Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지

Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study

최근 5년(2006-2010)간 소아 혈액 종양 환자에서 발생한 균혈증의 원인균 및 임상 양상: 단일기관 연구

  • Kang, Ji Eun (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Seok, Joon Young (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Yun, Ki Wook (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Kang, Hyoung Jin (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Choi, Eun Hwa (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Park, Kyung Duk (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Shin, Hee Young (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Lee, Hoan Jong (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Ahn, Hyo Seop (Department of Pediatrics, Seoul National University Children's Hospital)
  • 강지은 (서울대학교 어린이병원 소아청소년과) ;
  • 석준영 (서울대학교 어린이병원 소아청소년과) ;
  • 윤기욱 (서울대학교 어린이병원 소아청소년과) ;
  • 강형진 (서울대학교 어린이병원 소아청소년과) ;
  • 최은화 (서울대학교 어린이병원 소아청소년과) ;
  • 박경덕 (서울대학교 어린이병원 소아청소년과) ;
  • 신희영 (서울대학교 어린이병원 소아청소년과) ;
  • 이환종 (서울대학교 어린이병원 소아청소년과) ;
  • 안효섭 (서울대학교 어린이병원 소아청소년과)
  • Received : 2012.04.23
  • Accepted : 2012.07.24
  • Published : 2012.12.25
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. Methods : A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. Results : A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9 %). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6 % vs. 22.0%, P=0.04). Conclusion : This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.

목 적 : 소아 종양 환자의 균혈증의 원인균과 위험 인자에 대한 지속적인 감시 및 조사를 통해 적절한 치료와 생존율 향상에 기여하고자, 2006년부터 2010년의 최근 5년간 서울대학교 어린이 병원 소아 종양 환자에게 발생했던 균혈증의 원인균 분포와 이들의 항생제 감수성을 분석하여 항생제 선택에 실제적인 도움을 얻고자 하였다. 방 법 : 2006년 1월부터 2010년 12월까지 5년간 서울대학교 어린이병원에서 입원 치료를 받은 소아 종양환자들에게 발생한 균혈증에 대하여, 의무기록을 후향적으로 분석하였다. 의무기록 분석 시, 선행 질환 및 호중구 수치, 치료 경과 등을 조사하였고, 호중구 감소증, 중심 정맥관 등 균혈증의 예후 인자에 대한 분석을 함께 시행하였다. 결 과 : 총 176명의 소아 종양 환자에게 226례의 균혈증이 발생하였고, 246균주가 분리되었다. 이 중 그람 음성균, 그람 양성균, 진균이 각각 63.4%, 34.6%, 2.0%이었다. 그람 음성균 중에는 Klebsiella species, E. coli, 그람 양성균 중에는 coagulase-negative staphylococci, S. aureus 등이 높은 비율로 분리되었다. 그람 양성균의 penicillin, oxacillin, vanconycmin 내성률은 각각 85.7%, 65.9%, 9.5%이었으며, 그람 음성균의 cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, amikacin 내성률은 각각 37.2%, 17.1%, 6.2%, 32.2%, 13.7%이었다. 전체 환자에서 치사율은 12.7%였다. 그람 음성균 균혈증의 쇼크 발생률이 그람 양성균 균혈증보다 유의하게 높았고(48.4% vs. 11.9%, P<0.01), 치사율 역시 그람 음성균이 더 높았다(12.1% vs. 3.0%, P=0.03). 쇼크 발생률은 호중구 감소증을 동반한 환자군에서 호중구 감소증을 동반하지 않은 환자군에서보다 유의하게 높았다(39.6% vs. 22.0%, P=0.04). 결 론 : 그람 음성균이 소아 종양 환자의 균혈증의 흔한 원인균이며, 불량한 예후와도 관련성이 높은 점들은 기존 연구결과들과 일치하였다. 향후 원인 균주의 분포와 항생제 내성률의 변화에 대한 지속적인 모니터링이 필요할 것으로 생각된다.

Keywords

References

  1. Viscoli C, Varnier O, Machetti M. Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis 2005;40:S240-5. https://doi.org/10.1086/427329
  2. Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993; 328:1323-32. https://doi.org/10.1056/NEJM199305063281808
  3. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966; 64:328-40. https://doi.org/10.7326/0003-4819-64-2-328
  4. Ramphal R. Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens. Clin Infect Dis 2004;39: S25-31.
  5. Yun BY, Lee HJ. Septicemia in children with neoplastic disease. J Korean Pediatr Soc 1992;35:1481-92.
  6. Lee DG, Yoon JM, Cho JH, Choi SM, Park YH, Kim YJ, et al. Selective bowel decontamination for the prevention of infection in acute myelogenous leukemia: a prospective vandomized trial. Korean J Med 2001;60:167-74.
  7. Kim SH, Lee YA, Eun BY, Kim NH, Lee JA, Kang HJ, et al. Etiological agents isolated from blood in children with hemato-oncologic diseases (2002-2005). Korean J Pediatr 2007;50:56-64. https://doi.org/10.3345/kjp.2007.50.1.56
  8. Kim YH, Lee HD, Hah JO. Bacteremia in pediatric cancer patients: causative organisms and antibiotic sensitivities. J Korean Pediatric Soc 2005;48:619-23.
  9. Park HW, Youn HS, Im HJ, Kim MN, Seo JJ, Moon HN. Risk factors of bloodstream infection associated mortality in pediatric patients with hemato-oncologic disease. Korean J Hematol 2007;42:343-52. https://doi.org/10.5045/kjh.2007.42.4.343
  10. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 2003;36:1103-10. https://doi.org/10.1086/374339
  11. Gonz lez-Barca E, Fern ndez-a a Sevilla A, Carratala J, Granena A, Gudiol F. Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution. Eur J Clin Microbiol Infect Dis 1996;15:291-6. https://doi.org/10.1007/BF01695660
  12. Chang MS, Sung KW, Kim YJ. Clinical characteristics of bacteremia in children with cancer. Korean J Pediatr Infect Dis 2011;18:201-6.
  13. Choi EH, Pyo JW, Park JY, Kwon KB, Yun BY, Shin HY, et al. Infections in children with neoplastic disease. J Korean Pediatr Soc 1995;38:366-77.
  14. Oliveira AL, de Souza M, Carvalho-Dias VMH, Ruiz MA, Silla L, Tanaka PY, et al. Epidemiology of bacteremia and factors associated with multi-drug-resistant gram-negative bacteremia in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2007;39: 775-81. https://doi.org/10.1038/sj.bmt.1705677
  15. Song JH, Joo EJ. The crisis of antimicrobial resistance: current status and future strategies. J Korean Med Assoc 2010;53:999-1005. https://doi.org/10.5124/jkma.2010.53.11.999
  16. Lee HM, Kim CK, Lee JW, Lee SH, Ahn JY, Hong SG, et al. Antimicrobial resistance of clinically important bacteria isolated from 12 hospitals in Korea in 2005 and 2006. Korean J Clin Microbiol 2007;10:59-67.
  17. Paul M, Bishara J, Levcovich A, Chowers M, Goldberg E, Singer P, et al. Effectiveness and safety of colistin: prospective comparative cohort study. J Antimicrob Chemother 2010;65:1019-27. https://doi.org/10.1093/jac/dkq069
  18. Whimbey E, Kiehn TE, Brannon P, Blevins A, Armstrong D. Bacteremia and fungemia in patients with neoplastic disease. Am J Med 1987;82:723-30. https://doi.org/10.1016/0002-9343(87)90007-6
  19. Tamburro R. Pediatric cancer patients in clinical trials of sepsis: factors that predispose to sepsis and stratify outcome. Pediatr Crit Care Med 2005;6:S87-91. https://doi.org/10.1097/01.PCC.0000161288.00396.49
  20. Viscoli C. Management of infection in cancer patients: studies of the EORTC International Antimicrobial Therapy Group (IATG). Eur J Cancer 2002;38:S82-7. https://doi.org/10.1016/S0959-8049(01)00461-0