Tuberculosis and Respiratory Diseases

  • 제61권1호
  • /
  • Pages.13-19
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  • 2006
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지

Acinetobacter 병원내 폐렴에서 다제 내성군과 약제 감수성군 간의 임상적 특징과 예후

Clinical Characteristics and Prognosis of Acinetobacter Nosocomial Pneumonia between MDR and non-MDR

  • 박인일 (한림대학교 의과대학 내과학교실) ;
  • 김익근 (한림대학교 의과대학 내과학교실) ;
  • 구현철 (한림대학교 의과대학 내과학교실) ;
  • 한재필 (한림대학교 의과대학 내과학교실) ;
  • 김영묵 (한림대학교 의과대학 내과학교실) ;
  • 이명구 (한림대학교 의과대학 내과학교실) ;
  • 정기석 (한림대학교 의과대학 내과학교실)
  • Park, In-Il (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Kim, Ick-Keun (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Koo, Hyun-Cheol (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Han, Jae-Pil (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Kim, Young-Mook (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Lee, Myung-Goo (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine) ;
  • Jung, Ki-Suck (Division of Pulmonary, Allergy and Critical Care Medicine of Hallym University Medical Center, Hallym University College of Medicine)
  • 투고 : 2006.05.11
  • 심사 : 2006.06.21
  • 발행 : 2006.07.30
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초록

연구 배경: A. baumannii는 전 세계적으로 중요한 병원 내 병원균으로 부각되고 있고 이들 균에 의한 감염 또한 빠르게 증가하고 있다. 이들 감염에 연관된 사망률(균혈증:52%, 폐렴:23-73%)은 매우 높고 다제 내성은 비교적 흔하게 발생하고 있는 실정이다. 그러므로 다제 내성 A. baumannii 감염에 대한 효과적인 치료를 위해서 이들의 임상 특징과 결과를 분석하고 이해하는 것이 필요하다. 이에 본 연구는 A. baumannii 병원내 폐렴 중 다제 내성군과 약제 감수성군 간의 임상적 특징, 사망률, 이환율을 비교하였다. 방 법: 2002년 1월 1일부터 2004년 11월 1일까지 춘천성심병원에 입원했던 환자 중 Acinetobacter 병원 내 폐렴으로 판단되는 47명의 환자를 연구 대상으로 하였고 이들의 의무기록을 후향적으로 분석하였다. 본 연구에서는 다제 내성 A. baumannii를 실험 환경에서 A. baumannii에 효과적이며 상업적으로 이용할 수 있는 모든 항생제에 내성을 보이는 것으로 정의하였다. 결 과: 47명의 A. baumannii 병원내 폐렴 환자 중 17명이 다제 내성군, 30명이 약제 감수성군으로 분류되었다. 이들의 평균 연령은 다제 내성군은 $69{\pm}11$세, 약제 감수성군 $70{\pm}13$세이었고 APACHE II 점수, 중환자실 입원기간, 사망률에 있어서 두 군간에 유의한 차이는 없었다($16.1{\pm}5.4$ vs $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs $39.1{\pm}31.0$, P=0.2, 58.8% vs 40%, P=0.21). 결 론: Acinetobacter baumannii 다제 내성군과 약제 감수성군 간의 사망률과 임상적 특징 사이에서 유의한 차이는 보이지 않았다. 그러나 양군 모두 사망률과 이환율은 높게 나타나 A. baumannii 감염의 효과적인 감시 및 조절이 지속적으로 필요하겠다.

Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was $69{\pm}11$ years old and the latter was $70{\pm}13$ years old. The mean APCHE II score, ICU days and mortality were not different between the two groups ($16.1{\pm}5.4$ vs. $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs. $39.1{\pm}31.0$, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

키워드

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