Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Bacterial meningitis in children experienced at a university hospital, 1993-2006

서울의 한 대학병원에서 경험한 소아의 세균성 수막염: 1993-2006

  • Cho, Sung Yoon (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Kim, Tae Yeon (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Lee, Hyunju (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Kim, Kyung Hyo (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Yoo, Eun Sun (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Kim, Hae Soon (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Park, Eun Ae (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Ryu, Kyung Ha (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Sohn, Sejung (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Seo, Jeong Wan (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Lee, Seung Joo (Department of Pediatrics, School of Medicine, Ewha Womans University)
  • 조성윤 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 김태연 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 이현주 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 김경효 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 유은선 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 김혜순 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 박은애 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 유경하 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 손세정 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 서정완 (이화여자대학교 의학전문대학원 소아과학교실) ;
  • 이승주 (이화여자대학교 의학전문대학원 소아과학교실)
  • Received : 2008.05.06
  • Accepted : 2008.08.17
  • Published : 2008.10.15
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Abstract

Purpose : Despite the seriousness of bacterial meningitis in children, there is little information on the incidence, causative organisms, mortality rate and age distribution. We studied the frequency by age group and causal pathogens, and clinical characteristics in children with bacterial meningitis in the private sector in Korea. Methods : The medical records containing the data on bacterial meningitis patients under 18 years of age confirmed by cerebrospinal fluid (CSF) findings were retrospectively analyzed from September, 1993 to August, 2006 at Ewha Womans University Mokdong Hospital. Results : Eighty-one cases of bacterial meningitis were observed. Overall the most common organism was Streptococcus agalactiae (group B streptococcus, GBS) (30 cases, 37.0%) followed by Haemophilus influenzae (22 cases, 27.2%), Streptococcus pneumoniae (12 cases, 14.8%), Escherichia coli (3 cases, 3.7%), Neisseria meningitidis (1 case, 1.2%) and others (13 cases, 16.0%). In neonates and young infants under 2 months, the most common organism was GBS. In children between 3 months, and 5 years, the most common organism was H. influenzae. S. pneumoniae was the most common organism in children over 5 years of age. Thirty-one patients (38.3%) had complications. Of all ages, the mortality rate of bacterial meningitis markedly decreased compared with the previously reported rate. Conclusion : In neonates, GBS meningitis was most common. The frequency of H. influenzae meningitis decreased after the introduction of H. influenzae type b vaccination. A strategy for the prevention of GBS meningitis in neonates should be established. The influence of the pneumococcal conjugate vaccine on S. pneumoniae meningitis should be studied.

목 적: 세균성 수막염은 소아에서 심각한 감염 질환이지만 우리나라에서 그 빈도와 원인균, 사망률, 나이별 분포에 대한 연구가 많지 않다. 본 연구에서는 서울의 한 대학 병원에서 세균성 수막염의 연령별, 원인균 별 빈도와 임상 양상에 대해 알아보았다. 방법: 1993년 9월부터 최근 2006년 8월까지 13년간 이화여자대학교 목동 병원에 세균성 수막염으로 입원한 신생아에서 18세까지의 소아를 대상으로 하여 연령별 원인균 및 발생 빈도와 역학을 후향적으로 분석하였다. 세균성 수막염의 정의는 첫째로 뇌척수액에서 세균이 분리 배양되었거나, 둘째로 뇌척수액에서 세균은 배양되지 않았지만 뇌막 자극 증상이 있고 뇌척수액에 백혈구수의 증가가 있으며 혈액에서 세균이 배양되어 배양된 세균이 수막염의 원인으로 추정되는 경우로 하였다. 결과: 총 81례 중 GBS가 30례(37.0%)로 가장 흔한 원인균이었고 이어서 H. influenzae가 22례(27.2%), S. pneumoniae가 12례(14.8%), E. coli가 3례(3.7%), N. meningitidis가 1례(1.2%), 기타균이 13례(16.0%)이었다. 신생아와 2개월 이하의 수막염에서 GBS가 가장 흔한 균이었다. 3개월에서 5세에서는 H. influenzae가 가장 흔한 균이었으며 5세 이상에서는 S. pneumoniae가 가장 흔했다. 31례에서 합병증이 있었으며 사망률은 과거에 비해 감소하였다. 결론: 신생아에서 세균성 수막염의 원인으로 GBS가 가장 많았다. Hib 백신의 도입 이후 H. influenzae에 의한 수막염의 빈도가 감소하는 추세였다. 단백결합 폐구균 백신의 효과에 대한 연구가 필요하며 GBS에 대한 예방전략을 세워야 한다.

Keywords

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