Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Epidemiology of Staphylococcus aureus Bacteremia in Children at a Single Center from 2002 to 2016

단일 기관에서 2002년부터 2016년까지 발생한 소아 황색포도알균 균혈증의 역학

  • Lim, Seonhee (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Ha, Seok Gyun (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Tchah, Hann (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Jeon, In Sang (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Ryoo, Eell (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Son, Dong Woo (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Cho, Hye Jung (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Sun, Yong Han (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Kim, Hyo Jung (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Ahn, Jung Min (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center) ;
  • Cho, Hye-Kyung (Department of Pediatrics, Gachon University College of Medicine, Gil Medical Center)
  • 임선희 (가천대학교 의과대학 소아과학교실) ;
  • 하석균 (가천대학교 의과대학 소아과학교실) ;
  • 차한 (가천대학교 의과대학 소아과학교실) ;
  • 전인상 (가천대학교 의과대학 소아과학교실) ;
  • 류일 (가천대학교 의과대학 소아과학교실) ;
  • 손동우 (가천대학교 의과대학 소아과학교실) ;
  • 조혜정 (가천대학교 의과대학 소아과학교실) ;
  • 선용한 (가천대학교 의과대학 소아과학교실) ;
  • 김효정 (가천대학교 의과대학 소아과학교실) ;
  • 안정민 (가천대학교 의과대학 소아과학교실) ;
  • 조혜경 (가천대학교 의과대학 소아과학교실)
  • Received : 2018.09.13
  • Accepted : 2018.12.31
  • Published : 2019.04.25
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Abstract

Purpose: We aimed to investigate the epidemiological characteristics of Staphylococcus aureus bacteremia in Korean children. Methods: We retrospectively collected and analyzed data from the medical records of the patients with S. aureus bacteremia ${\leq}18years$ of age in Gil Medical Center from 2002 to 2016. Results: A total of 212 SAB cases were detected. The annual incidence of SAB from 2002 to 2016 ranged from 0.77 to 1.95 per 1,000 patients hospitalized. The neonate group (<28 days of age) and the pediatric group (28-18 years of age) were 51.4% (n=109) and 48.6% (n=103), respectively. According to the origin of infection, there were 93 cases (43.9%) of community-associated (CA)-SAB and 119 cases (56.1%) of healthcare-associated (HA)-SAB. The rates of HA-SAB among the neonate group and among the pediatric group were 64.2% and 47.6%, respectively (P=0.015). There was no difference in complications between CA-SAB and HA-SAB, but mortality was higher in HA-SAB. The proportion of methicillin-resistance S. aureus (MRSA) was the highest in neonates (88.1%), decreased with age, and was 36.4%-37.5% among children aged ${\geq}5years$. The MRSA proportion was 72.2%, showing no consistent trend over the period. Conclusions: The annual incidence of SAB and the proportion of MRSA in SAB remained constant in the recent 15 years in children. Judicious decision of antimicrobial agents for treatment considering the patient's age and the origin of infection is necessary.

목적: 본 연구를 통해 소아청소년에서 발생한 황색 포도알균혈증(Staphylococcus aureus bacteremia; SAB)의 역학적 특성을 알아보고자 하였다. 방법: 2002년부터 2016년까지 15년 간 가천대 길병원에 입원한 18세 이하 소아청소년 중 SAB 환자의 의무기록을 후향적으로 분석하였다. 결과: 총 212명의 소아청소년 SAB 환자가 분석에 포함되었다. 2002년부터 2016년까지 연간 SAB 발생률은 입원환자 1,000명당 0.77-1.95명이었다. 전체 SAB 중 신생아군(28일 미만)과 소아청소년군(28일-18세 이하)은 각각 51.4% (n=109), 48.6%(n=103)이었으며, 지역사회 관련 감염(community associated [CA])과 의료기관 관련 감염(healthcare associated [HA])은 각각 43.9% (n=93), 56.1% (n=119)였다. 소아청소년군(47.6%)보다 신생아군(64.2%)에서 HA-SAB의 비중이 더 높았다(P=0.015). CA-SAB와 HA-SAB에서 합병증 발생 여부는 차이가 없었으나, 사망률은 HA-SAB에서 더 높았다. 메티실린 내성 황색포도알균(methicillin-resistance S. aureus [MRSA])의 비율은 신생아군에서 가장 높았고(88.1%), 연령이 증가할수록 감소하여 5세 이상에서는 36.4-37.5%였다. MRSA 비율은 72.2%로 시간에 따른 일정한 추세는 보이지 않았다. 결론: 지난 15년 간 소아청소년에서 SAB의 발생률 및 MRSA의 비율은 일정한 추세 없이 유지되었다. 소아청소년의 SAB에서 적절한 항생제를 선택하기 위해 환자의 연령 및 감염 기원에 대한 신중한 고려가 필요하다.

Keywords

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