• 대한한방내과학회지
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• 제41권6호
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• pp.1191-1199
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• 2020

We studied the effect of Korean medicine treatment on the clearance of vancomycin-resistant enterococcus (VRE) colonization and on improvement in symptoms in a stroke patient. The patient was continuously followed up with stool VRE cultures while being treated with herbal medicine, Chunglijagam-tang, acupuncture, and oxygen therapy. We also checked the coccygeal pressure sore condition and the oxygen levels during therapy. No VRE colonization was found after treatment and the oxygen levels and pressure sores had improved. This study proved that Korean medicine treatment could be effective for the clearance of VRE colonization and improvement of symptoms.

• 대한의생명과학회지
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• 제6권3호
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• pp.201-208
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• 2000

Vancomycin은 세포벽의 합성을 억제하여 세균에 대한 항균효과를 나타내는 glycopeptide 계 항생물질로서 그람양성세균으로 인한 감염치료에 광범위하게 사용되며, 특히 methicillin 내성 포도상구균의 선택적 치료제로 쓰이고 있다. 그러나 최근 임상검체에서도 중등도의 내성을 가지는 포도상구균 (Mu50: MIC 8 $\mu\textrm{g}$/ml)이 나타나기 시작하였고 여러 가지 여건상 국내에서도 내성균주가 분리될 가능성이 높다고 사료되어 임상검체 중 methcillin 내성 포도상구균을 대상으로 vancomycin 감수성 및 내성빈도 조사를 실시하고 이에 따른 내성기전을 알아보고자 하였다. 본 실험 결과 107주 (株)의 methicillin 내성균주 중 23.3%가 vancomycin에 대하여 내성을 보였으며 vancomycin 내성을 나타내는 표준균주인 Mu50과 Mu3의 중간 정도의 내성빈도를 보였다. 중합효소 연쇄반응을 통해 장구균의 vancomycin 내성에 관여하는 vanA, vanB, vanC1, vanC2, vanH 특이 유전자는 증폭되지 않았다. SDS-PAGE를 실시하여 81 kDa, 58 kDa, 33 kDa, 28 kDa 등의 주요 단백 분획을 확인하였고, Mu50에서 45 kDa의 특징적인 단백 분획을 관찰하였다. LDH enzyme assay에서는 한 개의 검체가 Mu50과 함께 높은 LDH 활성을 보였다.

• 한국의료질향상학회지
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• 제3권2호
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• pp.26-35
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• 1997

Background : Glycopeptide antibiotics are the only drugs for treatment of infections due to beta-lactam-resistant Gram-positive bacteria. As the incidence of infection and colonization with vancomycin-resistant enterococci(VRE) rapidly increases, the hospital infection control practices advisory committee(HICPAC) recommends prudent vancomycin use to detect, prevent and control infection and colonization with VRE. Methods : The inpatients admitted from September to December, 1996 in Pusan National University Hospital, with Gram-positive bacterial infections were evaluated retrospectively to see whether the administrations of glycopeptide antibiotics were appropriate or not, upon comparison with the recommendations for preventing the spread of vancomycin resistance by HICPAC. Results : Teicoplanin has been chosen more frequently than vancomycin of the glycopeptide antibiotics. The indications of administration of glycopeptides in patients with pneumonia, wound infections, sepsis, and in febrile or neutropenic patients with malignancies were appropriate, but the use of glycopeptides for elimination of merely colonized bacteria in the oral cavity could not be excluded. Inappropriate use of glycopeptides was 10.6%, and inappropriately long-term use without positive culture for beta-lactam-resistant Gram-positive organisms was about 40% of total days of drug use. Conclusion : It seems essential for the quality assurance committee to make a plan in teaching the HICPAC recommendations to the medical practitioners who prescribed the glycopeptides inappropriately or used for irrelevantly long to his patient, monitor and survey their use of glycopeptides prospectively and periodically, and if there are repeated inappropriate prescriptions, a certain penalty would be given to the practitioners.

• 한국식품과학회지
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• 제50권6호
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• pp.581-586
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• 2018

본 연구에서는 서울과 경기도 지역 소매점 및 대형마트에서 판매되고 있는 샐러드, 어린잎, 새싹채소로부터 Enterococcus의 존재를 파악하고 9개 항생제에 대한 항생제 저항성 프로파일을 확보했다. Quinupristin/dalfopristin에 저항성을 가지는 분리주가 85.0%에 이르렀고, 특히 E. faecalis 분리주는 18종 중 17종이 저항성을 나타냈다. 또한 critically important 항생제 중 highest priority로 분류되는 ciprofloxacin과 erythromycin에 대해 각각 40.0, 50.0%가 중간 정도의 저항성을 보였으며, vancomycin에 대한 저항성을 가지는 분리주는 검출되지 않았다. Enterococci의 항생제 저항성 정도는 식품 안전뿐만 아니라 공중 보건에 있어서도 중요하다는 측면에서 본 연구의 Enterococcus 오염 정도, 항생제 내성율에 대한 결과는 향후 신선 편이식품 섭취가 인체 건강에 미치는 위험분석을 위한 기초자료로서 유용한 정보를 제공할 것으로 보이며 앞으로 특별한 열처리 없이 섭취하는 신선 편이식품에 대한 지속적인 모니터링이 필요할 것이라 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제45권3호
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• pp.174-180
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• 2012

Objectives: An ambulance can be a potential source of contagious or droplet infection of a community. We estimated the prevalence of positive carriage of tuberculosis (TB), methicillin-resistant $Staphylococcus$ $aureus$ (MRSA), and vancomycin-resistant $Enterococci$ (VRE) in patients transported by ambulance. Methods: This was a retrospective observational study. We enrolled all patients who visited a tertiary teaching hospital emergency department (ED). Blood, sputum, urine, body fluid, and rectal swab samples were taken from patients when they were suspected of TB, MRSA, or VRE in the ED. The patients were categorized into three groups: pre-hospital ambulance (PA) group; inter-facility ambulance (IA) group; and non-ambulance (NA) group. Adjusted odds ratio (OR) and 95% confidence intervals (CI) were calculated using a multivariable logistic regression model for the prevalence of each infection. Results: The total number of patients was 89206. Of these, 9378 (10.5%) and 4799 (5.4%) were in the PA and IA group, respectively. The prevalence of TB, MRSA, and VRE infection were 0.3%, 1.1%, and 0.3%, respectively. In the PA group, the prevalence of TB, MRSA, and VRE were 0.3%, 1.8%, and 0.4%. In the IA group, the prevalence of TB, MRSA, and VRE were 0.7%, 4.6%, and 1.5%, respectively. The adjusted ORs (95% CI) of the PA and IA compared to the NA group were 1.02 (0.69 to 1.53) and 1.83 (1.24 to 2.71) for TB, 2.24 (1.87 to 2.69) and 5.47 (4.63 to 6.46) for MRSA, 2.59 (1.78 to 3.77) and 8.90 (6.52 to 12.14) for VRE, respectively. Conclusions: A high prevalence of positive carriage of TB, MRSA, and VRE in patients transported by metropolitan ambulances was found.

• 한국미생물학회:학술대회논문집
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• 한국미생물학회 2005년도 International Meeting of the Microbiological Society of Korea
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• pp.143-147
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• 2005

The non-pathogenic, non-glycopeptide-producing actinomycete Streptomyces coelicolor carries a cluster of seven genes (vanSRJKHAX) that confers inducible, high-level resistance to vancomycin. The van genes are organised into four transcription units, vanRS, vanJ, vanK and vanHAX, and these transcripts are induced by vancomycin in a vanR-dependent manner. vanHAX are orthologuous to genes found in vancomycin resistant enterococci that encode enzymes predicted to reprogramme peptidoglycan biosynthesis such that cell wall precursors terminate in D-Ala-D-Lac, rather than D-Ala-D-Ala. vanR and vanS encode a two-component signal transduction system that mediates transcriptional induction of the seven van genes. vanJ and vanK are novel genes that have no counterpart in previously characterised vancomycin-resistance clusters from pathogens. VanK is essential for vancomycin resistance in S. coelicolor and it is required for adding Gly branch to stem peptides terminating D-Ala-D-Lac. Because VanK can recognise D-Lac-containing precursors but the constitutively expressed femX enzyme, encoded elsewhere on the chromosome, cannot recognize D-Lac-containing precursors as a substrate, vancomycin-induced expression of VanHAX in a vanK mutant is lethal. Further, femX null mutants are viable in the presence of glycopeptide antibiotics but die in their absence. Bioassay using vanJp-neo fusion reporter system also showed that all identified inducers for van genes expression were glycopeptide antibiotics, but teicoplanin, a membrane-anchored glycopeptide, failed to act as an inducer.

• 대한한방내과학회지
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• 제31권4호
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• pp.908-913
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• 2010

Bojungiki-tang is a traditional oriental medicine to boost the immune system. In this study, we investigated the effects of Bojungiki-tang by withdrawal of isolation of VRE colonization. Four cases of post-stroke patients with VRE colonization took Bojungiki-tang and continuously were followed up with stool cultures. After three times negative stool VRE, we withdrew isolation of VRE colonization. One case patient was diagnosed with VRE colonization in another hospital and had no withdrawal during that period. He was admitted to Kyung-hee University Oriental Medicine where he took Bojungiki-tang. After three times negative stool VRE, we withdrew isolation of the patient. These results demonstrate that Bojungiki-tang is effective on boosting immunity level. Further studies are needed to better characterize this protective effect of Bojungiki-tang.

• 한국의료질향상학회지
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• 제19권1호
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• pp.30-42
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• 2013

Objectives: This study was intended to check if the "Creating Clean Wards" project, which is an innovative reinforced campaign activity targeting infection control strategies and active surveillance cultures for VRE (vancomycin resistant enterococci) high-risk patients to be admitted in the NS (neuro-surgery) wards, would be reduced the incidence rates of VRE acquisition, transmission rates. Methods: 75 subjects of the VRE high-risk patients were surveyed by carrying out active surveillance cultures of VRE colonization 11 times from January to March, 2012. And the retrospective study was conducted dividing them into two groups. Results: The incidence rates of VRE acquisition was reduced to 3.67 cases per 1,000 patients day in the control group and to 2.88 cases in experimental group, which was not statistically significant (p = .753). VRE transmission rates of 0.0015 per day before the project tended to increase to 0.0019, although not statistically significant (p = .650). As a result of multivariate analysis with regard to using glycopeptide antibiotics in order to find out risk factors of VRE colonization, the patients who had been treated with glycopeptide until VRE colonization showed 274.41 times higher rate. Conclusion : For effective VRE infection control in NS wards, We should carry out active surveillance culture regularly, especially patient of using glycopeptide. And block the spread of VRE by strengthening infection control through the strict isolation and the changed mind-set of members motivated by the "Creating Clean Wards" campaign.

• 대한약침학회지
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• 제26권3호
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• pp.247-256
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• 2023

Objectives: Enterococcus faecalis is a gram positive diplococci, highly versatile and a normal commensal of the gut microbiome. Resistance to vancomycin is a serious issue in various health-care setting exhibited by vancomycin resistant Enterococci (VRE) due to the alteration in the peptidoglycan synthesis pathway. This study is thus aimed to detect the VRE from the patients with root caries from the clinical isolates of E. faecalis and to evaluate the in-silico interactions between vanA and the Aegles marmelos bio-compounds. Methods: E. faecalis was phenotypically characterized from 20 root caries samples and the frequency of vanA and vanB genes was detected by polymerase chain reaction (PCR). Further crude methanolic extracts from the dried leaves of A. marmelos was assessed for its antimicrobial activity. This is followed by the selection of five A. marmelos bio-compounds for the computational approach towards the drug ligand interactions. Results: 12 strains (60%) of E. faecalis was identified from the root caries samples and vanA was detected from two strains (16%). Both the stains showed the presence of vanA and none of the strains possessed vanB. Crude extract of A. marmelos showed promising antibacterial activity against the VRE strains. In-silico analysis of the A. marmelos biocompounds revealed Imperatonin as the best compound with high docking energy (-8.11) and hydrogen bonds with < 140 TPSA (Topological polar surface area) and zero violations. Conclusion: The present study records the VRE strains among the root caries with imperatorin from A. marmelos as a promising drug candidate. However the study requires further experimentation and validation.

• 대한임상검사과학회지
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• 제36권2호
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• pp.76-88
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• 2004

본 연구에서는 임상검체에서의 Enterococcus sp.의 균종별 분리현황을 조사하고, 분리균의 항생제 감수성 양상을 알아보는 한편, aminoglycoside계 항생제에 내성을 나타내는 균주를 대상으로 Rep-PCR을 실시하여 유전적인 다양성을 알아보고자 하였다. 각종 임상검체로부터 E. faecalis 49주, E. faecium 34주, E. avium 9주, E. gallinarum 4주, E. casseliflavus 3주, E. hirae 1주 등 총 100주를 분리하였다. 대부분 외래를 통하기보다는 입원환자의 검체로부터 분리됨을 관찰하면서 원내감염의 원인균 중의 하나임을 알 수 있었다. Urine과 pus, sputum에서 대부분의 균들이 분리되었고 E. faecalis와 E. faecium이 주 종을 이루었다. 항생제 감수성양상으로는 disk법과 ViteK GPS-430의 MIC결과와 유사하게 관찰 되었으며, 대부분의 Enterococcus sp.가 cephalosporin계 항생제에는 80% 정도의 내성을 보였다. E. faecalis의 경우 항생물질에 대해 고른 감수성양상을 볼 수 있었고, E. faecium의 경우 다른 Enterococcus sp.와는 차별적으로 항생물질에 대해 높은 내성 양상을 볼 수 있었다. 또한 vancomycin에 대한 내성을 보이는 Enterococcus sp.는 전체 10%정도를 차지하였고 aminoglycoside계 항생제인 amikacin과 gentamicin에 대해서 높은 고도내성을 나타냈었고, streptomycin의 경우에는 50% 정도의 내성률을 나타내었다. Aminoglycoside계 항생제에 내성을 보이는 Enterococcus sp.를 대상으로 Rep-PCR을 실시하여 유전자 분획유형을 분석하였으나 유전적 다양성에 있어 크게 차이를 보이지 않아 DNA양상의 기원이 크게 다르지 않다는 것으로 생각되었다.