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Salmonellosis in children: Analysis of 72 Salmonella-positive culture cases during the last 10 years

소아의 살모넬라 감염증: 최근 10년동안 살모넬라 배양 양성인 72례에 대한 분석

  • Noh, Sung Hoon (Department of Pediatrics, Chonbuk National University Medical school) ;
  • Yu, Ka Young (Department of Pediatrics, Chonbuk National University Medical school) ;
  • Kim, Jung Soo (Research Institute of Clinical Medicine) ;
  • Hwang, Pyoung Han (Research Institute of Clinical Medicine) ;
  • Jo, Dae Sun (Research Institute of Clinical Medicine)
  • 노성훈 (전북대학교 의학전문대학원 소아과학교실) ;
  • 유가영 (전북대학교 의학전문대학원 소아과학교실) ;
  • 김정수 (전북대학교병원 임상연구소) ;
  • 황평한 (전북대학교병원 임상연구소) ;
  • 조대선 (전북대학교병원 임상연구소)
  • Received : 2009.03.31
  • Accepted : 2009.06.12
  • Published : 2009.07.15

Abstract

Purpose : We aimed to investigate the clinical manifestations of and antibiotic resistance in culture-proven childhood salmonellosis. Methods : Clinical manifestations and laboratory data of and antibiotic use in subjects with culture-proven childhood salmonellosis, who were treated at the Chonbuk National University Hospital between September 1998 and August 2008, were analyzed retrospectively. Patients with underlying diseases or concomitant illnesses were excluded. Results : We assessed a total of 72 patients. There were 68 stool culture-positive cases, 7 blood culture-positive cases, and 3 both stool culture- and blood culture-positive cases. Salmonella group D was the most frequent pathogen in stool (63.9%) and blood (71.4%) cultures. Salmonella typhi was isolated in 1 case. Of the 72 patients, 45 (62.5%) were male children, of which 29 (40.3%) were aged <3 years. The patients most commonly presented with diarrhea (90.2%) and fever (83.3%). Leukocytosis (leukocyte count, >$15,000/{\mu}L$) and leukopenia (leukocyte count, <$4,000/{\mu}L$) were detected in 8.3% and 5.6% of the patients, respectively. Elevated serum C-reactive protein concentration (>5 mg/dL) and erythrocyte sedimentation rate (>20 mm/h) were observed in 88.9% and 58.3% of the patients, respectively. Fifty-two (85.2%) of 61 patients who had undergone antibiotic treatment received a third-generation cephalosporin as definitive antibiotic therapy. Multidrug resistance rate was 40.0 % in the first 5 years of the study and 71.4% in the last 5 years. No fatalities occurred in this series. Conclusion : Children with culture-proven salmonellosis showed relatively benign clinical outcomes. Appropriate antibiotic treatment of <2 weeks is probably adequate for those without a suppurative focus of infection. The incidence of antibiotic resistant isolates was recently seen to increase.

목 적 : 살모넬라는 우리나라에서 비교적 흔한 질환이다. 그러나 요즈음 살모넬라 환아에 대한 임상적 양상과 항생제 내성여부에 관한 연구가 적은 실정이다. 이번 연구는 최근 우리나라의 생활수준의 향상과 환경 위생 시설의 개선 등으로 살모넬라 감염 환아의 양상과 동정되는 살모넬라 균주의 변화, 그리고 항생제 내성에 변화가 있을 것으로 보고 이에 대해 알아보고자 하였다. 방 법 : 1998년 9월부터 2008년 8월까지 약 10년간 전북대학교 병원 소아청소년과에 입원하여 대변이나 혈액 배양검사로 확인된 살모넬라 감염 환아를 대상으로 임상양상, 항생제 사용, 검사실 자료 등에 대해 여러 가지 방법으로 그룹으로 나누어 후향적으로 각종자료를 비교 분석하였다. 선천적으로 동반 질환을 갖고 있는 환아들은 연구대상에서 제외하였으며 심각한 중증 질환에 이환되어 있거나 면역기능에 이상이 있는 경우에도 연구대상에서 제외하였다. 결 과 : 우리는 총 72명의 환아를 분석하였다. 그중에서 68명에서 대변배양검사 양성이었고 7명에서 혈액배양검사 양성이었으며 3명은 두 가지 모두 양성이었다. 살모넬라 D 그룹이 대변배양검사에서 가장 흔한 병원체였고(63.9%) 혈액 배양에서도 가장 흔한 병원체였다(71.4%). S. typhi는 1명에서 배양되었으며, S. paratyphi도 1명에서 배양되었다. 45명(62.5%)이 남아였고 29명(40.3%)이 3세 미만이었다. 설사(90.2%)와 열(83.3%)이 가장 흔한 초기 증상이었다. 말초혈액 백혈구 증가증(백혈구 >$15,000/{\mu}L$)이 8.3%이고 백혈구 감소증(백혈구 <$4,000/{\mu}L$)이 5.6%였다. CRP의 상승(>5 mg/dL)이 88.9%였고 ESR의 상승(>20 mm/hr)이 58.3%였다. 항생제 치료를 받은 환아 61명중 52명(85.2%)이 3세대 세팔로스포린을 최종 항생제로 치료받았다. 다제 약제 내성(3가지 약제이상에 내성)이 처음 5년 동안에는 40.0%였으나 나중 5년 동안에는 71.4%로 증가하고 있는 추세였고 이 기간 동안 사망 환아는 없었다. 결 론 : 살모넬라 배양에 양성인 환아들은 상대적으로 양성인 임상경과를 보였으며 항생제 치료는 2주 미만의 투여가 적절한 것으로 사료되었다. 또한 최근 들어 항생제에 대한 내성 균주가 증가하고 있는 추세를 보였다.

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