Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Bacteremia in pediatric cancer patients : A single center study

소아 암 환아에서 발생한 균혈증의 분석 : 단일기관 연구

  • Park, Sun Mi (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Choe, Byung Kyu (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Kim, Chun Soo (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Kim, Joon Sik (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Kim, Heung Sik (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Ryoo, Nam-Hee (Department of Laboratory Medicine, Keimyung University School of Medicine)
  • 박선미 (계명대학교 의과대학 소아과학교실) ;
  • 최병규 (계명대학교 의과대학 소아과학교실) ;
  • 김천수 (계명대학교 의과대학 소아과학교실) ;
  • 김준식 (계명대학교 의과대학 소아과학교실) ;
  • 김흥식 (계명대학교 의과대학 소아과학교실) ;
  • 류남희 (계명대학교 의과대학 진단검사의학과교실)
  • Received : 2006.05.08
  • Accepted : 2006.06.13
  • Published : 2006.08.15
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Abstract

Purpose : Bacteremia is one of the major concerns in the treatment of pediatric cancer patients. This study was to determine the etiologic agents and the pattern of antibiotic susceptibilities in a single tertiary medical center. Methods : We retrospectively reviewed the medical records of the cases of bacteremia in pediatric cancer patients from 1998 to 2005 in Keimyung University Dongsan Medical Center. Results : There were 62 cases of bacteremia from 44 patients. Gram-positive organisms(48.3%) were more common than gram-negative organisms(38.7%) or fungi(13%). Among gram-positive organisms, Staphylococcus epidermidis was the most common etiologic agent(63.3%), followed by Staphylococcus aureus(16.7%), ${\alpha}$-hemolytic Streptococcus(16.7%), and Streptococcus mitis(3.3%). Among gram-negative organisms, Alcaligenes xylosoxidans was the most common agent(41.7%) and the other organisms were Klebsiella pneumoniae(20.8%), Stenotrophomonas maltophilia(12.5%), Acinetobacter baumanii(8.2%), etc. In febrile neutropenic patients, however, K. pneumoniae was the most common cause of gram-negative bacteremia. All of the isolated K. pneumoniae in our center produced extended-spectrum beta-lactamase and were related with high mortality. S. aureus, S. epidermidis, and Streptococcus species were all susceptible to vancomycin and teicoplanin. Most staphylococci were resistant to penicillin and oxacillin. Most of the gram-negative organisms were susceptible to imipenem. Conclusion : Gram-positive organisms were more commonly isolated than gram-negative organisms in pediatric cancer patients like other studies. We could obtained valuable information on the choice of proper antibiotics in our institution. Further studies will be needed to explain the prevalence of A. xylosoxidans in our center.

목 적 : 소아 종양 환아 치료에서 감염은 사망까지 초래할 수 있어, 균혈증에 적절히 대처하는 것은 매우 중요하다. 이에 저자들은 현 시점에서 소아 암 환아에서 발생한 균혈증을 분석하여 앞으로의 치료에 참조하기 위해 이 연구를 시행하였다. 방 법 : 1998년 2월부터 2005년 5월 까지 계명대학교 동산의료원 소아과 병동에서 총 44명의 소아 종양 환아에서 발생되었던 62건의 균혈증을 후향적으로 분석하였다. 입원 당시 감염 소견이 있거나 입원 48시간 이내 발열이 있었던 환아들은 대상군에서 제외하였다. 결 과 : 그람양성균에 의한 균혈증은 30례, 그람음성균에 의한 균혈증은 24례, 진균혈증은 8례로 그람양성균의 빈도가 가장 높았다. 그람양성균 중에서는 Staphylococcus epidermidis 19례, Staphylococcus aureus 5례, alpha-hemolytic Streptococcus 5례의 순으로 빈도가 높았으며, 그람음성균에서는 Alcaligenes xylosoxidans 10례, Klebsiella pneumoniae 5례, Stenotrophomonas maltophilia 3례의 순으로 빈도가 높았다. 절대 호중구 수치가 $500/mm^3$ 이하인 경우는 모두 28례(45.2 %)였으며 그람양성균에서는 S. epidermidis가, 그람음성균에서는 K. pneumoniae가 가장 많았다. 항생제 감수성 검사를 시행하여서는 그람양성균 모두가 vancomycin과 teicoplanin에 감수성이 있었으나 methicillin에 내성을 보이는 경우가 S. epidermidis에서 61.5%(8/13), S. aureus에서 80%(4/5)이었다. 그람음성균에서의 감수성 결과, 대부분이 imipenem에 감수성을 보였다. K. pneumoniae는 모든 경우에서 extended-spectrum beta-lactamase(ESBL)가 양성이었고 K. pneumoniae에 감염된 환아 5례 중 4례가 패혈증과 관련되어 사망하였다. 결 론 : 본원에서도 다른 기관과 마찬가지로 균혈증의 원인으로 그람양성균이 많았다. 앞으로 주기적으로 균혈증의 원인균주를 분석하고 그 균주에 대한 항생제의 감수성을 참조하여 적절한 항생제를 선택할 수 있도록 하여야 할 것이다.

Keywords

References

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