Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Increasing Rates of Community Associated Methicillin-Resistant Staphylococcus aureus in Children with Muscular-Skeletal Infections in Korea: A Single Center Experience from 2000 to 2012

소아의 근골격계 감염에서 지역사회 관련 메치실린 내성 황색 포도알균의 증가: 2000년 9월-2012년 8월간의 단일기관 연구

  • Park, Jae-Hong (Department of Pediatrics, CHA Bundang Medical Center, CHA University) ;
  • Lee, Taek-Jin (Department of Pediatrics, CHA Bundang Medical Center, CHA University)
  • 박재홍 (CHA의과학대학교 분당차병원 소아과학교실) ;
  • 이택진 (CHA의과학대학교 분당차병원 소아과학교실)
  • Received : 2012.09.08
  • Accepted : 2012.10.24
  • Published : 2013.08.25
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Abstract

Purpose : This study aimed to explore how prevalent the community-related methicillin-resistant Staphylococcus aureus (CA-MRSA) was in children with muscular-skeletal infections. Methods : We retrospectively reviewed the medical records of patients of 18 years or under who were diagnosed with suppurative arthritis or osteomyelitis and S. aureus from September 2000 through August 2012 at the CHA Bundang Medical center. Results : Thirty-one cases of suppurative arthritis or osteomyelitis were identified. The patients were between 17 days old and 18 years old with an average age of 7. Eleven cases (33.5%) of suppurative arthritis and 16 cases (51.6%) of osteomyelitis were observed. Five cases were accompanied by the two diseases. Methicillin sensitive S. aureus (MSSA) was isolated in 25 cases (80.6%) and methicillin resistant S. aureus (MRSA) was isolated in 6 cases (19.4%). Multidrug resistant strains were not observed. MRSA was not found from 2000 through 2005. All patients were treated with antibiotics and the duration of antibiotics treatment was $26.4{\pm}12.7$ days. Vancomycin was used as the initial antibiotic treatment in 4 cases (12.9%) and vancomycin was used as the definitive antibiotics in the 10 cases (32.3%). Conclusions : The result of this study showed that methicillin resistance rate of S. aureus from muscular-skeletal infections was concentrated in the latter half of the 12 year period.

목 적 : 본 연구에서는 CA-MRSA로 인한 소아의 세균성 근골격계 감염의 임상양상을 연구하기로 하였다. 방 법 : 2000년 9월부터 2012년 8월까지 12년간 분당 차병원에 입원한 18세 이하의 환아 중 혈액과 관절액, 조직이나 고름의 세균 배양검사에서 S. aureus가 동정된 환아를 대상으로 의무기록을 후향적으로 분석하였다. 결 과 : 대상 환아 수는 총 31례였으며 중간값은 7세(최소 17일, 최대 18세)이다. 화농성 관절염으로 진단된 경우는 11례(35.5%), 골수염은 16례(51.6%), 화농성 관절염과 골수염이 병발된 경우는 5례(16.1%)였다. 환아의 혈액이나 관절액, 조직이나 고름 등에서 동정된 S. aureus 31례 중 MSSA는 25례(80.6%), MRSA는 6례(19.4%)였다. 검출된 균주 중 다제내성균은 관찰되지 않았다. MRSA가 배양되었던 6례는 모두 2006년 이후 발생하였다. 모든 증례에서 항생제가 투여되었으며 항생제 투여 기간은 $26.4{\pm}12.7$일이었고, 첫 항생제로 반코마이신을 동반 사용한 경우는 4례(12.9%)였으며 10례(32.3%)에서 최종 항생제로 반코마이신이 투여되었다. 결 론 : 본 연구를 통하여 최근 12년간 세균성 근골격계 감염에서 MRSA의 발생은 연구기간 후반에 편중되었다.

Keywords

References

  1. Krogstad P. Osteomyelitis and septic arthritis. Textbook of Pediatric Infectious Diseases, 5th ed. W.B Saunders, Philadelphia, 2004;713-36.
  2. Gillespie WJ. Epidemiology in bone and joint infection. Infect Dis Clin North Am 1990;4:361-76.
  3. Park JS, Yeom JS, Hwang SC, Park ES, Seo JH, Lim JY, et al. Clinical study of acute pyogenic osteomyelitis in children. Korean J Pediatr 2005;48:731-6.
  4. Dormans JP, Drummond DS. Pediatric hematogenous osteomyelitis: New trends in presentation, diagnosis, and treatment. J Am Acad Orthop Surg 1994;2:333-41. https://doi.org/10.5435/00124635-199411000-00005
  5. Manzotti A, Rovetta L, Pullen C, Catagni MA. Treatment of the late sequelae of septic arthritis of the hip. Clin Orthop Relat Res 2003;410:203-12. https://doi.org/10.1097/01.blo.0000063782.32430.37
  6. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev 2002;15:527-44. https://doi.org/10.1128/CMR.15.4.527-544.2002
  7. Scott RJ, Christofersen MR, Robertson WW Jr, Davidson RS, Rankin L, Drummond DS. Acute osteomyelitis in children : a review of 116 cases. J Pediatr Orthop 1990;10:649-52. https://doi.org/10.1097/01241398-199009000-00015
  8. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health 2005;41:59-62. https://doi.org/10.1111/j.1440-1754.2005.00538.x
  9. Choi EH. Clinical manifestation and treatment of methicillin- resistant Staphylococcus aureus infections in children. Korean J Pediatr Infect Dis 2009;16:1-5.
  10. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing ; Nineteenth informational supplement. CLSI document M100-S19; Philadelphia, CLSI 2009.
  11. Yi J, Kim EC. Microbiological characteristics of methicillin- resistant Staphylococcus aureus. Korean J Clin Microbiol 2010;13:1-6. https://doi.org/10.5145/KJCM.2010.13.1.1
  12. Chong Y, Lee K. Present situation of antimicrobial resistance in Korea. J Infect Chemother 2000;6:189-95. https://doi.org/10.1007/s101560070001
  13. Kim HB, Jang HC, Nam HJ, Lee YS, Kim BS, Park WB, et al. In vitro activities of 28 antimicrobial agents against Staphylococcus aureus isolates from tertiary-care hospitals in Korea: a nationwide survey. Antimicrob Agents Chemother 2004;48:1124-7. https://doi.org/10.1128/AAC.48.4.1124-1127.2004
  14. Otter JA, French GL. Molecular epidemiology of community- associated methicillin resistant Staphylococcus aureus in Europe. Lancet Infect Dis 2010;10:227-39. https://doi.org/10.1016/S1473-3099(10)70053-0
  15. Bukharie HA. Increasing threat of community- acquired methicillin-resistant Staphylococcus aureus. Am J Med Sci 2010;340:378-81. https://doi.org/10.1097/MAJ.0b013e3181e95fdc
  16. Adam HJ, Allen VG, Currie A, McGeer AJ, Simor AE, Richardson SE, et al. Community-associated methicillinresistant Staphylococcus aureus: prevalence in skin and soft tissue infections at emergency departments in the Greater Toronto Area and associated risk factors. CJEM 2009;11:439-46. https://doi.org/10.1017/S1481803500011635
  17. Diederen BM, Kluytmans JA. The emergence of infections with community-associated methicillin resistant Staphylococcus aureus. J Infect 2006;52:157-68. https://doi.org/10.1016/j.jinf.2005.09.001
  18. Kwak YH, Park SE, Hong JY, Jung HS, Park JY, Choi JH, et al. Etiologic agents and clinical features of acute pyogenic osteoarthritis in children. J Korean Pediatr Soc 2000;43:506-13.
  19. Como-Sabetti K, Jernigan JA, Harriman K, Harrison LH, Lynfield R, Farley MM. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005:352:1436-44. https://doi.org/10.1056/NEJMoa043252
  20. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763-71. https://doi.org/10.1001/jama.298.15.1763
  21. Gutman L. Osteomyelitis and suppurative arthritis In : Katz SL, Gershon AA, Hotez PJ. editors. Infectious diseases of children. 10th ed. St Luis : Mosby, 1998;290-301.
  22. Song JS, Choe PG, Song KH, Cho JH, Kim SH, Bang JH, et al. Multicenter study for frequency and clinical features of community-associated methicillin-resistant Staphylococcus aureus in Korea. Infect Chemother 2006;38:325-33.
  23. Prez-Roth E, Claverie-Martin F, Villar J, Mndezlvarez S. Multiplex PCR for simultaneous identification of Staphylococcus aureus and detection of methicillin and mupirocin resistance. J Clin Microbiol 2001;39:4037-41. https://doi.org/10.1128/JCM.39.11.4037-4041.2001
  24. Bae IG, Kim JS, Kim S, Heo ST, Chang C, Lee EY. Genetic correlation of community-associated nethicillin-resistant Staphylococcus aureus strains from carriers and from patients with clinical infection in one region of Korea. J Korean Med Sci 2010;25:197-202. https://doi.org/10.3346/jkms.2010.25.2.197
  25. Diederen BM, Kluytmans JA. The emergence of infections with community-associated methicillin resistant Staphylococcus aureus. J Infect 2006;52:157-68. https://doi.org/10.1016/j.jinf.2005.09.001
  26. Lee SO, Kim ES, Kim HY, Park ES, Jin HY, Ki HK et al. Korean nosocomial infections surveillance system, intensive care unit module report: data summary from July 2007 through June 2008. Korean J Nosocomial Infect Control 2008;13:69-82.
  27. Jeong HY, Jang SJ, Lee SD, Park SH, Chang JY, Min CS, et al. Antibiotic resistance of Staphylococcus aureus isolated from community in Korea. [SL-09] In : Program and abstract of the 4th International Symposium on Antimicrobial Agent and Resistance (Seoul). Republic of Korea : Asian-Pacific Research Foundation for Infectious Diseases, 2003.
  28. Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, et al. Comparison of community and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976-84. https://doi.org/10.1001/jama.290.22.2976
  29. Salgado CD, Farr BM, Calfee DP. Community acquired methicillin-resistant Staphylococcus aureus : a metaanalysis of prevalence and risk factors. Clin Infect Dis 2003:36:131-9. https://doi.org/10.1086/345436
  30. Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2010;51:183-97. https://doi.org/10.1086/653519
  31. 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.
  32. National Committee for Clinical Laboratory Standards, 2002. Performance standards for antimicrobial susceptibility testing; twelfth informational supplement (M100-S12), Wayne, PA.