• 한국임상약학회지
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• 제28권3호
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• pp.181-187
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• 2018

Background: Posaconazole is a broad-spectrum triazole antifungal agent and the most recommended prophylactic antifungal agent for patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. In this study, we evaluated the status and effectiveness of posaconazole as a prophylactic antifungal agent in pediatric patients receiving induction chemotherapy for AML. Methods: We retrospectively reviewed the electronic medical records of 36 pediatric patients with AML (between January 2013 and September 2017) at the Yonsei University Health System. Invasive fungal disease (IFD) was assessed as the primary endpoint of prophylactic antifungal effect. The secondary endpoints were incidence of fever, persistent fever despite the use of broad-spectrum antibiotics for 72 h, alteration of antifungal agent, intensive care unit admission, and death within 100 days. Results: Among the 36 patients, 18 patients used posaconazole, 12 were treated with suspension formula, and 6 of them were treated with tablets. Eighteen patients did not use antifungal agents prophylactically. The mean number of days of posaconazole administration was $26.8{\pm}16days$. IFD occurred in 2/18 (11.1%) patients in the no prophylaxis group and in 1/18 (5.6%) patients in the posaconazole group (p=0.49). Conclusion: Posaconazole is expected to be useful for the prevention of IFD in pediatric patients with AML undergoing induction chemotherapy. Prospective studies of the effectiveness of posaconazole prophylaxis should be conducted in more pediatric patients in the future.

• 병원약사회지
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• 제35권4호
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• pp.391-399
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• 2018

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians'antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

• 대한기관식도과학회지
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• 제15권2호
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• pp.64-70
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• 2009

Descending necrotizing mediastinitis(DNM) can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high mortality rate. Therefore, We emphasize that aggressive and emergent mediastinal drainage by surgical approach is most important method of DNM treatment. We studied 5cases diagnosed as DNM from 2005 through 2007. All patients underwent emergent surgical drainage of deep neck infection combined with mediastinal drainage through a thoracic approach. Primary oropharyngeal infection lead to DNM in four cases(80%) and odontogenic abscess in one case(20%). The outcomes were favorable 5patients. Overall mortality rate was 0%. The time interval from diagnosis based on manifestation of initial symptoms(oral or pharyngolaryngeal area) to surgical intervention was $7.4{\pm}4.2$days. One patient required reoperation due to remnant mediastinal abscess and pericardial effusion. Early diagnosis and emergent combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease. And intensive postoperative care which it is continuous mediastinal irrigation and antibiotics use can significantly reduce the mortality rate.

• 한국수산과학회지
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• 제39권2호
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• pp.66-71
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• 2006

Fluoroquinoles have a wide range of antimicrobial properties and are effective in the treatment of bacterial diseases in fish. The use of fluoroquinoles continues to grow steadily. Fluoroquinolone antibiotics are probably the most important class used among synthetic antibiotics in human and veterinary medicines because of their broad activity spectrum and good oral absorption. This study was conducted to estimate the residue of antibiotics in four species of farmed fishes, including olive flounder (Paralichthys olivaceus), black rock fish (Sebastes schlegeli), red sea bream (Pagrus major), and sea bass (Lateolabrax japonicus), collected from fish farms located in the southern coastal area of Korea. The residues of fluoroquinolones were determined using high performance liquid chromatography (HPLC) with a fluorescence detector. Residuals of five fluoroquinolones in muscle tissue of farmed fish were analyzed. We found that enrofloxacin was the most common agent in fish muscle, and that ciprofloxacin was the next most common. The range of detected concentrations of fluoroquinolones in olive flounder muscle was 0-0.859 mg/kg in 32.6% of all samples. Enrofloxacin was commonly detected in sea bass muscle at a range of 0-0.143 mg/kg in 38.9% of all samples. Fluoroquinolones were detected in 6.9% of black rock fish muscle and in 16.6% of sea bream, although the detected concentration was below 0.01 mg/kg. The maximum detection value of enrofloxacin and ofloxacin in olive flounder at the time of shipping was 0.102 mg/kg and 0.09 mg/kg, respectively; no other antimicrobials were detected. We detected no antimicrobial substances in red sea bream.

• International Journal of Oral Biology
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• 제34권1호
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• pp.43-48
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• 2009

Thrombin-induced platelet microbicidal protein (tPMP) is a small cationic peptide that exerts potent in vitro microbicidal activity against a broad spectrum of human pathogens, including Staphylococcus aureus and Streptococcus rattus BHT. Earlier evidence has suggested that tPMP targets and disrupts the bacterial membrane. However, it is not yet clear whether membrane disruption itself is sufficient to kill the bacteria or whether subsequent, presumably intracellular, events are also involved in this process. In this study, we investigated the microbicidal activity of rabbit tPMP toward S. rattus BHT cells in the presence or absence of a pretreatment with antibiotics that differ in their mechanisms of action. The streptocidal effects of tPMP on control cells (no antibiotic pretreatment) were rapid and concentration-dependent. Pretreatment of S. rattus BHT cells with either penicillin or amoxicillin (inhibitors of bacterial cell wall synthesis) significantly enhanced the anti-S. rattus BHT effects of tPMP compared with the effects against the respective control cells over most tPMP concentration ranges tested. On the other hand, pretreatment of S. rattus BHT cells with tetracycline or doxycycline (30S ribosomal subunit inhibitors) significantly decreased the streptocidal effects of tPMP over a wide peptide concentration range. Furthermore, pretreatment with rifampin (an inhibitor of DNA-dependent RNA polymerase) essentially blocked the killing of S. rattus BHT by tPMP at most concentrations compared with the respective control cells. These results suggest that tPMP exerts anti-S. rattus BHT activity through mechanisms involving both the cell membrane and intracellular targets.

• Restorative Dentistry and Endodontics
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• 제45권4호
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• pp.50.1-50.11
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• 2020

Objectives: In this study, we investigated the potential of amoxicillin-loaded polymeric microspheres to be delivered to tooth root infection sites via a bioactive reparative cement. Materials and Methods: Amoxicillin-loaded microspheres were synthesized by a spray-dray method and incorporated at 2.5% and 5% into a mineral trioxide aggregate cement clinically used to induce a mineralized barrier at the root tip of young permanent teeth with incomplete root development and necrotic pulp. The formulations were modified in liquid:powder ratios and in composition by the microspheres. The optimized formulations were evaluated in vitro for physical and mechanical eligibility. The morphology of microspheres was observed under scanning electron microscopy. Results: The optimized cement formulation containing microspheres at 5% exhibited a delayed-release response and maintained its fundamental functional properties. When mixed with amoxicillin-loaded microspheres, the setting times of both test materials significantly increased. The diametral tensile strength of cement containing microspheres at 5% was similar to control. However, phytic acid had no effect on this outcome (p > 0.05). When mixed with modified liquid:powder ratio, the setting time was significantly longer than that original liquid:powder ratio (p < 0.05). Conclusions: Lack of optimal concentrations of antibiotics at anatomical sites of the dental tissues is a hallmark of recurrent endodontic infections. Therefore, targeting the controlled release of broad-spectrum antibiotics may improve the therapeutic outcomes of current treatments. Overall, these results indicate that the carry of amoxicillin by microspheres could provide an alternative strategy for the local delivery of antibiotics for the management of tooth infections.

• Pediatric Infection and Vaccine
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• 제18권2호
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• pp.135-142
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• 2011

목 적 : 집중 치료를 받고 있는 환자들에서 MDR-HAI이 전세계적으로 중요한 문제로 인식되고 있다. 그러나 이와 관련하여 소아 환자들을 대상으로 한 연구는 성인에 비해 상대적으로 부족하다. 본 연구에서는 단일 대학병원 중환자실에 입원한 소아환자를 대상으로 MDR-HAI의 발생률과 연관인자를 알아보고자 하였다. 방 법: 2009년 1월부터 2010년 12월까지 본원 환자실에서 3일 이상 입원치료 하였던 135명의 소아 환자를 대상으로 입원기록을 후향적으로 검토하였다. 원내감염을 MDR-HAI과 non-MDR-HAI의 두 군으로 나누어 각각 임상적 특징과 여러 연관인자들을 비교하였다. 결 과: 39명의 환자에서 45례의 중환자실내 원내감염이 발생하였다. 원내감염의 발생률은 중환자실 재원 1,000일당 47.7이었다. 45례 원내감염 중 36례(80.0%)가 다제 내성균에 의한 감염이었다. A. baumannii는 MDR-HAI군에서 더 흔하게 검출되었다(54.5% vs. 8.3%; P=0.007). 중환자실 입원 적응증 중 내과적 질환, 인공 호흡기 치료, 도뇨관 삽입, 이전 광범위 항생제 사용은 MDR-HAI군에서 통계적으로 유의하게 높았다. 회귀분석 결과 이전 광범위 항생제 사용만이 MDR-HAI의 독립적 위험인자였다. 결 론 : 중환자실내 원내감염의 발생률은 이전에 보고된 것보다 높았으며, 이전 광범위 항생제 사용이 MDR-HAI의 독립적 위험인자였다. 향후 중환자실에 입원한 소아 환자에게 발생한 MDR-HAI의 정확한 특징을 확인하기 위해 추가적인 연구가 필요할 것으로 생각된다.

• 한국식물병리학회지
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• 제14권3호
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• pp.191-202
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• 1998

About 300 actinomycetes were isolated from two forest and one sea-shore soil and tested for inhibitory effects on mycelial growth of six plant pathogenic fungi Magnaporthe grisea, Alternaria mali, Colletotrichum gloeosporioides, Phytophthora capsici, Fusarium oxysporum f. sp. cucumerinum, and Rhizoctonia solani. Among 300 actinomycetes tested, only 16 actinomycetes showed the antifungal activity against the test fungi. Isolate NH 50 was selected for production and purification of antifungal antibiotic substances. Actinomycete isolate NH 50 displayed the broad antifungal spectra against 11 plant pathogenic fungi. To identify actinomycete isolate NH 50, cultural characteristics on various agar media, diaminopimelic acid type, and morphological characteristics by scanning electron microscopy were examined. As a result, actinomycete isolate NH 50 was classified as a rare actinomycete that had LL-DAP type and did not produce spores. After incubation of isolate NH 50 in yeast extract-malt extract-dextrose broth, antifungal compound NH-B1 that inhibited mycelial growth of some plant pathogenic fungi was purified from the methanol eluates of XAD-16 resins by a series of purification procedures, i.e., silica gel flash chromatography, C18 flash chromatography, Sephadex LH-20 column chromatography, silica gel medium pressure liquid chromatography (MPLC), C18 MPLC, and high pressure liquid chromatography (HPLC). UV spectrum and 1HNMR spectrum of antifungal compound NH-B1 dissolved in methanol were examined. The antibiotic NH-B1 showed the major peaks at 230 and 271.2nm. Based on the data of 1H-NMR spectrum, NH-B1 was confirmed to be an extremely complex polymer of sugars called polysaccharides. The antibiotic NH-B1 showed strong antifungal activity against Alternaria solani and Cercospora kikuchi, but weak activity against M. grisea.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권4호
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• pp.251-259
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• 2020

Oral and maxillofacial infection is a common complication in patients undergoing chemotherapy. The treatment of oral diseases in such patients differs from that administered to healthy patients. This paper reports a case of acute osteomyelitis of odontogenic origin following a recent chemotherapy session. The patient's condition was life-threatening because of neutropenic fever and sepsis that developed during the inpatient supportive care. However, the patient showed prompt recovery within 40 days following the use of appropriate antibiotics and routine dressing, without the requirement for surgical treatment, except tooth extraction. As seen in this case, patients undergoing chemotherapy are more susceptible to rapid progression of infections in the oral and maxillofacial areas. Therefore, accurate diagnosis through prompt clinical and radiological examination, identification of the extent of infection, and assessment of the patient's immune system are crucial for favorable outcomes. It is also necessary to eliminate the source of infection through appropriate administration of antibiotics. In particular, a broad-spectrum antibiotic with anti-pneumococcal activity is essential. Proper antibiotic administration and wound dressing are essential for infection control. Furthermore, close consultation with a hemato-oncologist is necessary for effective infection management based on the professional evaluation of patients' immune mechanisms.

• 생명과학회지
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• 제15권2호
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• pp.279-286
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• 2005

손바닥선인장 추출물은 한의학에서 항염증 작용, 화상, 부종, 소화 불량 등 몇 가지의 생리학적 기능이 확인되었다. 본 연구에서는 손바닥선인장 줄기를 메탄올을 이용하여 추출한 후 그 추출물을 이용하여 항균활성을 확인한 결과 병원균 등 일반 세균에서 항균활성을 확인하였다. 특히, 약제내성균 및 혐기성 균인 여드름 원인균 뿐만 아니라 효모, 곰팡이 등 진균류에서도 항균활성을 나타내어 넓은 항균 스펙트럼을 가지고 있음을 확인할 수 있었다. 또한 열 처리, 저장온도 및 저장기간이 항균활성에 영향을 미치지 않았으므로 온도 및 기간에 안정함을 확인할 수 있었고, 식품 보존제로서의 가능성 확인 시험에서도 기존의 식품 보존제보다 안전성이 있는 항균활성 물질로 평가되었다.