Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Characteristics of Methicillin-resistant Staphylococcus aureus Nasal Colonization Among Neonatal Unit Staff and Infection Control Measures

일개 병원 신생아실 근무 의료인에서 시행한 비강 내 MRSA 집락의 특성 및 전파예방에 관한 보고

  • Kim, Dong Hwan (Department of Pediatrics, Sahmyook Seoul Hospital) ;
  • Kim, Sun Mi (Department of Pediatrics, Sahmyook Seoul Hospital) ;
  • Park, Ji Young (Department of Pediatrics, Sahmyook Seoul Hospital) ;
  • Cho, Eun Young (Department of Pediatrics, Sahmyook Seoul Hospital) ;
  • Choi, Chang Hee (Department of Pediatrics, Sahmyook Seoul Hospital)
  • 김동환 (삼육서울병원 소아청소년과) ;
  • 김선미 (삼육서울병원 소아청소년과) ;
  • 박지영 (삼육서울병원 소아청소년과) ;
  • 조은영 (삼육서울병원 소아청소년과) ;
  • 최창희 (삼육서울병원 소아청소년과)
  • Received : 2009.08.14
  • Accepted : 2009.10.06
  • Published : 2009.12.25
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Abstract

Purpose : In February 2007, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections occurred in two newborns in the neonatal unit of Sahmyook Seoul Hospital. We performed this study to investigate the characteristics of MRSA nasal carriage among neonatal unit staffs and the effective infection control measures. Methods : Nasal swab specimens were obtained from the neonatal unit staff for the presence of MRSA. MRSA-colonized staffs were offered decolonization therapy with oral trimethoprim-sulfamethoxazole or 2% mupirocin ointment. Every 2-4months after decolonizaton, repeat nasal swab specimens were obtained. Also, samples from the neonatal unit environment and room air were collected. Results : Successful decolonization was achieved in 92% of the cases in 2 weeks after decolonization therapy, but most of the staffs were recolonized after several months. The nature of antibiotic susceptibility was changed from multi-drugsusceptible to multi-drug-resistant. The most frequently contaminated objects were dressing carts, computer keyboards, bassinets and washbowls. In environmental cultures using the settle microbe count method, the colony counts were decreased significantly at the last study period compared with the first study period in the neonatal room, breastfeeding room, service room, and dressing room (P <0.05). Conclusion : Effective control of sustained MRSA transmission within an institution may require prompt identification, treatment, and monitoring of colonized and/or infected staffs. However, nasal decolonization therapy may induce multi-drugresistant MRSA infection and had no effect on decreasing the MRSA nasal carriage rate in our study. Other factors might be more important, such as improving staff education, increasing hand hygiene practices, and environmental sterilization for controlling MRSA infections.

목 적: 본 연구는 2명의 정상 신생아에서 다제 감수성을 보이는 MRSA 균주에 의한 피부 고름집이 연속적으로 발생하여 병원 내 신생아실 근무 의료인을 대상으로 MRSA 집락의 특성, 그리고 전파 예방에 대해 알고자 시행하였다. 방 법: 2007년 2월부터 2008년 10월까지 삼육서울병원 신생아실에 근무하는 의료인과 신생아실 물품들을 대상으로 2-4개월 간격으로 의료인 10명의 비강과 손에서 총 7회(비강 45례, 손 44례)에 걸쳐 세균배양 검사 및 항생제 감수성 검사, 신생아실 내 물품을 대상으로 총 8회의 세균배양 검사 그리고 4개월 간격으로 총 6회의 낙하균 검사를 시행하였다. 비강 세균배양 검사에서 MRSA 균주가 동정되었을 경우, 탈집락 요법으로 7일간 trimethoprim-sulfamethoxazole (80 mg/400 mg twice daily) 경구 투여, 혹은 2% mupirocin 연고를 도포하여, 치료 종료 후 2주 후 비강 세균배양 재검사를 시행하여 MRSA가 동정되지 않은 경우를 단기 치료에 성공한 것으로 보고, MRSA가 동정된 경우를 치료에 실패한 것으로 판단하였다. 결 과: MRSA 탈집락요법 2주 후 92%에서 탈집락이 관찰되었으나 대부분에서 2개월에서 16개월 사이에 재 집락이 관찰되었으며 2-4개월 간격으로 시행한 신생아실 근무 의료인의 비강 세균배양 검사 시 마다 16.7%에서 50%의 MRSA 보균이 관찰되었다. 비강 내 MRSA 균주는 초기 다제 감수성을 보이다가 다제 내성 균주 증가 양상이 관찰되었다. 물품 배양검사에서 드레싱 운반차 50%, 컴퓨터 키보드 43.8%, 신생아 침대 25%, 목욕대야 25%, 그리고 전화대야서 18.8%에서 균이 동정되었다. 낙하균 검사에서 연구 초기에 비해 후기에 유의하게 낙하균 감소가 관찰되었다(P <0.05). 결 론: 병원 내 지역 사회 연관 MRSA 유행 시에 선별검사를 통한 보균자의 조기치료가 단기적으로 보았을 때는 항생제의 경구 복용과 비강 도포 모두에서 효과가 좋았으나 장기적으로 보았을 때 유의하게 보균율의 차이가 없었으며 순응도 감소 및 항생제 내성의 증가가 관찰되어 보균자의 조기 치료만으로는 MRSA의 지속적 전파를 차단할 수 없으며, 교육을 통한 손 소독 강화, 주기적인 감시체제를 통한 경각심, 그리고 신생아실 내 손소독제의 사용, 환경 소독 등의 고식적인 방법 들이 더욱 중요하리라 생각된다.

Keywords

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