higher resistance made penicillin alone not to be chosen as the first antibiotic drug for severe endodontic infections. Combinations with other drug, penicillin with wider spectrum of activity, or changing to other antibiotics was considered while remembering the increased risk of resistant microorganism.

• Journal of Yeungnam Medical Science
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• 제32권1호
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• pp.35-37
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• 2015

Pleuropulmonary diseases caused by Clostridial species infections are rare, but have a mortality rate of up to 30%. Furthermore, older people are at greater risk of developing invasive clostridium infections, and the majority of reported cases of clostridium empyema have been attributed to iatrogenic trauma or aspiration. The authors report a case of spontaneous empyema caused by Clostridium perfringens. A 72-year-old woman was admitted to Kangwon National University Hospital for empyema. The patient had no history of trauma, a dental procedure, or aspiration, and was treated using empirical antibiotics and by drainage of pleural fluid. Bacteria species that cause empyema are usually not detected, but on the 4th day of admission, C. perfringens was isolated from the pleural space. The patient was continuously treated with antibiotics for C. perfringens and drainage, and was discharged 25 days after admission with almost a fully recovered status. Increased awareness of Clostrium species infection in the elderly is needed to ensure appropriate treatment.

• Clinical and Experimental Pediatrics
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• 제63권12호
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• pp.469-476
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• 2020

The major pathogens that cause atypical pneumonia are Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Community-acquired pneumonia (CAP) caused by M. pneumoniae or C. pneumoniae is common in children and presents as a relatively mild and self-limiting disease. CAP due to L. pneumophila is very rare in children and progresses rapidly, with fatal outcomes if not treated early. M. pneumoniae, C. pneumoniae, and L. pneumophila have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant M. pneumoniae that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant M. pneumoniae pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without M. pneumoniae epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.

• Pediatric Infection and Vaccine
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• 제26권1호
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• pp.1-10
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• 2019

목적: 최근 4년간 서울아산병원에 내원한 소아청소년에서 분리된 폐구균의 항생제 감수성 양상을 파악하여, 3차 의료기관 내원 환자에서 발생한 폐구균 감염증에서 적절한 경험적 항균 요법을 제시하고자 하였다. 방법: 2014년 3월부터 2018년 5월까지서울아산병원어린이병원에폐구균감염으로입원하였던 18세미만의환아를대상으로 연령, 성별, 기저질환 및 폐구균의 ${\beta}-lactams$ 및 macrolide 항생제 감수성 양상을 후향적 의무 기록을 통해 조사하였다. Fallon 등이 제시한 Monte Carlo simulation 모델을 이용하여 경구 amoxicillin의 치료 효과를 예측하였다. 결과: 총 63례의 폐구균 감염증이 연구에 포함되었고, 87.3%(55례)는 기저질환이 있는 환아에서 발생하였다. 20.6%(13례)가 혈액(11례)을 포함한 무균성 체액에서 분리된 침습성 감염증이었으며, 폐구균에 의한 뇌수막염은 발생하지 않았다. Amoxicillin, 정주용 penicillin, cefotaxime 및 erythromycin에 대한 내성률은 각각 50.8%, 31.8%, 25.4% 및 95.2%이었으며, amoxicillin과 cefotaxime에 대한 고도 내성률은 각각 23.8% 및 9.5%이었다. Monte Carlo simulation에 의하면 경구용 amoxicillin을 90 mg/kg/day의 용량으로 투여 시 적절한 치료 효과를 기대할 수 있는 amoxicillin MIC 값은 $2.0{\mu}g/mL$ 이하로서 본 연구에서 포함된 비침습성 폐구균의 46.0%가 이 범위에 속하였다. 결론: 최근 4년간 기저질환을 가진 소아환자에서 분리된 폐구균 중 amoxicillin 및 cefotaxime에 고도 내성을 보이는 균주의 비율이 증가하였으며, erythromycin에 대하여 95% 이상 내성이다. 이에 다양한 기저질환을 동반한 고위험군 환아에서 발생한 폐구균 감염증에서 신중한 경험적 항생제 선택이 필요하겠으며, 침습 감염 및 내성 확산 방지를 위한 적절한 폐구균 백신 접종이 필수적이다.