어린이집 소아에서의 황색포도알균의 비강 보균율에 관한 연구

Nasal Carriage of Staphylococcus aureus from Healthy Children Attending Day Care Center

  • 김영민 (서울대학교 어린이병원 소아청소년과) ;
  • 오지은 (서울대학교 어린이병원 소아청소년과) ;
  • 김소희 (서울대학교 어린이병원 소아청소년과) ;
  • 이진아 (분당서울대학교병원 소아청소년과) ;
  • 최은화 (서울대학교 어린이병원 소아청소년과) ;
  • 이환종 (서울대학교 어린이병원 소아청소년과)
  • Kim, Young Min (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Oh, Chi Eun (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Kim, So Hee (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Lee, Jina (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Choi, Eun Hwa (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Lee, Hoan Jong (Department of Pediatrics, Seoul National University Children's Hospital)
  • 투고 : 2010.02.05
  • 심사 : 2010.03.25
  • 발행 : 2010.06.25

초록

목 적 : 국내 어린이집을 다니는 소아를 대상으로 황색포도알균의 비강 내 보균율과 이런 보균율에 영향을 끼치는 요인들에 대해 알아보고자 하였다. 방 법: 2008년 9월에서 10월까지 서울 지역에 위치한 7개 어린이집의 소아 중 서면 동의를 받은 428명을 대상으로 설문지를 통해 인구학적 자료 및 의료기관 관련 위험 요인에 대한 자료를 수집하였다. 또한 어린이집의 소아들의 비강을 도찰하여 얻은 검체를 증균 및 선택배지에 접종한 후 생화학적 검사를 통해 황색포도알균을 동정 및 분리하였고 디스크 확산법을 통해 메티실린 감수성을 결정하였다. 결 과:대상 환아의 평균 연령은 55개월 이었으며 남녀비는 1.1:1.0이었고 최근 1년 이내에 입원력 및 수술력이 있는 환아는 각각 9.2%, 3.6%였고 항생제 사용력은 약 40%에서 확인되었다. 전체 428명의 소아 중 163명에서 비강 내 황색포도알균이 분리되어 황색포도알균의 비강 내 보균율은 38.1%였으며 분리된 균주의 24.5%는 메티실린 내성 균주였다. 연령이 증가함에 따라 황색포도알균의 비강 내 보균율도 증가 추세를 보였다. 비강 내 MRSA 보균이 9.3%의 소아에서 확인되었으며 이들 대부분이 의료기관 관련 위험요소가 없는 소아였다. 결 론:국내 소아의 약 38% 및 9%가 비강 내 황색포도알균 및 MRSA 보균자임을 확인하였으며, 특히 분리된 MRSA의 95%가 CA-MRSA 균주였다. 향후 비강내 황색포도알균의 보균율의 변화 및 CA-MRSA 보균율의 변화에 대해 지속적인 연구가 필요하겠다.

Purpose : This study was performed to investigate the prevalence of Staphylococcus aureus (S. aureus) nasal carriage in Korean children attending day care centers. Methods : During September and October 2009, a survey for nasal carriage of S. aureus and methicillin-resistant S. aureus (MRSA) was conducted among children attending day care centers located in Seoul with questionnaire survey for evaluation of risk factors of acquisition of MRSA was obtained from their guardians. A culture of the anterior nares swabs using enrichment broth was executed for isolating S. aureus and oxacillin susceptibility was assessed by the disk diffusion method. Results : Out of the 428 children enrolled whose mean age was 55 months old, 163 (38.1%) were colonized with S. aureus. Of the 163 isolates, 40 (24.5%) were MRSA. The nasal carriage rate of S. aureus showed an increasing trend with increase of age. Based on the answer to the questionnaire, 9.2% and 3.6% of children had a recent history of hospitalization and surgery, respectively, and approximately 40% of children had a history of prescription of antibiotics within 1 year prior to enrollment. Of the 428 subjects, 40 (9.3%) were MRSA nasal carriers. Conclusion : S. aureus and MRSA carriage rate of children attending day care center in Korea was 38.1% and 9.3%, respectively. Continued surveillance for nasal carriage rate of S. aureus and MRSA (especially community-associated MRSA) is mandatory.

키워드

참고문헌

  1. Kallen AJ, Driscoll TJ, Thornton S, Olson PE, Wallace MR. Increase in community acquired methicillin-resistant Staphylococcus aureus at a Naval Medical center. Infect Control Hosp Epidemiol 2000;21:223-6. https://doi.org/10.1086/501750
  2. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001;344:11-6. https://doi.org/10.1056/NEJM200101043440102
  3. Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346:1871-7. https://doi.org/10.1056/NEJMoa003069
  4. Kuehnert MJ, Kruszon-Moran D, Hill HA, McQuillan G, McAllister SK, Fosheim G, et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006;193:172-9. https://doi.org/10.1086/499632
  5. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362-86. https://doi.org/10.1086/502213
  6. van Belkum A, Verkaik NJ, de Vogel CP, Boelens HA, Verveer J, Nouwen JL, et al. Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis 2009; 199:1820-6. https://doi.org/10.1086/599119
  7. Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751-62. https://doi.org/10.1016/S1473-3099(05)70295-4
  8. Choe YJ, Lee SY, Sung JY, Yang MA, Lee JH, Oh CE, et al. A review of Staphylococcus aureus infections in children with an emphasis on community associated methicillin resistant S. aureus infections. Korean J Pediatr Infect Dis 2009;16:150-61.
  9. Brown DF, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner KJ, et al. Guidelines for the laboratory diagnosis and susceptibility testing of methicillinresistant Staphylococcus aureus (MRSA). J Antimicrob Chemother 2005;56:1000-18. https://doi.org/10.1093/jac/dki372
  10. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 18th information supplement, CLSI document M100-S18. Wayne (PA): The Committee; 2008.
  11. Solberg CO. A study of carriers of Staphylococcus aureus with special regard to quantitative bacterial estimations. Acta Med Scand Suppl 1965;436:1-96.
  12. Ellis MW, Hospenthal DR, Dooley DP, Gray PJ, Murray CK. Natural history of community-acquired methicillinresistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39:971-9. https://doi.org/10.1086/423965
  13. Kazakova SV, Hageman JC, Matava M, Srinivasan A, Phelan L, Garfinkel B, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005;352:468-75. https://doi.org/10.1056/NEJMoa042859
  14. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aurues bacteremia in nasal carriers versus non-carriers. Lancet 2004;364:703-5. https://doi.org/10.1016/S0140-6736(04)16897-9
  15. Jensen AG, Wachmann CH, Poulsen KB, Espersen F, Scheibel J, Skinhoj P, et al. Risk factors for hospitalacquired Staphylococcus aureus bacteremia. Arch Intern Med 1999;159:1437-44. https://doi.org/10.1001/archinte.159.13.1437
  16. Que YA, Moreillon P. Staphylococcus aureus (including Staphylococcal toxic shock). In : Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious disease. 7th edition. Philadelphia : Elsevier Churchill Livingstone, 2010:2543-78.
  17. Jeong HY, Lee JE, Choi BK, Seo KW, Park SH, Kim YL, et al. Molecular epidemiology of community-associated antimicrobial-resistant Staphylococcus aureus in Seoul, Korea (2003): pervasiveness of multidrug-resistant SCCmec type II methicillin-resistant S. aureus. Microb Drug Resist 2007;13:178-85. https://doi.org/10.1089/mdr.2007.709
  18. Adler A, Givon-Lavi N, Moses AE, Block C, Dagan R. Carriage of community-associated methicillin-resistant Staphylococcus aureus in a cohort of infants in southern Israel : risk factors and molecular features. J Clin Microbiol 2010;48:531-8. https://doi.org/10.1128/JCM.02290-08
  19. Lo WT, Lin WJ, Tseng MH, Lu JJ, Lee SY, Chu ML, et al. Nasal carriage of a single clone of communityacquired methicillin-resistant Staphylococcus aureus among kindergarten attendees in nothern Taiwan. BMC Infect Dis 2007;7:51. https://doi.org/10.1186/1471-2334-7-51
  20. Lu PL, Chin LC, Peng CF, Chiang YH, Chen TP, Ma L, et al. Risk factors and molecular analysis of community methicillin-resistant Staphylococcus aureus carriage. J Clin Microbiol 2005;43:132-9. https://doi.org/10.1128/JCM.43.1.132-139.2005
  21. Alfaro C, Mascher-Denen M, Fergie J, Purcell K. Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in patients admitted to Driscoll Children's Hospital. Pediatr Infect Dis J 2006;25:459-61. https://doi.org/10.1097/01.inf.0000215228.25382.bd
  22. Ko KS, Lee JY, Baek JY, Peck KR, Rhee JY, Kwon KT, et al. Characterization of Staphylococcus aureus nasal carriage from children attending an outpatient clinic in Seoul, Korea. Microb Drug Resist 2008;14:37-44. https://doi.org/10.1089/mdr.2008.0776
  23. Heo SY, Song YJ, Kim SJ, Park SY, Kang DC, Ma SH. A clinical review of community acquired methicillin resistant staphylococcal scaled skin syndrome. Korean J Pediatr Infect Dis 2007;14:83-90.