Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

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

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

  • 노성훈 (전북대학교 의학전문대학원 소아과학교실) ;
  • 유가영 (전북대학교 의학전문대학원 소아과학교실) ;
  • 김정수 (전북대학교병원 임상연구소) ;
  • 황평한 (전북대학교병원 임상연구소) ;
  • 조대선 (전북대학교병원 임상연구소)
  • 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)
  • 투고 : 2009.03.31
  • 심사 : 2009.06.12
  • 발행 : 2009.07.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

  1. Robert MK, Richard EB, Hal BJ, Bonita FS. Nelson textbook of pediatrics. 18th ed: Philadelphia: WB Saunders Co, 2007: 1182-90
  2. Lim HS. Changing patterns of communicable diseases in korea. Korean J Prev Med 2005;38:117-24
  3. Lee JK. Summary of communicable disease outbreak during thirty fifth week in 2007. Communicable disease weekly report 2007;6:1-35
  4. centers for disease control and prevention. The analysis on the prevalence status and characteristics of bacterial pathogens causing acute diarrhea in Korea, 2007. Public health weekly report 2008;1:116-22
  5. Lee MA. Usefulness of selenite F enrichment broth for the isolation of salmonella from stool. Korean Soc Emerg Med 2001;12:64-73
  6. Jeon HS, Hong YJ, Lee MI, Sohn KC. Clinical studies of salmonellosis in childhood. Korean J Pediatr 1994;37:199-204
  7. Shin HB, Jeong SH, Kim M, Kim WH, Lee K, Chong Y. Isolation trend of enteropathogenic bacteria in 1969-1998. Korean J Clin Microbiol 2001;4:87-95
  8. Nah SY, Park JY, Lee HJ, Seo JK. Epidemiologic and clinical features of salmonellosis in children over 10 years (1986- 1995). Korean J Infect Dis 1999;31:129-35
  9. Chun JS, Lee KY, Lee HS, Kim SY, Han JW, Her JK. Salmonellosis in children in daejeon, korea, 1994-1999. Korean J Infect Dis 2000;7:211-7
  10. Qutaishat SS, Stemper ME, Spencer SK, Borchardt MA, Opitz JC, Monson TA, Anderson J, et al. Transmission of salmonella enterica serotype typhimurium DT104 to infants through mother　s breast milk. Pediatrics 2003;6:1442-6
  11. Park JK, Seok WS, Choi BJ, Kim HM, Lim BK, Yoon SS, et al. Salmonella enterica serovar london infections associated with consumption of infant formula. Yonsei Med J 2004;45:43-8
  12. Lim HS. Contributing factors of infectious waterborne and foodborne outbreaks in korea. J Korean Med Assoc 2007;50: 582-91 https://doi.org/10.5124/jkma.2007.50.7.582
  13. Lim HS, Min YS, Lee K, Lim SH. Epidemiologic investigation into an outbreak of typhoid fever recognized by electronic data interchange in gyeongsangbuk-do, 2003. Korean J Epidemiol 2004;26:59-68
  14. Shin SY, Hong JY, Bae JM. An Epidemic survey for salmonellosis occurred on a baby's first birthday banquet in jeju island. Korean J Epidemiol 2004;26:27-38
  15. Korea center for disease control and prevention. Outbreak of infections caused by salmonella saintpaul in the united states. Public health weekly report 2008;1:212-3
  16. Lim HS, Min YS, Lee HS. Epidemiologic investigation on an outbreak of salmonellosis in yeongcheon-si, Korean J Prev Med 2005;38:457-64
  17. Kim MK, Lim HS, Jung C, Ha GY. An epidemiological survey on a salmonella enteritidis outbreak in kyongju, korea. Korean J Epidemiol 1998;20:187-201
  18. Lee DS, Oh HT, Han DH, Ann BY, Kim SH, Kim KW, et al. A clinical and epidemiological analysis on an outbreak of typhoid fever during 1996 summer through autumn in chunju area. Korean J Infect Dis 1998;30:54-60
  19. Kim YD, Lee SM, Son BS, Lee EY, Chang CL. Salmonella osteomyelitis of the sternoclavicular joint mimicking tuberculosis in an otherwise healthy person. Korean J Clin Microbiol 2006;9:146-8
  20. Hwang YD, Choi YK, Lim JY, Jae HC, Kim MS, Kim JM, et al. One case of thoracic empyema due to salmonella choleraesuis. Infect Chemother 2007;39:50-3
  21. Choi JW, Choi SJ, Kwon HC, Cheong JY, Lee KM, Yoo BM, et al. A case of salmonella liver abscess. Korean J Gastroenterol 2006;47:316-9
  22. Cho GJ, Lee JY, Chang JH, Jeong YA, Lee YS, Na JY. A case of ovarian abscess caused by salmonella typhi infection. Korean J Obstet Gynecol 2005;48:794-8
  23. Lee JH, Huh JG, Nah JC, Kim ES, Lee HK, Shin BM, et al. Enteric fever with bowel perforation caused by nontyphoidal group D salmonella. Infect Chemother 2004;36:251-4
  24. Kang HS, Cho H, Park JH, Kim JY, paik JS. A case of salmonella meningitis. J Korean Neurol Assoc 2004;22:175-6
  25. Choi YS, Jung YS, Kim SI, Oh SH. A case of scrotal abscess associated with gastroenteritis and sepsis due to salmonella group D in a one month old infant. Korean J Pediatr 2003;46:602-5
  26. Tsai MH, Huang YC, Chiu CH, Yen MH, Chang LY, Lin PY, et al. Nontyphoidal salmonella bacteremia in previously healthy children: Analysis of 199 episodes. Pediatr Infect Dis J 2007;26:909-13 https://doi.org/10.1097/INF.0b013e318127189b
  27. Kim GT, Kim JC, Song HS. Stool cultures and antibiotic therapy in cases of acute diarrhea. J Korean Clin Pathol 2000;20:184-7
  28. Seo S, Lee MA. The serogroup and antimicrobial resistance of salmonella spp. Isolated from the clinical specimens during 6 years in a tertiary university hospital. Korean J Clin Microbiol 2004;7:72-6
  29. Seo JT, Jung YS, Park JW, Kim KD. A study on salmonella species isolated from several university hospitals in korea. J Korean Med Assoc 1989;32:1230-8
  30. Yoo SM, Pai HJ, Jeong HB, Youn HK, Kim SH, Lee BK. Epidemiology of salmonella enterica serotype typhi infections in korea for recent 9 years: Trends of antimicrobial resistance. J Korean Med Sci 2004;19:15-20 https://doi.org/10.3346/jkms.2004.19.1.15
  31. Meloni T, Marinaro AM, Desole MG. Ceftriaxone treatment of salmonella enteric fever. Pediatr Infect Dis J 1986;7:734-5 https://doi.org/10.1097/00006454-198810000-00015
  32. Lee H, Kim CK, Lee J, Lee SH, Ahn JY, Hong SG, et al. Antimicrobial resistance of clinically important bacteria isolated from 12 hospitals in korea in 2005 and 2006. Korean J Clin Microbiol 2007;10:59-69
  33. Chiu CH, Chuang CH, Chiu S, Su LH, Lin TY. Salmonella enterica serotype choleraesuis infections in pediatric patients. Pediatrics 2006;117:1193-6 https://doi.org/10.1542/peds.2005-2251
  34. Na SY, Kim BC, Yang HR, Jung SJ, Lee KH, Ko JS, et al. Non-typhoidal salmonella gastroenteritis in childhood: Clinical features and antibiotics resistance. Korean J Pediatr Gastroenterol Nutr 2002;5:150-7
  35. Aserkoff B, Bennett JV, Effect of antibiotic therapy in acute salmonellosis on the fecal excretion of salmonellae. N Eng J Med 1969;281:636-40 https://doi.org/10.1056/NEJM196909182811202
  36. Ajunod M, Yamaguchi N, Lopez R. Correlative study of hydrochloric acid, pepsin, and intrinsic factor secretion in newborns and infants. Am J Dig Dis 1969;14:400-14 https://doi.org/10.1007/BF02239360
  37. Oh MH, Shin DH, Pee DH, Shin YK, Choi BM, Sohn JW, et al. Immunogenicity and safety of oral live attenuated salmonella typhi vaccine. Infect Chemother 2004;36:11-7

피인용 문헌

  1. Diffuse Colonic Ulcer Caused bySalmonella enteritidisin a 32-month-old Female vol.15, pp.3, 2012, https://doi.org/10.5223/pghn.2012.15.3.193