Neonatal Medicine

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

DOI QR Code

Risk Factors of Catheter-related Bloodstream Infection Due to Methicillin-resistant Staphylococcus aureus in Very Low Birth Weight Infants

극소저체중 출생아에서 메티실린 내성 포도상구균으로 인한 카테터 연관 혈류감염의 위험인자

  • Cho, Il-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Jung, Tae-Woong (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Ju-Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Moon, Se-Na (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Bin, Joong-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Hyun-Seung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jung-Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, So-Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Sung, In-Kyung (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 조일현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정태웅 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이주영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 문세나 (가톨릭대학교 의과대학 소아과학교실) ;
  • 빈중현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이현승 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이정현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김소영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 성인경 (가톨릭대학교 의과대학 소아과학교실)
  • Published : 2011.11.30
⟨ Previous Next ⟩

Abstract

Purpose: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased in children and in neonates, and is particularly associated with frequent use of central venous catheter in very low birth weight (VLBW) infants. It is known that the morbidity and mortality of MRSA infection are low in neonates, as compared with adults. The objective of this study was to examine the difference in clinical characteristics between VLBW infants that survived and those that did not, a catheter-related bloodstream infection (CRBSI) of MRSA. Methods: Thirty-four VLBW infants had laboratory-confirmed bloodstream infection with S. aureus. We examined the incidence, mortality and morbidity of CRBSI, and predictive factors associated with mortality. Results: Twenty-six infants had same pathogen (24 MRSA, 2 Methicillin-sensitive Staphylococcus aureus) in the blood and in the catheter tip. Eight infants (25.8%) died in the CRBSI and they all had MRSA blood infections. Sex ratio, gestational age, duration between blood collection and identification of pathogens, and WBC and platelet count were not significantly different between patients that died from and patients that survived CRBSI of MRSA. C-reactive protein (CRP) was significantly higher in VLBW infants that died. Mean age of onset and hospital day was earlier (9.1${\pm}$6.6 vs. 26.9${\pm}$20.2; P=0.005) and shorter for patients that died (10.1${\pm}$7.0 vs. 73.0${\pm}$32.4; P=0.000). Two survivors had complications of pyogenic arthritis of the lower extremities and soft tissue infection, respectively. Conclusion: Mortality of CRBSI was likely to be high in VLBW infants and might be anticipated by CRP and early onset of disease.

목적: 소아와 신생아에서의 MRSA 감염의 발병률은 증가되었고, 특히 극소저체중 출생아에서 중심정맥카테터의 빈번한 사용과 연관되었다. 이번 연구는 NICU에 입원한 극소저체중 출생아를 대상으로 MRSA로 인한 CRBSI의 임상적 특징을 조사하고, CRBSI로 인해 사망한 환자와 생존한 그룹 간의 차이를 분석하여, 사망과 관련된 위험인자를 예측해보고자 하였다. 방법: 34명의 극소저체중 출생아는 실험실적으로 확인된 S. aureus 의 혈류감염을 보였고 카테터 연관 혈류감염의 발병률, 사망률, 유병률 그리고 사망률과 연관된 예측인자를 조사하였다. 결과: 26명의 환아는 혈액과 카테터 tip에서 같은 병원균(24 MRSA, 2 MSSA)을 보였다. 8명(25.8%)은 CRBSI로 사망하였고 모두 MRSA 혈액 감염을 보였다. MRSA로 인한 CRBSI으로부터 생존한 그룹과 사망한 환자 간에 성비, 재태연령, 병원균 확인과 혈액채취의 기간, 백혈구, 혈소판 수는 분명한 차이를 보이지 않았다. CRP는 사망한 환자에서 분명히 증가되었다. 사망한 환자에서 발현 나이의 평균값은 빠르고(9.1${\pm}$6.6 vs. 26.9${\pm}$20.2; P= 0.005) 입원일수는 짧았다(10.1${\pm}$7.0 vs. 73.0${\pm}$32.4; P=0.000). 2명의 생존아는 하지에 화농성 관절염과 연부조직염의 합병증을 가졌다. 결론: 카테터 연관 혈류감염의 사망률은 극소저체중 출생아에서 높은 것으로 보이고 CRP와 질환의 조기발병에 의해 예측되었다.

Keywords

References

  1. Sannoh S, Clones B, Munoz J, Montecalvo M, Parvez B. A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection. Am J Infect Control 2010;38:424-9. https://doi.org/10.1016/j.ajic.2009.07.014
  2. Zingg W, Posfay-Barbe KM, Pfister RE, Touveneau S, Pittet D. Individualized catheter surveillance among neonates: a prospective, 8-year, single-center experience. Infect Control Hosp Epidemiol 2011;32:42-9. https://doi.org/10.1086/657634
  3. Hsu JF, Tsai MH, Huang HR, Lien R, Chu SM, Huang CB. Risk factors of catheter-related bloodstream infection with percutaneously inserted central venous catheters in very low birth weight infants: a center's experience in Taiwan. Pediatr Neonatol 2010;51:336-42. https://doi.org/10.1016/S1875-9572(10)60065-4
  4. de Brito CS, de Brito DV, Abdallah VO, Gontijo Filho PP. Occurrence of bloodstream infection with different types of central vascular catheter in critically neonates. J Infect 2010;60:128-32. https://doi.org/10.1016/j.jinf.2009.11.007
  5. Wylie MC, Graham DA, Potter-Bynoe G, Kleinman ME, Randolph AG, Costello JM, et al. Risk factors for central line-associated bloodstream infection in pediatric intensive care units. Infect Control Hosp Epidemiol 2010;31:1049-56. https://doi.org/10.1086/656246
  6. Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002;8:295-309. https://doi.org/10.1046/j.1469-0691.2002.00467.x
  7. Kang HC, Lee KC, Kim SS, Park JO, Kim CH. Staphylococcal infection in the neonatal intensive care unit. J Korean Soc Neonatol 2007;14:215-20.
  8. Lee YJ, Kim HJ, Byun SY, Park SE, Park HJ. Risk factors associated with complicated methicillin-resistant Staphylococcus aureus bacteremia in neonates. Korean J Pediatr 2010;53:173-7. https://doi.org/10.3345/kjp.2010.53.2.173
  9. Benjamin DK Jr, Miller W, Garges H, Benjamin DK, McKinney RE Jr, Cotton M, et al. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001;107:1272-6. https://doi.org/10.1542/peds.107.6.1272
  10. Kim CR, Kim SY, Park HJ, Ki MR, Yoon HS. Risk factors of nosocomial sepsis in very low birth weight infants. J Korean Soc Neonatol 2010;17:84-93.
  11. Krediet TG, Mascini EM, van Rooij E, Vlooswijk J, Paauw A, Gerards LJ, et al. Molecular epidemiology of coagulase-negative staphylococci causing sepsis in a neonatal intensive care unit over an 11-year period. J Clin Microbiol 2004;42:992-5. https://doi.org/10.1128/JCM.42.3.992-995.2004
  12. Arnon S, Litmanovitz I, Regev R, Lis M, Shainkin-Kestenbaum R, Dolfin T. The prognostic virtue of inflammatory markers during late-onset sepsis in preterm infants. J Perinat Med 2004;32:176-80.
  13. Hermans MA, Leffers P, Jansen LM, Keulemans YC, Stassen PM. The value of the Mortality in Emergency Department Sepsis (MEDS) score, C reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department. Emerg Med J 2011 Apr 21. [Epub ahead of print]
  14. Lee CC, Chen SY, Tsai CL, Wu SC, Chiang WC, Wang JL, et al. Prognostic value of mortality in emergency department sepsis score, procalcitonin, and C-reactive protein in patients with sepsis at the emergency department. Shock 2008;29:322-7.
  15. Garland JS, Alex CP, Sevallius JM, Murphy DM, Good MJ, Volberding AM, et al. Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. Infect Control Hosp Epidemiol 2008;29:243-9. https://doi.org/10.1086/526439
  16. Cooper GL, Schiller AL, Hopkins CC. Possible role of capillary action in pathogenesis of experimental catheter-associated dermal tunnel infections. J Clin Microbiol 1988;26:8-12.
  17. Teo BW, Sau PY, Xu H, Ma V, Vathsala A, Lee EJ. Microbiology of tunnelled catheter-related infections in a multi-ethnic South-East Asian patient population. Nephron Clin Pract 2011;118:c86-92. https://doi.org/10.1159/000319866