Pediatric Infection and Vaccine

  • 제16권2호
  • /
  • Pages.150-161
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  • 2009
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지

소아 황색포도알균 감염증의 임상 양상에 대한 고찰: 지역사회 관련 메티실린 내성 황색포도알균 감염을 중심으로

A Review of Staphylococcus aureus Infections in Children with an Emphasis on Community-associated Methicillin-resistant S. aureus Infections

  • 최영준 (서울대학교 의과대학 소아과학교실) ;
  • 이소연 (서울대학교 의과대학 소아과학교실) ;
  • 성지연 (서울대학교 의과대학 소아과학교실) ;
  • 양미애 (서울대학교 의과대학 소아과학교실) ;
  • 이준호 (서울대학교 의과대학 소아과학교실) ;
  • 오지은 (서울대학교 의과대학 소아과학교실) ;
  • 이진아 (서울대학교 의과대학 소아과학교실) ;
  • 최은화 (서울대학교 의과대학 소아과학교실) ;
  • 이환종 (서울대학교 의과대학 소아과학교실)
  • Choe, Young June (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, So Yeon (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Sung, Ji Yeon (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Yang, Mi Ae (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Joon Ho (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Oh, Chi Eun (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Jina (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Choi, Eun Hwa (Department of Pediatrics, Seoul National University College of Medicine) ;
  • Lee, Hoan Jong (Department of Pediatrics, Seoul National University College of Medicine)
  • 투고 : 2009.09.24
  • 심사 : 2009.10.18
  • 발행 : 2009.12.25
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초록

목 적: 황색포도알균은 소아에서 피부 및 연부조직 감염과 침습성 감염을 일으키는 주요한 원인균이다. 최근 미국에서는 지역사회관련 메티실린 내성 황색포도알균(communityassociated MRSA, CA-MRSA)에 의한 심한 감염이 증가하는 추세로 알려졌지만, 우리나라에서는 소아에서의 황색포도알균 감염의 임상적 특성에 대한 체계적 연구 결과가 아직 없는 실정이다. 본 연구에서는 단일기관에서 경험한 소아 황색포도알균 감염을 CA-MRSA 감염을 중심으로 조사하였다. 방 법: 2004년 1월부터 2007년 12월까지 4년 동안 서울대학교 어린이병원에서 치료받은 소아로부터 분리되었던 황색포도알균의 항균제 감수성 결과 및 균주가 분리되었던 환자 429명의 후향적 의무기록을 통해 검체 부위, 병원 감염 여부, 기저질환, 면역상태, 임상 질환 및 임상 경과에 대한 자료를 분석하였다. 감염의 발생 장소와 위험인자의 유무에 따라 원내 발생(Hospital-onset, HO), 또는 지역사회 발생(community-onset, CO) 의료기관 관련 감염(healthcare-associated, HA)과 지역사회 관련 감염(community-associated, CA)로 구분하였다. 결 과: 1세 미만의 환자 206명 중에서는 HO-HA 감염이 72%, CO-HA 감염이 7%, 그리고 CA 감염이 21%였으며 1세 이상의 환자 223명 중에서는 각각 48%, 28%, 24%였다. HA감염 중 CO-HA 감염의 비율은 1세 이상 환자군에서 1세 미만에 비해 높았으며(8.6% vs. 37.1%, P <0.001), CO 감염 중 HA 감염의 비율 역시 1세 이상 환자군에서 높았다(24.5% vs.54.3%, P <0.001). 전체 분리된 균주의 57%가 MRSA였고 CA감염의 30% (29/96)가 MRSA였으며, CA-MRSA 중 가장 흔한 감염 형태는 피부 및 연조직 감염이었다. 결 론 : 지역사회에서 발생하는 감염을 일으키는 황색포도알균의 메티실린 내성율이 높으며, CA-MRSA는 피부 및 연조직 감염이 가장 흔히 일으켰다.

Purpose : Staphylococcus aureus causes a variety of infections, ranging from benign skin infections to fatal invasive infections. Recently, methicillin-resistant S. aureus (MRSA) infections have emerged in patients who do not have established risk factors. This study was conducted to characterize S. aureus infections in children with an emphasis on communityassociated MRSA infections at a tertiary care pediatric facility during a 3-year period. Methods : Four hundred twenty-nine cases of S. aureus infections diagnosed at the Seoul National University Children's Hospital between January 2004 and December 2006 were retrospectively reviewed. The cases were classified as hospitalonset (HO) or community-onset (CO), healthcare-associated (HA), or community-associated (CA) infections. Results : Among the 206 cases <1 year of age, 72%, 7%, and 21% were HO-HA, CO-HA, and CA infections, respectively, as compared to 48%, 28%, and 24% among the 223 cases >1 year of age. The proportion of CO-HA infections among HA infections (8.6% vs. 37.1%, P<0.001) and the proportion of HA infections among the CO infections (24.5% vs. 54.3%, P <0.001) were greater in older children than in infants. Overall, 57% of the isolates were methicillin-resistant. Twenty-nine (30%) of 96 CA strains were MRSA, and the most common site of CA-MRSA infection was the skin and soft tissues (26 cases). Conclusion : The methicillin resistance rate of S. aureus from CA infections was high and CA-MRSA was most often associated with skin and soft tissue infections.

키워드

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