Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Causative Agents and Antimicrobial Sensitivity of Neonatal Sepsis : Ten-year Experience in One Neonatal Intensive Care Unit

단일 신생아중환자실에서 경험한 10년간의 신생아 패혈증의 원인균 및 항생제 감수성 변화

  • Park, Hye-Won (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center) ;
  • Lim, Gin-A (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center) ;
  • Koo, So-Eun (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center) ;
  • Lee, Byong-Sop (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center) ;
  • Kim, Ki-Soo (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center) ;
  • Pi, Soo-Young (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center) ;
  • Kim, Ai-Rhan (Department of Pediatrics, Division of Neonatology, University of Ulsan College of Medicine, childrens Hospital, Asan Medical Center)
  • 박혜원 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 임진아 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 구소은 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 이병섭 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김기수 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 피수영 (울산대학교 의과대학 서울아산병원 소아청소년과) ;
  • 김애란 (울산대학교 의과대학 서울아산병원 소아청소년과)
  • Published : 2009.11.30

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Abstract

Purpose: To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. Methods: We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. Results: Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late-onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. Conclusion: The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.

목 적 : 신생아 사망 및 이환의주요 원인인 패혈증의 치료에 있어서 적절한 항생제의 선택은 항생제 내성을 줄이고 다약제 내성 균주의 출현을 방지할 수 있다. 이제 저자들은 단일 신생아중환자실에서 경험한 신생아 패혈증 빈도와 원인균 및 항생제 감수성 변화를 지난 10년간에 걸쳐 조사하였다. 방 법 : 1998년 1월부터 2007년 12월까지 본원 신생아 중환자실에 입원한 환아 중 혈액 배양 검사상 균이 동정되었던 환아들을 대상으로 의무기록을 통해 1998년부터 2002년까지를 전반기, 2003년부터 2007년까지를 후반기로 구분하여 각 발생 시기에 따른 패혈증의 원인균과 항생제 감수성을 후향적으로 분석하였다. 결 과 : 315명의 환아가 총 350례의 패혈증을 경험하였으며, 조기 패혈증의 원인균으로는 전반기는 S. epidermidis, S.aureus, P. aeruginosa, Enterobacter cloacae, 후반기에는 S. epidermidis, E. cloacae가 흔하게 검출되었다. 후기 패혈증의 경우는 전반기에는 coagulase negative S. epidermidis, S. aureus, K. pneumoniae가 전반기와 후반기 모두에서 가장 흔하게 배양되었다. 다약제 내성균에 의한 패혈증은 엄격한 감염관리를 시행한 이후 감소하는 경향을 보였다. 그람 양성균의 경우 penicillin, ampicillin, 그리고 cefotaxime에 대해 전후반기 모두에서 0-20%의 낮은 감수성을 보였다. 그람 음성균의 경우는 Enterobacter spp의 amikacin에 대한 감수성이 전반기(15.8%)에 비해 후반기(37.5%)에 증가하는 양상이었다. P. aeruginosa는 amikacin에 대해 전반기 33.3%에서 후반기 20%로 감수성이 감소하였다. P. aeruginosa를 제외한 그람 음성균은 cefotaxime에 대해 50-60% 정도의 항생제 감수성을 보였다. P. aeruginosa를 제외한 그람 음성균의 경우 imipenem과 ciprofloxacin에 대해 80% 이상의 감수성을 보였다. 결 론 : 지난 10년간의 신생아 패혈증의 원인균과 항생제 감수성의 변화양상을 확인하였으며, 이는 경험적 항생제 사용을 선택하는데 도움이 될 것으로 생각된다. 전반기에 비해 후반기에는 엄격한 감염관리를 통해 다약제 내성균에 의한 패혈증 및 전체 신생아 패혈증의 발생이 현저히 감소하였다. 따라서 신생아 패혈증의 발생과 감염에 의한 사망을 줄이기 위해서는 적절한 항생제 선택과 더불어 지속적인 감염관리가 필요할 것으로 사료된다.

Keywords

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