Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Increased risk of refractory Mycoplasma pneumoniae pneumonia in children with atopic sensitization and asthma

  • Shin, Jeong Eun (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cheon, Bo Ram (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shim, Jae Won (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Deok Soo (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Hae Lim (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Moon Soo (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shim, Jung Yeon (Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2013.08.01
  • 심사 : 2014.01.02
  • 발행 : 2014.06.10
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초록

Purpose: A nationwide outbreak of Mycoplasma pneumoniae pneumonia (MP) refractory to macrolide antibiotics occurred in Korea during 2011. Steroid therapy has been reported to be both efficacious and well tolerated in pediatric patients with refractory MP. We compared clinical features and laboratory characteristics between children with refractory MP requiring steroid treatment and those with macrolide-responsive MP and evaluated the risk factors associated with refractory MP. Methods: We investigated 203 children who were admitted to our institution with MP from June to November 2011. Refractory MP was defined by persistent fever over $38.3^{\circ}C$ with progressive pulmonary consolidation or pleural effusion despite administration of appropriate macrolide antibiotics for 5 days or longer after admission. Steroid therapy was initiated on the fifth day after admission for refractory cases. Results: There were 26 patients with refractory MP requiring steroid therapy. The mean duration of steroid therapy was 5.4 days and most of the patients were afebrile within 24 hours after initiation of steroid therapy. The prevalence of refractory MP was higher in patients with pleural effusion, lobar pneumonia affecting more than 2 lobes, higher levels of serum lactate dehydrogenase, increased oxygen requirements, and longer duration of hospitalization. Atopic sensitization and history of asthma were also associated with refractory MP after adjusting for age and gender. Conclusion: Children with refractory MP had more severe pneumonia. Atopic sensitization and history of asthma may be risk factors for refractory MP requiring steroid therapy in Korean children.

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참고문헌

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