Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors Associated with Gastrointestinal Tract Colonization by Enterobacteriaceae in Neonatal Intensive Care Unit Patients

신생아 집중 치료실에 입원한 신생아에서 장내 세균에 의한 장관 집락화와 관련된 위험 인자

  • Kim, Min-Ji (Department of Pediatrics, Kosin University Gospel Hospital) ;
  • Jung, Yu-Jin (Department of Pediatrics, Kosin University Gospel Hospital) ;
  • Hong, Yoo-Rha (Department of Pediatrics, Kosin University Gospel Hospital) ;
  • Bae, Il-Kwon (Research Institute of Bacterial Resistance, Yonsei University College of Medicine)
  • 김민지 (고신대학교 복음병원 소아청소년과) ;
  • 정유진 (고신대학교 복음병원 소아청소년과) ;
  • 홍유라 (고신대학교 복음병원 소아청소년과) ;
  • 배일권 (연세대학교 의과대학 세균 내성 연구소)
  • Published : 2011.11.30
⟨ Previous Next ⟩

Abstract

Purpose: The incidence of nosocomial infection caused by Gram-negative bacilli (GNB) has increased in neonatal intensive care units (NICU). This study identified the progression of sepsis caused by GNB colonization and analyzed the risk factors associated with using periodic stool culture surveillance. Methods: We included 86 newborns admitted to the NICU, Kosin University Gospel Hospital from October 2007 to May 2008. Three stool specimens were collected right after birth and two more were collected at 2 week intervals. The risk factors related to GNB colonization were established from each medical record and related references. Results: The incidence of colonization by GNB was 22 (25.6%) per 86 neonates but none had culture-proven sepsis. The three most commonly isolated GNB were Pseudomonas aeruginosa, Enterobacter cloacae, and Citrobacter freundii. Approximately 89% (32/36) of isolated GNB were susceptible to amikacin. The probability of GNB colonization increased in infants who were fed a small volume during enteral feeding. In contrast, delayed enteral feeding resulted in a decreased probability for GNB colonization. Conclusion: Colonized GNB in the intestine was confirmed by enteric surveillance culture of newborns admitted to the NICU. However, we found no evidence of culture-proven GNB sepsis. As lower feeding volume on the colonization day is a risk factor for GNB colonization, the chance for GNB colonization should be considered when feeding intolerance is present.

목적: 최근 신생아 집중 치료실(neonatal intensive care unit, NICU)에 입원한 신생아들의 병원내 감염 중 그람 음성 간균(Gram negative bacilli, GNB)에 의한 패혈증이 증가하고 있다. NICU에서 정기적인 대변의 감시 배양을 통해 GNB에 의한 장관 집락화가 같은 균에 의한 패혈증으로 이행되는 지를 확인하고, 집락화된 GNB 병원균의 종류를 확인하며 집락화에 관여하는 위험인자를 조사하고자 하였다. 방법: 2007년 10월부터 2008년 5월까지 고신대학교 복음병원 신생아 집중치료실에 입원한 86명의 환아를 대상으로 하였다. 모든 환아에게 총 3회의 대변 채집을 계획하였는데, 출생 후 첫 대변과 2주 간격으로 2회 채집을 계획하였다. 장관의 GNB 집락화와 관련된 위험 인자들은 대상 환아들의 의무기록을 열람하거나 연관된 논문의 고찰을 통해 설정하였다. 결과: 86명의 환아 중 22명(25.6%)이 GNB에 의한 장관 집락화가 있었으나 이 환아들을 퇴원까지 추적하였을 때 GNB로 인한 패혈증은 없었다. Pseudomonas aeruginosa, Enterobcter cloacae, Citrobacter freundii가 가장 많이 분리되었다. 분리된 GNB 중 약 89% (32/36)는 amikacin에 감수성이 있었다. GNB 에 의한 장관 집락화의 가능성은 집락화 당시 수유량이 적을 때 증가한 반면, 첫 수유 시기가 지연될 때 그 가능성은 감소하였다. 결론: 저자들은 NICU에 입원한 신생아에서 장관 감시배양을 통해 장관에 집락화된 GNB를 확인하였으나 연구에 포함된 환아에서 GNB에 의한 패혈증이 발생하지 않았으므로 집락화가 패혈증으로 이행되는 지를 확인할 수는 없었다. 집락화시 적은 수유량(feeding volume at colonization day)이 집락화의 위험요인이었으므로 장관 영양의 진행이 원활하지 않을 경우 장관의 GNB 집락화 가능성을 고려해야 한다.

Keywords

References

  1. Graham PL 3rd, Della-Latta P, Wu F, Zhou J, Saiman L. The gastrointestinal tract serves as the reservoir for Gram-negative pathogens in very low birth weight infants. Pediatr Infect Dis J 2007;26:1153-6. https://doi.org/10.1097/INF.0b013e31814619d4
  2. Park HW, Lim G, Koo SE, Lee BS, Kim KS, Pi SY, et al. Causative agents and antimicrobial sensitivity of neonatal sepsis: ten-year experience in one neonatal intensive care unit. J Korean Soc Neonatol 2009;16:172-81.
  3. Kim CR, Kim SY, Park HJ, Ki MR, Yoon H. Risk factors of nosocomial sepsis in very low birth weight infants. J Korean Soc Neonatol 2010;17:84-93.
  4. Graham PL 3rd, Begg MD, Larson E, Della-Latta P, Allen A, Saiman L. Risk factors for late onset gram-negative sepsis in low birth weight infants hospitalized in the neonatal intensive care unit. Pediatr Infect Dis J 2006;25:113-7. https://doi.org/10.1097/01.inf.0000199310.52875.10
  5. Nambiar S, Singh N. Change in epidemiology of health care-associated infections in a neonatal intensive care unit. Pediatr Infect Dis J 2002;21:839-42. https://doi.org/10.1097/00006454-200209000-00011
  6. Shah SS, Ehrenkranz RA, Gallagher PG. Increasing incidence of gram-negative rod bacteremia in a newborn intensive care unit. Pediatr Infect Dis J 1999;18:591-5. https://doi.org/10.1097/00006454-199907000-00005
  7. Cordero L, Rau R, Taylor D, Ayers LW. Enteric gram-negative bacilli bloodstream infections: 17 years' experience in a neonatal intensive care unit. Am J Infect Control 2004;32:189-95. https://doi.org/10.1016/j.ajic.2003.07.004
  8. Saiman L. Risk factors for hospital-acquired infections in the neonatal intensive care unit. Semin Perinatol 2002;26:315-21. https://doi.org/10.1053/sper.2002.36264
  9. Smith A, Saiman L, Zhou J, Della-Latta P, Jia H, Graham PL 3rd. Concordance of gastrointestinal tract colonization and subsequent bloodstream infections with gram-negative bacilli in very low birth weight infants in the neonatal intensive care unit. Pediatr Infect Dis J 2010;29:831-5. https://doi.org/10.1097/INF.0b013e3181e7884f
  10. Boo NY, Ng SF, Lim VK. A case-control study of risk factors associated with rectal colonization of extended-spectrum beta-lactamase producing Klebsiella sp. in newborn infants. J Hosp Infect 2005;61:68- 74. https://doi.org/10.1016/j.jhin.2005.01.025
  11. Goldmann DA. The bacterial flora of neonates in intensive caremonitoring and manipulation. J Hosp Infect 1988;11 Suppl A:340-51.
  12. Goldmann DA, Leclair J, Macone A. Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978;93:288-93. https://doi.org/10.1016/S0022-3476(78)80523-X
  13. Fryklund B, Tullus K, Berglund B, Burman LG. Importance of the environment and the faecal flora of infants, nursing staff and parents as sources of gram-negative bacteria colonizing newborns in three neonatal wards. Infection 1992;20:253-7. https://doi.org/10.1007/BF01710789
  14. Evans ME, Schaffner W, Federspiel CF, Cotton RB, McKee KT Jr, Stratton CW. Sensitivity, specificity, and predictive value of body surface cultures in a neonatal intensive care unit. JAMA 1988;259:248-52. https://doi.org/10.1001/jama.1988.03720020050036
  15. Waters V, Larson E, Wu F, San Gabriel P, Haas J, Cimiotti J, et. al. Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers' hands in neonatal intensive care units. Clin Infect Dis 2004;38:1682-7. https://doi.org/10.1086/386331
  16. Almuneef MA, Baltimore RS, Farrel PA, Reagan-Cirincione P, Dembry LM. Molecular typing demonstrating transmission of gramnegative rods in a neonatal intensive care unit in the absence of a recognized epidemic. Clin Infect Dis 2001;32:220-7. https://doi.org/10.1086/318477
  17. Jun NL, Kim MN, Jeong JS, Kim YS, Kim EA, Kim KS, et al. Molecular- epidemiologic study on outbreak of colonization by extended spectrum beta-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. Korean J Pediatr 2006;49:150-6. https://doi.org/10.3345/kjp.2006.49.2.150
  18. Duman M, Abacioglu H, Karaman M, Duman N, Ozkan H. Betalactam antibiotic resistance in aerobic commensal fecal flora of newborns. Pediatr Int 2005;47:267-73. https://doi.org/10.1111/j.1442-200x.2005.02064.x
  19. Toltzis P, Dul MJ, Hoyen C, Salvator A, Walsh M, Zetts L, et al. Molecular epidemiology of antibiotic-resistant gram-negative bacilli in a neonatal intensive care unit during a nonoutbreak period. Pediatrics 2001;108:1143-8. https://doi.org/10.1542/peds.108.5.1143
  20. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285-91. https://doi.org/10.1542/peds.110.2.285