Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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신생아 중환자실에서 포도알균 감염에 대한 임상적 고찰과 위험 요인 조사

Clinical characteristics and risk factors for staphylococcal infections in neonatal intensive care unit

  • 정민국 (한일병원 소아과) ;
  • 최정호 (한일병원 소아과) ;
  • 장진근 (한일병원 소아과) ;
  • 정성훈 (경희대학교 의과대학 소아과학교실) ;
  • 배종우 (경희대학교 의과대학 소아과학교실) ;
  • 차성호 (경희대학교 의과대학 소아과학교실)
  • Chung, Min Kook (Department of Pediatrics, Hanil General Hospital) ;
  • Choi, Jeong Ho (Department of Pediatrics, Hanil General Hospital) ;
  • Chang, Jin Keun (Department of Pediatrics, Hanil General Hospital) ;
  • Chung, Sung Hoon (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Bae, Chong Woo (Department of Pediatrics, College of Medicine, Kyunghee University) ;
  • Cha, Sung Ho (Department of Pediatrics, College of Medicine, Kyunghee University)
  • 투고 : 2006.07.27
  • 심사 : 2006.09.12
  • 발행 : 2006.12.15
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초록

목 적 : 신생아 중환자실에서 포도알균 감염이 증가하고 있어서 감염시 사망률과 유병율이 높기 때문에 신생아 중환자실에서 포도알균 감염의 임상적인 특징과 위험인자에 대하여 조사하였고 최근 늘어가고 있는 Methicilline 저항성 포도알균과 관련하여 항생제에 대한 감수성을 조사하였다. 방 법 : 2000년 1월부터 2004년 12월까지 한일병원과 경희의 대부속병원 신생아 중환자실에 입원한 세균 배양 검사상 포도알균에 양성을 보인 환아 240명을 대상으로 하여 의무 기록을 후 향적으로 조사하였다. 포도알균을 MRSA, MSSA, S.epidermidis, S.epidermidis 외 CNS로 나누어 감염에 대한 임상적 특징과 여러요인과 발생빈도에 있어서의 연관성에 대한 조사를 시행하였다. 포도알균에 양성을 보인 240명의 환아중 MRSA는 88명, MSSA는 41명, S.epidermidis는 63명, S.epidermidis 외 CNS는 48명이었다. 결 과 : 5년동안 신생아실에 입원한 3,593명 중에 배양검사를 시행한 환아수는 7,481명이었으며 배양검사상 양성 환아수는 2000년도에 23명, 2001년도에 109명, 2002년도에 53명, 2003년도에 35명, 2004년도에 20명이었다. 포도알균 감염의 위험요인은 제태연령 37주 미만, 5분 아프가 점수가 7점 미만, 입원후 총정맥영양 시행, 입원후 인공호흡기의 사용, 제대정맥관 또는 제대동맥관 삽입, 입원후 비강 또는 구강용 영양튜브의 사용 등이었다. 항생제 감수성에 있어서는 모두 vancomycin에 감수성이 100%였으며 teicoplanin, trimethoprim-sulfamethoxazole, chloramphenicol, clindamycin에 감수성이 높았으며 gentamycin과 erythromycin에는 감수성이 낮았다. 결 론 : 포도알균 감염의 빈도를 줄이기 위해서는 철저한 산전 관리 등을 통해 미숙아 출생을 낮춰야 하며 신생아실에 입원하는 환아에게 총정맥영양의 시행, 인공호흡기 사용, 중심정맥도관의 삽입, 비강 또는 구강용 영양튜브의 사용을 최소한도로 해야 하겠으며 최근 신생아실에서 증가하고 있는 methicillin 저항성 포도알균에 대해서는 조기에 적절한 항생제를 사용하는 것이 MRSA 감염으로 인한 유병률과 사망률을 낮출수 있을 것으로 사료된다.

Purpose : The importance of staphylococcal infections in NICU has been emphasized in terms of increased resistant strains and increased incidence of morbidity and mortality. In this study, we inrestignted the clinical characteristics and risk factors for staphylococcal infections, and looked into sensitivity trends of antibiotics in the era of a high rate of methicillin-resistant staphylococcus aureus (MRSA) in our society. Methods : This study included 240 neonates with positive blood, urine and other sites cultures for staphylococci who were admitted to NICU of Hanil General Hospital and Kyunghee University Hospital from January 2000 to December 2004. The analyses included clinical characteristics of staphylococcal infections and the relationship of incidence rate among various factors, including invasive procedures. Results : For 5 years, 3,593 patients were hospitalized in the NICU and 7,481 specimens were cultured from blood, urine, and other sites. During the study period, staphylococci were isolated from 240 patients, of whom 88 patients had MRSA, 41 patients methcillin sensitive staphylococcus aureus (MSSA), 63 patients S. epidermidis, 48 patients coagulase-negative staphylococcus (CNS) except S. epidermidis infections. The risk factors associated with staphylococcal infections were less than 37 weeks of gestational age, less than 7 on a 5 minutes Apgar score, receiving TPN, applied mechanical ventilation, use of central venous catheters and other tubes. The sensitivity to vancomycin was 100 percent. A relatively high sensitivity against teicoplanin, trimethoprim-sulfamethoxazole, chloramphenicol, clindamycin and low sensitivity against gentamicin and erythromycin were shown. Conclusion : To reduce staphylococcal infections in NICU, we need to monitor and manage premature neonates from the beginning of the birth process and to avoid as many invasive procedures as possible in NICU. Considering MRSA, control of preceding factors and early use of appropriate antibiotics is expected to reduce the morbidity and mortality caused by MRSA infections.

키워드

참고문헌

  1. Boyce JM, White RL, Spruill EY. Impact of resistant staphylococcus aureus on the incidence of nosocomial staphylococcal infection. J Infect Dis 1983;148:763-4 https://doi.org/10.1093/infdis/148.4.763
  2. Urrea M, Iriondo M, Thio M, Krauel X, Serra M, LaTorre C, et al. A prospective incidence study of nosocomial infections in a neonatal care unit. Am J Infect Control 2003;31:505-7 https://doi.org/10.1016/S0196-6553(03)00077-4
  3. Behrman RE, Kliegman R, Jenson HB. Nelson textbook of pediatrics. 16th ed. Philadelphia(PA) : WB Sanders Co, 2003: 627-30
  4. Behrman RE, Kliegman R, Jenson HB. Nelson textbook of pediatrics. 17th ed. Philadelphia(PA) : WB Sanders Co, 2004: 861-2
  5. La Gamma EF, Drusin LM, Mackles AW, Machalek S, Auld PA. Neonatal infections: an important determinant of late NICU mortality in infants less than 1,000g at birth. Am J Dis Child 1983;137:838-41 https://doi.org/10.1001/archpedi.1983.02140350016005
  6. Carrieri MP, Stolfi I, Moro ML. Italian study group on hospital acquired infections in NICU. Intercenter variability and time of onset: two crucial issues in the analysis of risk factor for nosocomial sepsis. Pediatr Infect Dis J 2003; 22:599-609 https://doi.org/10.1097/00006454-200307000-00007
  7. Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309-17 https://doi.org/10.7326/0003-4819-97-3-309
  8. Locksley RM, Mitchell LC, Quinn TC, Tompkins LS, Coyle MB, Kirihara JM, et al. Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982;97:317-24 https://doi.org/10.7326/0003-4819-97-3-317
  9. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593-8 https://doi.org/10.1001/jama.279.8.593
  10. Jevons MP. Celbenin-resistant staphylococci. BMJ 1961;1:124-5
  11. Klin MW, Mason EO Jr, Kaplan SL. Outcome of heteroresistant staphylococcus aureus infection in children. J Infect Dis 1987;156:205-8 https://doi.org/10.1093/infdis/156.1.205
  12. Weber MW, Carlin JB, Gatchalian S, Lehmann D, Muhe L, Mulholland EK, et al. Predictors of neonatal sepsis in developing countries. Pediatr Infect Dis J 2003;22:711-7 https://doi.org/10.1097/01.inf.0000078163.80807.88
  13. Villari P, Iacuzio L, Torre I, Scarcella A. Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit. J Infect 1998;37:274-81 https://doi.org/10.1016/S0163-4453(98)92107-7
  14. Kawagoe JY, Segre CA, Pereira CR, Cardoso MF, Silva CV, Fukushima JT. Risk factors for nosocomial infections in critically ill newborns:a 5 years prospective cohort study. Am J Infect Control 2001;29:109-14 https://doi.org/10.1067/mic.2001.114162
  15. Crossley K, Loesh D, Landesman B, Mead K, Chern M, Strate R. An outbreak of infections caused by strains of staphylococcus aureus resistant to methicillin and ammunoglycosides. J infect Dis 1979;139:273-9 https://doi.org/10.1093/infdis/139.3.273
  16. Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GM, et al. Nosocomial pneumonia in intubated patients given sulcralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 1987;317:1376-82 https://doi.org/10.1056/NEJM198711263172204
  17. Weber JR, Angstwurm K, Rosenkranz T, Lindauer U, Burger W, Einhaupl KM, et al. Histamine(H1) receptor antagonist inhibits leukocyte rolling in pial vessels in the early phase of bacterial meningitis in rats. Neurosci Lett 1997;226:17-20 https://doi.org/10.1016/S0304-3940(97)00233-4
  18. Jessen O, Rosendal K, Bulow P, Faber V, Erikson KR. Changing staphylococci and staphylococcal infection. N Engl J Med 1969;281:627-35 https://doi.org/10.1056/NEJM196909182811201
  19. Jain SK, Khanna SK. Staphylococcal suppurative lymphadenitis. Postgrad Med J 1983;59:191-3 https://doi.org/10.1136/pgmj.59.689.191
  20. Sitges-Serra A, Puig P, Juarrieta E, Garau J, Alastrue A, Sitges-Creus A. Catheter sepsis due to staphylococcus epidermidis during parenteral nutrition. Surg Gynecol Obstet 1980;151:481-3
  21. Moyer MA, Edwards LD, Farley L. Comparative culture methods on 101 intravenous catheters: routine, semiquantitative, and blood cultures. Arch Int Med 1983;143:66-9 https://doi.org/10.1001/archinte.143.1.66
  22. Klimek JJ, Marsik FJ, Bartlett RC, Weir B, Shea P, Quintiliani R. Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin resistant staphylococcus at a large community hospital. Am J Med 1976;61:340-5 https://doi.org/10.1016/0002-9343(76)90370-3
  23. Richmond AS, Simberkoff MS, Schaefler S, Rahal JJ Jr. Resistance of Staphylococcus aureus to semisynthetic penicillins and cephalothin. J Infect Dis 1977;135:108-12 https://doi.org/10.1093/infdis/135.1.108
  24. Kim KS, Jung WS, Kwon OH, Lee SY. Circulation rate of methicillin resistant staphylococcus and antibiotic susceptibility. Korean J Pathol 1983;17:32-7
  25. Jung WS, Lee MK, Lee SY. Seperate rate of methicillin resistant staphylococcus aureus and susceptibility of fusidic acid. Korean J Inf 1985;17:141-7.
  26. Kjellander JO, Klein JO, Finland M. In vitro activity of penicillins against Staphylococcus epidermidis. Proc Soc Exp Biol Med 1963;113:1023-31
  27. Sabath LD, Barrett FF, Wilcox C, Gerstein DA, Finland M. Methicillin resistance of staphylococcus aureus and staphylococcus epidermidis. Antimicrobial Agents Chemother 1968; 1:302-6
  28. Archer GL. Antimicrobial susceptibility and selection of resistance among staphylococcus epidermidis isolates recovered from patients with infection of indwelling foreign devices. Antimicrobial Agents Chemother 1978;14:353 https://doi.org/10.1128/AAC.14.3.353
  29. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RF, Boyle-Vavra S, et al. Community acquired methicillin-resistant staphylococcus in children with no identified predisposing risk. JAMA 1998;279:593-8 https://doi.org/10.1001/jama.279.8.593
  30. Hussain FM, Boyle-Vavra S, Bethel CD, Daum RS. Current trends in community-acquired methicillin-resistant staphylococcus aureus at a tertiary care pediatric facility. Pediatr Infect Dis J 2000;19:1163-6 https://doi.org/10.1097/00006454-200012000-00009
  31. Baek YW, Kim JS, Jung WJ, Park SJ, Kim H. The stastical study of methicillin resistant staphylococcus aureus. J Korean Pediatr Soc 1991:34;645
  32. Schaad UB, McCracken GH, Nelson JD. Clinical pharmacology and efficacy of vancomycin in pediatric patients. J Pediatr 1980;96:119 https://doi.org/10.1016/S0022-3476(80)80347-7
  33. Cook FV, Farrar WF. Vancomycin revisited. Ann Intern Med 1978;88:813 https://doi.org/10.7326/0003-4819-88-6-813
  34. Ring JC, Cates KL, Belani KK, Gaston TL, Sveum RJ, Marker SC, et al. Rifampin for CSF shunt infections caused by coagulase-negative staphylococci. J Pediatr 1979;95:317-9 https://doi.org/10.1016/S0022-3476(79)80684-8