도시홍수 저감을 위한 근거기반 계획 : 서울시를 중심으로

학위논문 (석사) -- 서울대학교 대학원 : 농업생명과학대학 생태조경·지역시스템공학부(생태조경학), 2021. 2. 강준석.최근 기후변화로 인해 발생되고 있는 사회/경제적 피해는 급속히 증가하고 있다. 기후변화로 인한 2차적 피해로는 폭염, 홍수 등이 있다. 그중에서 극한 강우는 도심지역에 큰 피해를 발생시키고 있다. 대표적으로는 2011년 발생한 집중호우 등이 있는데, 당시에는 최대 110.5 mm/hr의 기록적인 강수가 내렸다. 현대 도시에서 발생하는 홍수의 대부분 원인은 불투수성 포장면의 급격한 증가와 내수배제 불능, 물순환 시설 부재 등의 원인이 있다. 기상청에서 제공하는 기후변화 시나리오에 따르면, 향후 100년간 도시의 평균 강수량은 줄어들 것으로 파악된다. 하지만, 일시에 폭우가 내리는 빈도가 증가하고 국지성 피해가 뚜렷하게 발생할 것으로 판단된다. 현재 상태의 기반시설들에 보수나 방어기술이 수립되지 않으면, 그 피해는 상당할 것으로 판단된다. 이에 본 연구는 총 세 가지 연구 목표를 수립하여 수행하였다. 첫 번째, 기상청에서 제공하는 기후변화 시나리오(RCP 4.5/RCP 8.5)로 인해 발생할 수 있는 향후 80년(2020년-2100년)의 도시 홍수 피해량을 정량적으로 분석한다. 두 번째, 정량적으로 분석된 피해량에 기반한 재해 저감 시설을 선정하고, 재해의 저감량을 분석한다. 이를 통해 근거 기반(Evidence-Based Planning)의 시설배치 및 설계한다. 재해 저감 시설은 미래 세대가 지속적으로 사용할 수 있는 친환경(Eco-Friendly) 시설물을 선정하였다. 세 번째, HCFD (Hazard Capacity Factor Design) 모델의 개발을 통해, 향후 변화할 수 있는 시설물들의 용량과 성능에 대해 정량적으로 분석한다. HCFD 모델은 저감 기술을 유지하는 방법을 고려하는데 사용된다. 이러한 목표를 달성하기 위해서 방어 기술로 총 세 가지를 도입하였다. 저류조, 투수성 포장 그리고 생태수로가 이에 해당한다. 저류조의 경우, 환경부에서 지정하고 있는 법령을 참고하여 도입 가능한 용량을 파악하였다. 투수성포장과 생태수로는 법령으로 명확히 규정하는 설계 지침이 없기에, 타 연구 보고서를 참고하였다. 각 기술들의 도입 규모를 산정하기 위해서 Arc-GIS ArcHydro Plug in을 사용하였고 Watershed를 분석하였다. Watershed에 영향을 미치는 범위를 파악하기 위해서 기후변화시나리오에서 제공하는 강수량을 시간 단위로 분석하였고, 이를 위해 Huff Curve 공식을 사용하였다. 위에서 언급된 세 가지 기술은 빗물의 저장 용량을 증가시켜 홍수 완화에 기여할 것으로 판단된다. 세 가지 기술을 모두 도입하였을 때 2050년과 2060년에는 RCP 8.5 시나리오의 모든 홍수피해를 저감할 수 있을 것으로 판단된다. 2070년 이후에는 유출이 발생할 것으로 분석되지만, 적응 기술을 통해 홍수를 크게 줄일 수 있을 것으로 예측된다. 본 연구 논문에서는 10년 단위의 홍수와 적응량을 산정하였지만, 추후 후속 연구에서는 1년 단위의 분석이 실시되어야 할 것으로 판단된다. 또한 저류조 내부에 퇴적되는 비점오염원의 청소 시기가 산정되었습니다. 저류조의 경우 MOUSE 회귀 분석을 통해 내부에 축적된 비점오염원 제거 시기를 산정하였다. 빗물 저류조 내부 관리는 크게 주의단계, 일반단계, 안전단계로 지방자치단체를 구분하였다. 주의단계에 해당하는 지방자치단체는 9개, 일반단계에 해당하는 지방자치단체는 10개, 안전단계에 해당하는 지방자치단계는 5개가 해당한다. 이 연구의 결과를 통해 도출된 결론 및 의의는 세 가지로 요약된다. 첫째, 본 연구는 기후변화 시나리오에 따라 발생할 수있는 홍수 가능성을 10년 주기로 분석했다.RCP 8.5 시나리오와 RCP 4.5 시나리오 모두 2070년 이후에 빈번한 홍수의 추이를 볼 수 있었다. RCP 8.5 시나리오의 2090년에 강수량이 가장 많을 것으로 예상된다. RCP 4.5 시나리오 2100년의 경우, 최대 690 mm, 시간당 강수량은 238 mm까지 내릴 것으로 판단된다. 두 번째, 본 연구 논문은 각 기술의 용량을 자치구별로 분석하였다. 본 연구에서 가정한 설치 규정에 따르면 서울시 전역에 설치할 수 있는 빗물 저류조의 부피는 776,588 m³, 투수성 포장은 89,049 m³, 생태수로는 81,986 m³이다. 각 지방자치단체가 두 가지 기술만을 적용하였을 때 효율적인 조합을 제안한 것은 본 연구가 가지는 중요한 의의입니다. 셋째, 각 재해저감 기술로 저감할 수 있는 유출량을 정량화했습니다. 이 연구는 지역 차원의 분산적 형태의 홍수가 더 자주 발생하고, 재난 저감 기술의 정량적 효과를 분석하였다는데 의의가 있다. 본 연구의 한계는 네 부분으로 나눌 수 있다. 첫 번째 한계는 기후변화 시나리오에 대한 불확실성이다. 탄소 배출량이나 시나리오의 변화는 강수량 값을 크게 변경할 수 있기 때문에 오류가 적은 시나리오를 사용하면 향후 연구가 더 중요한 연구로 발전할 것으로 판단된다. 최근 기후변화 시나리오의 불확실성을 줄일 수 있는 연구가 활발히 진행 중이기 때문에, 첫 번째 한계점을 보완한 후속연구가 진행될 것이라 판단된다. 두 번째 한계는 RCP 4.5 / RCP 8.5 시나리오가 10년의 빈도로 수행되었다는 것이다. 세 번째 한계점은 사회 변화 요인이 반영되지 않았다는 것 입니다. 네 번째는 검증의 한계입니다. 본 연구에서는 서울시의 유출수를 계산하기 위해 산술 방정식과 GIS Arc-hydro를 사용하였다.추후 SWMM 등의 홍수 해석 프로그램을 활용하여 추가적인 검증이 되어야 한다. 따라서, 위의 네 가지 한계를 극복하기 위해 후속 연구가 수행되어야 할 것으로 판단된다. 특히 첫 번째 문제점인 기후변화 시나리오의 불확실성 한계점은 후속되는 세 가지 한계점을 발생시키기에, 필수적으로 해결되어야 한다.The social and economic damage caused by climate change has increased rapidly over the last several decades, with increasing instances of heat waves, floods, and extreme rainfall. Of these, the damage caused by extreme rainfall is still ongoing, and more extreme rainfall is expected in Korean Peninsula in the future. There was up to 110.5 mm/hr of rainfall in Seoul, which caused 69 casualties and approximately USD 27.6 million in economic damage. Most of the causes of flooding in modern cities include a sharp increase in non-permeable packaging surfaces and a lack of water circulation facilities. According to climate change scenarios provided by the Korea Meteorological Administration, the average rainfall in cities over the next 100 years is expected to decrease. However, it is predicted that future instances of heavy rain will occur in the future, causing large amounts of local damage. If the current state of infrastructure is not equipped with repair or mitigating technologies, the damage will be significant. This study was conducted based on the following three objectives. First, to quantitatively analyze urban flood damage over the next 80 years (2020-2100) that could be caused by the climate change scenario provided by the Korea Meteorological Administration. Second, this study was selected disaster mitigation facilities and analyzed their impact on disaster mitigation. It also arranges and designs facilities based on an evidence-based planning. Sustainable facilities were selected by introducing eco-friendly facilities for future generations as mitigate technologies. Third, through the development of the HCFD (Hazard Capacity Factor Design) model, the capacity and performance of the facilities that may change in the future were analyzed. HCFD model was used to consider ways to maintain mitigating technologies. In order to achieve these goals, a total of three mitigating technologies have been installed. This includes water tanks, permeable pavement, and ecological waterways. In the case of water tanks, the capacity was calculated by referring to the statutes designated by the Ministry of Environment. Also, an Arc-GIS ArcHydro Plug-in was used to calculate the scale of each technology and watershed was analyzed. The precipitation provided by the climate change scenario was analyzed on an hourly basis to determine the extent to which watershed affects it, and the Huff dimensionless curve was used for this purpose. These three mitigating technologies can contribute to flooding by increasing the storage capacity of rainwater. This study suggests that all floods can be reduced by RCP8.5 in 2050, 2060. Although there will be run-off after 2070, it is analyzed that technology will significantly reduce the volume of the flood. It is deemed that a one-year analysis should be conducted in consideration of the maintenance aspects in the future. Furthermore, removal timing of the non-point source pollutant was calculated. In the case of water tanks, the amount of non-point source pollutant accumulated inside and the removal timing were calculated through MOUSE regression analysis. Internal management of water tank is classified into caution stage, general stage and safe stage. There were nine local governments that corresponded to the caution stage, ten local governments of general stage and five local governments of safe stage. There are three main conclusions drawn from the results of this study. First is that the possibility of flooding that could occur according to climate change scenarios was analyzed at a 10-year frequency. Both the RCP 8.5 scenario and RCP 4.5 scenario showed frequent flooding after 2070. For the RCP 8.5 scenario, it is predicted that the year 2090 has the highest amount of precipitation. However, for RCP 4.5 scenario 2100, the maximum daily rainfall is approximately 690 mm, with hourly precipitation of 238 mm. The second is that capacity of each technology was analyzed. According to the installation rules assumed in this study, the volume of water tanks that can be installed throughout the Seoul Metropolitan Government is 776,588 m³, permeable pavement is 89,049 m³, ecological waterway is 81,986 m³. It is siginificant that each local government has suggested an efficient combination of two technologies. Third, the amount of runoff that can be reduced by each mitigating technology was quantified. This study has identified that flooding at the local level will be more frequent and is meaningful in analyzing the quantitative effects of disaster mitigation technologies. Besides, when each local government installed flood mitigation technology in the future, quantification data would be provided to ensure optimized decision making for each situation. The limitations of this study can be diagnosed by dividing them into four parts. The first limitation is uncertainty about climate change scenarios. Since changes in carbon emissions or scenarios can significantly change precipitation values, it is believed that future studies will develop into a more significant study if a scenario with fewer errors is used. The second limitation is that the study was conducted at a frequency of 10 years, as both RCP4.5 / RCP8.5 scenarios were analyzed daily. Third, social change factors are not reflected. Fourth is the limitation of verification. In this study, an arithmetic equation and GIS Arc-hydro were used to calculate the run-off in the Seoul Metropolitan Government. The most ideal method to verification is to compare the results with other software. The reliability of this study can be improved by comparing the amount of runoff before applying technologies using programs such as SWMM, STORM, and MUSIC. Future studies, therefore, should be carried out to overcome the above four limitations. In particular, uncertainty problem of the climate change scenario should be solved.Chapter 1. Introduction 1 1.1 Background 1 1.2 Objectives 5 1.3 Scope 6 1.4 Definition of Floods 8 1.5 Vulnerability 11 Chapter 2. Literature Review 14 2.1 Overview 14 2.2 Policy Review 19 2.3 Types of Defense Technologies 21 2.4 Types of Analysis Programs 33 2.5 Target Site 37 2.6 Climate Change Scenarios 38 Chapter 3. Methodology 41 3.1 Hydrologic Analysis 41 3.2 Application of Mitigation Technology and Estimation of flood damage 46 3.3 Calculation of Current Rainfall Capacity and Run-off 48 3.4 Estimation of Hourly Precipitation in Climate Change Scenarios (RCP 8.5/RCP 4.5) using the Huff curve 51 3.5 The Concept of HCFD (Hazard Capacity Factor Design) Model for observing Future Ability Changes of Facilities 53 Chapter 4. Results 56 4.1 Site Analysis 56 4.2 The 10-year frequency flood damage analysis 65 4.3 Variation of the flooded area after application of disaster mitigating technology 71 4.4 Amount of non-point pollutant deposits in the water tank and maintenance time using the MOUSE regression equation 86 Chapter 5. Summary and Conclusions 94Maste

WTO SPS 협정의 지역화 조항에 관한 연구

학위논문 (석사)-- 서울대학교 대학원 : 국제대학원 국제학과, 2018. 2. 안덕근.Article 6 of the WTO SPS Agreement on adaptation to regional conditions allows Members to subdivide their national territory according to the level of pest or disease prevalence, and continue trade in areas that have been scientifically verified as disease-free. However, owing to the simplicity of the Article, Members have frequently experienced difficulties in implementing the regionalization concept. Thus, enhancing the implementation of Article 6 has been one of the essential goals of the WTO Member countries and the SPS Committee ever since the establishment of the regionalization provision in 1995. Nevertheless, despite the series of discussions undertaken at the WTO to add details to the provision, little improvement has been made. This thesis seeks to provide the implications for enhancing the implementation of the regionalization principle by examining the drafting history and the recent discussions within the WTO regarding Article 6. Furthermore, by analyzing a number of RTAs that include provisions on regionalization that go beyond the contents of Article 6 of the SPS agreement and drawing on past studies concerning the regionalization provision, this thesis points out the future challenges to enhancing the regionalization provision.1. Introduction 1 2. Background 4 2.1. Regulatory Development of the Regionalization Provision 4 2.1.1. Introduction of the Theoretical Concept 5 2.1.2. Drafting of Rules 8 2.2. International Standards on Regionalization 11 2.2.1. Animals: World Organization for Animal Health (OIE) 11 2.2.2. Plants: International Plant Protection Convention (IPPC) 13 3. Recent Discussions on Regionalization in the WTO 14 3.1. SPS Enhanced Informal Meeting on Article 6 14 3.1.1. Undue Delays 15 3.1.2. Acknowledgement of OIE recognition 19 3.1.3. Non-discrimination 23 3.2. Guidelines to Further the Practical Implementation of Article 6 23 4. Legal Application of the Regionalization Principle 25 4.1. Understanding Article 6: Adaptation to Regional Conditions 25 4.2. Case Study 31 4.2.1. India Agricultural Products Case 32 4.2.2. US Animals Case 39 4.2.3. Russia Pigs Case 46 5. Regionalization Provisions within RTAs 62 5.1. FTA 63 5.2. TPP 68 6. Future Challenges 70 7. Conclusion 74 Bibliography 76 국문초록 82Maste

A Study on the Operating Model of the IoT-based Port Passenger Terminal Monitoring System

4차 산업혁명이라는 시대의 흐름과 맞물려 글로벌 산업분야에 IoT 기반 기술이 다양하게 접목되고 있다. 공원시설이나 도시철도, 공항 등 공공시설물 관리 분야에서는 IoT 기반 시설 구축뿐만 아니라 재난 및 비상 상황에 대응 및 예방을 위해 IoT 기술을 활용한 연구가 활발히 진행되고 있다. 국내 항만분야 및 항만여객터미널 시설에 IoT 도입에 관한 연구는 미비하여 본 연구에서는 국내·외 IoT 적용 관련 사례 분석, 부산국제여객터미널 현황 및 문제점 분석을 통해 IOT 기반 모니터링시스템 운영 모델 구축 및 시사점 제시를 목적으로 한다. 부산항국제여객터미널은 부산 북항 재개발의 선도 사업으로 많은 이용객이 이용하는 다중이용시설로서 IoT 기반 모니터링시스템 도입 시 효과가 높을 것으로 판단되어 부산항국제여객터미널을 대상으로 하였다. 현재 국제여객터미널의 문제점은 대형 시설 관리의 어려움, 재난 및 비상상황에 대한 즉각적인 대응 시스템 부재, 상황에 따른 개인별 정보 제공 불가, 이용객 흐름 관리의 어려움, 시설물의 이상 유무 파악 및 대처 불가 등이 있다. 부산항국제여객터미널의 현황 및 문제점 분석을 통해 본 연구에서는 IoT 기반 모니터링시스템 운영모델을 제시하였다. 첫째, IoT 센서를 통한 실시간 재난 대응 모니터링시스템 운영모델은 스마트기기를 통한 정확한 재난 정보, 비상대피경로 등의 정보 제공으로 신속하고 안전하게 대피할 수 있도록 하는 모델이다. 둘째 주차장 IoT 기반 모니터링시스템 운영모델은 이용객에게 주차장 위치, 주차공간 정보, 차량 주차위치, 요금 등의 다양한 정보를 제공하는 모델이다. 셋째, 수하물 모니터링시스템 운영모델은 수하물에 IoT 기반 블루투스 센서를 부착하거나 GPS 태그를 부착하여 수하물의 위치를 확인하는 시스템으로 수화물 위탁 시간 절감 및 서비스의 고도화를 위한 모델이다. 넷째, 서비스 정보제공 모니터링시스템 운영모델은 부산항국제여객터미널에 방문 시 개인별 상황에 맞는 정보를 제공해주는 서비스 제공 모니터링시스템으로 이용객 개개인의 상황과 이용목적에 맞게 개인 디바이스를 통하여 필요한 정보를 실시간으로 제공하는 모델이다. 다섯째, 시설물 상태 모니터링시스템 운영모델은 실시간으로 시설물 상태를 확인할 수 있는 시설물 상태 시스템으로 시설물에 IoT 기반 센서를 도입하여 시설물의 상태 및 점검시기를 실시간으로 관리자에게 전달하고 공조시스템 및 조명 등의 시설물이 자동으로 제어되어 에너지 절감 효과를 높일 수 있는 모델이다. 본 연구에서 제시한 5가지 IoT 기반 모니터링시스템 운영을 통한 개선효과는 다음과 같다. 대규모 시설물에 인력을 효율적으로 배치할 수가 있어 부산항국제여객터미널의 효율적인 관리가 가능하며, 실시간 모니터링시스템은 만일의 재난에 대하여 재난 발생 시 피해를 최소화하고 대응을 신속하게 할 수 있다. 또한 이용객들은 맞춤형 정보를 제공받고 그것을 통해 서비스의 품질이 향상된다. 본 연구의 시사점은 부산항국제여객터미널에 IoT 기반 기술의 접목을 시작으로 기타 항만시설에도 IoT 기반 기술이 적용될 수 있는 발판을 마련하여 4차 산업의 적용분야를 확대하였다. 또한 IoT 기반 모니터링시스템 구축에 필요한 이론적 배경 및 대안을 제시하여 향후 연구의 바탕을 마련하였다.|In the Fourth Industrial Revolution Generation, IoT-based technologies have been variously applied to global industrial fields. In the field of public facilities management such as park facilities, urban railways and airports, researches related to IoT technology have been actively carried out in order to cope with and prevent disasters and emergencies as well as establishing IoT infrastructure. There are few studies on the introduction of IoT in domestic port area and port terminal facilities. Therefore this study is conducted to suggest an operation model of IOT-based monitoring system and implications through case analysis of domestic and foreign IOT application and current status of the Busan International Passenger Terminal and problem analysis. Busan International Passenger Terminal is a leading business for the redevelopment of Busan North Port, where is a multipurpose facility that many users use. We considered that the IoT based monitoring system will be effective in introducing the Busan International Passenger Terminal. Thus, we selected the Busan International Passenger Terminal as study target. Currently, the Busan international passenger terminal is having difficulties in managing large facilities, lacking of immediate response system for disaster and emergency situation, inability to provide individual information according to the situation, and manage user flow. In this study, IoT-based monitoring system operation model is suggested through analyzing the status and problems of the Busan International Passenger Terminal. First, real-time disaster response monitoring system with IoT sensor is a model that enables quick and safe evacuation by providing information such as accurate disaster information and emergency evacuation route through smart device. Second, parking lot with IoT-based monitoring system operation model provides various information such as parking lot location, parking space information, parking position and parking charge. Third, the operation model of baggage monitoring system is to check the position of baggage by attaching IoT-based Bluetooth sensor or GPS tag. It is a model for reducing baggage loading time and upgrading service. Fourth, the service information monitoring system operation model provides customized information when visiting the Busan International Passenger Terminal. It also provides the necessary information in real time through the device according to the situation and purpose of the user. Fifth, the facility status monitoring system operation model can check the status of the facilities in real time. It introduced IoT-based sensors to the facilities in order to deliver the status and the inspection time of the facilities to the manager in real time. It also can be automatically controlled to increase the energy saving effect. The improvement effects of the five IoT-based monitoring systems proposed in this study are as follows. It can manage the Busan International Passenger Terminal efficiently by allocating manpower to large facilities. The real-time monitoring system can minimize the damage and speed up the response in the event of a disaster. Users get also provided with tailored information, which improves the quality of service. The implication of this study is that the application of IoT-based technology to the Busan International Passenger Terminal which also has been applied to other port facilities in order to expand the application field of the fourth industry. In addition, we suggested the theoretical background and alternatives to construct IoT based monitoring system to establish the basis of future research.Abstract ⅴ 제1장 서 론 1 제1절 연구의 필요성 및 목적 1 제2절 연구의 방법 및 범위 3 제2장 이론적 배경 5 제1절 사물인터넷(Internet of Things)의 개념 및 특성 5 제2절 항만시설물의 정의와 유형 26 제3절 선행연구 33 제3장 국내외 IoT 기반 모니터링시스템 구축 현황 42 제1절 국외 IoT 기반 시설물 관리 사례 42 제2절 국내 IoT 기반 시설물 관리 사례 52 제4장 부산항국제여객터미널의 IoT 기반 모니터링시스템 60 제1절 부산항국제여객터미널 시설물 현황 및 문제점 60 제2절 IoT 기반 모니터링시스템 운영모델 69 제3절 IoT 기반 모니터링시스템 운영에 따른 효과 83 제5장 결 론 88 제1절 연구의 요약 및 시사점 88 제2절 연구의 한계점 및 향후 연구방향 89 91Maste

Incidence and Risk Factors for Surgical Site Infection after Gastric Surgery: A Multicenter Prospective Cohort Study

BACKGROUND: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. While gastrointestinal surgery is relatively common in Korea, few studies have evaluated SSI in the context of gastric surgery. Thus, we performed a prospective cohort study to determine the incidence and risk factors of SSI in Korean patients undergoing gastric surgery. MATERIALS AND METHODS: A prospective cohort study of 2,091 patients who underwent gastric surgery was performed in 10 hospitals with more than 500 beds (nine tertiary hospitals and one secondary hospital). Patients were recruited from an SSI surveillance program between June 1, 2010, and August 31, 2011 and followed up for 1 month after the operation. The criteria used to define SSI and a patient's risk index category were established according to the Centers for Disease Control and Prevention and the National Nosocomial Infection Surveillance System. We collected demographic data and potential perioperative risk factors including type and duration of the operation and physical status score in patients who developed SSIs based on a previous study protocol. RESULTS: A total of 71 SSIs (3.3%) were identified, with hospital rates varying from 0.0 - 15.7%. The results of multivariate analyses indicated that prolonged operation time (P = 0.002), use of a razor for preoperative hair removal (P = 0.010), and absence of laminar flow in the operating room (P = 0.024) were independent risk factors for SSI after gastric surgery. CONCLUSIONS: Longer operation times, razor use, and absence of laminar flow in operating rooms were independently associated with significant increased SSI risk after gastric surgery.ope

A Case of Rectal Squamous Cell Carcinoma with Metachronous Diffuse Large B Cell Lymphoma in an HIV-Infected Patient.

Diffuse large B cell lymphoma (DLBCL) is one of the most common acquired immune deficiency syndrome (AIDS)-defining malignancies among human immunodeficiency virus-infected patients, and rectal cancer has recently emerged as a prevalent non-AIDS-defining malignancy. We report a case of rectal squamous cell carcinoma that was metachronous with DLBCL in an HIV-infected patient who was receiving highly active antiretroviral therapy. The patient was diagnosed with DLBCL and showed complete remission after chemotherapy. Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma. Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported. After concurrent chemoradiation therapy, curative resection was performed.ope

Development of Arthrobacter woluwensis Bacteremia in a Patient with Multiple Myeloma: A Case Report and Comprehensive Literature Review.

Arthrobacter spp., which are coryneform gram-positive bacilli, are widely distributed in the environment, including soil. In humans, infection with Arthrobacter is recognized as an opportunistic infection. In particular, since the first reported case in 1996, human infection by A. woluwensis has been reported only four times. We report on a case of A. woluwensis bacteremia in a 76-year-old female patient with multiple myeloma. Performance of 16S rRNA gene sequence analyses resulted in identification of A. woluwensis. The patient was treated with teicoplanin, and the central venous port was removed. Since then, no growth has been observed on repeated blood cultures. The patient was discharged well after the fever subsided.ope

KISTI 정보화업무 만족도 조사 및 의견수렴

비매

Risk factors for mortality in patients with Serratia marcescens bacteremia

PURPOSE: Over the last 30 years, Serratia marcescens (S. marcescens) has emerged as an important pathogen, and a common cause of nosocomial infections. The aim of this study was to identify risk factors associated with mortality in patients with S. marcescens bacteremia. MATERIALS AND METHODS: We performed a retrospective cohort study of 98 patients who had one or more blood cultures positive for S. marcescens between January 2006 and December 2012 in a tertiary care hospital in Seoul, South Korea. Multiple risk factors were compared with association with 28-day all-cause mortality. RESULTS: The 28-day mortality was 22.4% (22/98 episodes). In a univariate analysis, the onset of bacteremia during the intensive care unit stay (p=0.020), serum albumin level (p=0.011), serum C-reactive protein level (p=0.041), presence of indwelling urinary catheter (p=0.023), and Sequential Oran Failure Assessment (SOFA) score at the onset of bacteremia (p<0.001) were significantly different between patients in the fatal and non-fatal groups. In a multivariate analysis, lower serum albumin level and an elevated SOFA score were independently associated with 28-day mortality [adjusted odds ratio (OR) 0.206, 95% confidential interval (CI) 0.044-0.960, p=0.040, and adjusted OR 1.474, 95% CI 1.200-1.810, p<0.001, respectively]. CONCLUSION: Lower serum albumin level and an elevated SOFA score were significantly associated with adverse outcomes in patients with S. marcescens bacteremia.ope

The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy

BACKGROUND: Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock. MATERIALS AND METHODS: We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission. RESULTS: The 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03-1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05-1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07-1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively. CONCLUSION: The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.ope