Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

신생아의 MRSA 균혈증에서 합병증 발생과 연관된 위험인자

Risk factors associated with complicated methicillin-resistant Staphylococcus aureus bacteremia in neonates

  • 이영진 (부산대학교 의학전문대학원 소아과학교실) ;
  • 김현진 (부산대학교 의학전문대학원) ;
  • 변신연 (부산대학교 의학전문대학원 소아과학교실) ;
  • 박수은 (부산대학교 의학전문대학원 소아과학교실) ;
  • 박희주 (부산대학교 의학전문대학원 소아과학교실)
  • Lee, Young Jin (Department of Pediatrics, School of Medicine, Pusan National University) ;
  • Kim, Hyen Jin (School of Medicine, Pusan National University) ;
  • Byun, Shin Yun (Department of Pediatrics, School of Medicine, Pusan National University) ;
  • Park, Su Eun (Department of Pediatrics, School of Medicine, Pusan National University) ;
  • Park, Hee Ju (Department of Pediatrics, School of Medicine, Pusan National University)
  • 투고 : 2009.09.15
  • 심사 : 2009.12.29
  • 발행 : 2010.02.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : MRSA는 대부분의 항생제에 강한 내성을 가지고 있어 감염시 극히 제한된 항생제로만 치료가 가능하며 종종 합병증을 동반한다. 저자들은 신생아에서 합병증이 동반된 MRSA 균혈증의 위험요소들을 알아보고자 하였다. 방 법 : 2002년 1월부터 2007년 12월까지 6년간 부산대학교 병원 신생아 중환자실에 입원한 환아들 중 MRSA 균혈증으로 확인된 44명을 대상으로 후향적 연구를 실시하였다. 합병증은 수막염, 감염 심내막염, 폐렴, 폐공기낭종, 패혈성 관절염, 지속성 균혈증으로 정의하였다. 결 과 : 1) 총 44명의 환아 중 남자는 31명(70.5%), 여자는 13명(29.5%) 이었으며, 평균 재태 주수는 $33.2{\pm}4.9$주, 평균 출생체중은 $1,919{\pm}962.2g$, 인공호흡기 치료를 받은 환아는 21명(47%), 평균 치료기간은 $8.8{\pm}13.8$일이었다. 2) 합병증이 생긴 환아는 13명(29.5%), 합병증이 생기지 않은 환아는 31명(70.5%) 이었다. 3) 두 군간의 재태 주수, 출생 시 체중, 첫 수유시작 날짜, 인공호흡기 치료 유무와, 제대혈관도관 유무, 중심 정맥도관 유무, 기저 질환 유무, 반코마이신의 초기사용 여부, 수혈유무를 변수로 하여 합병증 발생과의 연관성을 조사하였고 기저질환이 있는 경우와 수혈을 한 경우에서 합병증 발생이 유의하게 증가함을 보였다(P <0.05). 결 론 : 합병증이 동반된 MRSA 균혈증은 기저질환이 동반된 경우와 수혈을 한 경우 유의하게 증가하였다. 균 배양검사와 항생제 감수성 결과가 나오기 전 반코마이신을 초기에 사용한 경우 합병증을 동반한 MRSA 균혈증의 발생빈도와는 관계가 없었으며 더 정확한 결과를 위해서 대규모의 전향적 연구가 필요할 것으로 생각된다.

Purpose : Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen that causes nosocomial infection in NICU. It contributes to neonatal morbidity and mortality with variable complications. This study was conducted to identify the risk factors associated with complicated MRSA bacteremia in neonates. Methods : We reviewed the medical records of 44 neonates with positive blood culture for MRSA who were admitted to the NICU of Pusan National University Hospital from January 2002 to December 2007. We compared various factors of the complicated and uncomplicated MRSA bacteremia cases. Results : Of the 44 neonates, 31 were male and 13, female. The mean gestational age and birth weight were $33.2{\pm}4.9$ weeks and $1,859.9{\pm}962.2g$, respectively. Twenty-one of infants were treated with a mechanical ventilator during a mean of $8.8{\pm}13.8$ days. There were 13 cases of complicated and 31 cases of uncomplicated MRSA bacteremia. Between the 2 groups, we compared the following variables: gestational age, birth weight, ventilator use, umbilical catheter use and central catheter insertion, $O_2$ inhalation, first oral feeding day after birth, underlying disease, transfusion, and initial vancomycin use. The underlying disease and transfusion were the risk factors related to complicated MRSA bacteremia. Conclusion : Complicated MRSA bacteremia is related to underlying disease and transfusion. Since this was a retrospective study with a small sample size, it offered limited capacity to compare complicated and uncomplicated MRSA bacteremia. A prospective study with a larger population is needed to determine the exact characteristics of MRSA bacteremia in NICU.

키워드

참고문헌

  1. Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998:339;520-32 https://doi.org/10.1056/NEJM199808203390806
  2. Mandell GL, Bennett JE, Dolin R. Principles and practice of infectious diseases. 5th ed. New York: Churchil livingstone, 2000:2072
  3. Salmenlinna S, Lyytikainen O, Vuopio-Varkila J. Community- acquired methicillin-resistant Staphylococcus aureus, Finland. Emerg Infect Dis 2002:8;602-7
  4. Kono K. Methicillin resistant S. aureus (MRSA) isolated at Fukuoka University Hospital. Chemotherapy 1993;41:735
  5. Maradona JA, Carton JA, Lopez-Alonso J, Carcaba V, Nuno FJ, Arribas JM. Comparative study of community versus hospital- acquired Staphylococcus aureus bacteremia. Eur J Med 1992;1;113-5
  6. Cunney RJ, McNamara EB, alAnsari N, Smyth EG. Community and hospital acquired Staphylococcus aureus septicaemia: 115 casea frome a Dublin teaching hospital. J Infect 1996;33:11-3 https://doi.org/10.1016/S0163-4453(96)92643-2
  7. Behrman RE, Kliegman R, Jenson HB. Nelson textbook of pediatrics. 16th ed. Philadelphia: WB Sanders Co, 2003:627-30
  8. Corbella X, Dominguez MA, Pujol M, Ayats J, Sendra M, Pallares R, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16:351-7 https://doi.org/10.1007/BF01726362
  9. Frederiksen MS, Espersen F, Frimodt-Moller N, Jensen AG, Larsen AR, Pallesen LV, et al. Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000. Pediatr Infect Dis J 2007;26:398-405 https://doi.org/10.1097/01.inf.0000261112.53035.4c
  10. Steinberg JP, Clark CC, Hackman BO. Nosocomial and community-acquired Staphylococcus aureus bacteremias from 1980 to 1993:impact of intravascular devices and methicillin resistance. Clin Infect Dis 1996;23:255-9
  11. Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309-17
  12. Locksley RM, Mitchell LC, Quinn TC, Tompkins LS, Coyle MB, Kirihara JM, et al. Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982;97:317-24
  13. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta analysis. Clin Infect Dis 2003;36:53-9 https://doi.org/10.1086/345476
  14. Soriano A, Martinez JA, Mensa J, Marco F, Almela M, Moreno-Martinez A, et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368-73 https://doi.org/10.1086/313650
  15. Kim SH, Ryu JH, Kim MS, Choi HJ. The risk factors and prognosis of methicillin-resistant staphylococcus aureus bacteremia: focus on nosocomial acquisition. Korean J Med 2006:71:405-14
  16. La Gamma EF, Drusin LM, Mackles AW, Machalek S, Auld PA. Neonatal infections: an important determinant of late NICU mortality in infants less than 1,000g at birth. Am J Dis Child 1983;137:838-41
  17. Reboli AC, John JF Jr, Levkoff AH. Epidemic methicillingentamicin- resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child 1989;143:34-9
  18. Cimolai N. Staphylococcus aureus outbreaks among newborns: new fro ntiers in an old dilemma. Am J Perinatol. 2003;20:125-36 https://doi.org/10.1055/s-2003-40010
  19. Laupland KB, Church DL, Mucenski M, Sutherland LR, Davies HD. Population-based study of the epidemiology of and the risk factors for invasive staphylococcus aureus infections. J Infect Dis 2003:187:1452-9 https://doi.org/10.1086/374621
  20. Graffunder EM, Venezia RA. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 2002;49:999-1005 https://doi.org/10.1093/jac/dkf009
  21. Moro ML, De Toni A, Stolfi I, Carrieri MP, Braga M, Zunin C. Risk factors for nosocomial sepsis in newborn intensive and intermediate care units. Eur J Pediatr 1996;155:315-22 https://doi.org/10.1007/BF02002720
  22. Beck-Sague CM, Azimi P, Fonseca SN, Baltimore RS, Powell DA, Bland LA, et al. Bloodstream infections in neonatal intensive care unit patients: results of a multicenter study. Pediatr Infect Dis J 1994;13:1110-6
  23. Cunney RJ, McNamara EB, alAnsari N, Smyth EG. Community and hospital acquired Staphylococcus aureus septicaemia: 115 cases from a Dublin teaching hospital. J Infect 1996;33:11-3 https://doi.org/10.1016/S0163-4453(96)92643-2
  24. Cook FV, Farrar WF. Vancomycin revisited. Ann Intern Med 1978;88:813-8
  25. Mulligan ME, Murray-Leisure KA, Robner BS, Standiford HC, John JF, Korvick JA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313-28 https://doi.org/10.1016/0002-9343(93)90063-U

피인용 문헌

  1. Carriage Rates of Methicillin-resistantStaphylococcus aureusin Neonates with Neonatal Jaundice vol.18, pp.2, 2010, https://doi.org/10.14776/kjpid.2011.18.2.143
  2. Risk Factors of Catheter-related Bloodstream Infection Due to Methicillin-resistantStaphylococcus aureusin Very Low Birth Weight Infants vol.18, pp.2, 2010, https://doi.org/10.5385/jksn.2011.18.2.288
  3. 단일 기관에서 2002년부터 2016년까지 발생한 소아 황색포도알균 균혈증의 역학 vol.26, pp.1, 2010, https://doi.org/10.14776/piv.2019.26.e2