Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Pathogens and Prognotic Factors for Early Onset Sepsis in Very Low Birth Weight Infants

극소 저체중 출생아에서 조기 패혈증의 원인균과 예후인자

  • Kim, Yi-Sun (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jin-Kyu (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Hye-Soo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, So-Yoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Seo, Hyun-Ju (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Seo-Heui (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Soo-Kyung (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Yu-Jin (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Myo-Jing (Department of Pediatrics, Dong-A University College of Medicine) ;
  • Jeon, Ga-Won (Department of Pediatrics, Inje University College of Medicine, Busan Paik Hospital) ;
  • Koo, Soo-Hyun (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung-Hoon (Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun-Sil (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won-Soon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김이선 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 김진규 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 유혜수 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 안소윤 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 서현주 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 최서희 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 박수경 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 정유진 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 김묘징 (동아대학교 의과대학 소아과학교실) ;
  • 전가원 (인제대학교 의과대학 부산 백병원 소아과학교실) ;
  • 구수현 (성균관대학교 의과대학 마산삼성병원 소아과학교실) ;
  • 이경훈 (성균관대학교 의과대학 분자세포생물학교실) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아과학교실) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아과학교실)
  • Published : 2009.11.30

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Abstract

Purpose: This study was conducted to determine the incidence, causative pathogens, risk factors and mortality for early onset sepsis in the first three days in very low birth weight infants. Methods: The medical records of 1,124 very low birth weight infants admitted to the neonatal intensive care unit of Samsung Medical Center between November 1994 and December 2008 were retrospectively reviewed. The incidence, causative pathogens, risk factors, and mortality for early onset sepsis in the first 3 days of life in very low birth weight infants were evaluated. Results: Early onset sepsis, as confirmed by positive blood cultures, was present in 17 of 1,124 infants (1.5%). Sixty-four percent of the isolated pathogens were gram-positive bacteria and 35% of the isolated pathogens were gram-negative bacteria. The dominant pathogens of early onset sepsis included Staphylococcus aureus (23.5%), Esherichia coli (23.5%), and Enterococcus (17.6%). Vaginal delivery (adjusted odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.3; P=0.01) was associated with early onset sepsis. The overall mortality (adjusted hazard ratio, 3.0; 95% CI, 1.4-6.5; adjusted P=0.0039) and mortality within 72 hours of life (adjusted hazard ratio, 6.5; 95% CI, 2.2-18.9; adjusted P=0.0005) of infants with early onset sepsis were higher than that of uninfected infants. Conclusion: Early onset sepsis remains an uncommon, but potentially lethal problem among very low birth weight infants. Knowledge of the likely causative organisms and risk factors for early onset sepsis can aid in instituting prompt and appropriate therapy, in order to minimize mortality.

목 적 : 15년간 VLBWI에서 생후 3일내 발생한 조기 패혈증의 발생률과 원인균 및 위험인자를 분석하고 사망률에 대해 알아보고자 하였다. 방 법 : 1994년 11월부터 2008년 12월까지 삼성서울병원 신생아집중치료실에 입원한 출생체중 1,500 g 미만의 VLBWI 1,124명을 대상으로 의무기록을 후향적으로 분석하여 조기 패혈증의 발생률, 원인균, 위험인자 및 사망률에 대해 조사하였다. 결 과 : VLBWI의 3일내 조기 패혈증의 발생률은 1.5% (17명)였다. 조기 패혈증 원인균은 그람 양성균이 64.7% (11종), 그람 음성균 35.2% (6종)보다 높게 나타났고 Staphylococcus aureus (23.5%, 4명), Escherichia coli (23.5%, 4명), Enterococcus (17.6%, 3명) 순으로 많았다. 조기 패혈증과 관련된 위험인자는 질식 분만 (adjusted OR, 3.7; 95% CI, 1.3-10.3; P=0.01)이었고 전체 사망률은 조기 패혈증 군이 대조군에 비해 3.0배 높았고(adjusted hazard ratio, 3.0; 95% CI, 1.4-6.5; adjusted P=0.0039) 특히 3일 내 사망률은 조기 패혈증 군이 대조군에 비해 6.5배 높았다(adjusted hazard ratio, 6.5; 95% CI, 2.2 18.9; adjusted P=0.0005). 결 론 : VLBWI의 조기 패혈증은 흔하지 않지만 사망률이 매우 높다. 조기 패혈증의 원인균 및 위험인자를 밝혀 적절한 항생제 사용 및 주산기 관리로 조기 패혈증 사망률을 낮출 수 있도록 노력해야 할 것이다.

Keywords

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