Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Pattern of Hospital-Associated Infections in Children Admitted in the Intensive Care Unit of a University Hospital

일개 대학병원 중환자실에 입원한 소아 환자에서 발생한 원내감염의 양상

  • Kim, Su Nam (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Won, Chong Bock (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Cho, Hye Jung (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Eun, Byung Wook (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Sim, So Yeon (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Choi, Deok Young (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Sun, Yong Han (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Cho, Kang Ho (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Son, Dong Woo (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Tchah, Hann (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Jeon, In Sang (Department of Pediatrics, Graduate School of Medicine, Gachon University)
  • 김수남 (가천대학교 의학전문대학원 소아과학교실) ;
  • 원종복 (가천대학교 의학전문대학원 소아과학교실) ;
  • 조혜정 (가천대학교 의학전문대학원 소아과학교실) ;
  • 은병욱 (가천대학교 의학전문대학원 소아과학교실) ;
  • 심소연 (가천대학교 의학전문대학원 소아과학교실) ;
  • 최덕영 (가천대학교 의학전문대학원 소아과학교실) ;
  • 선용한 (가천대학교 의학전문대학원 소아과학교실) ;
  • 조강호 (가천대학교 의학전문대학원 소아과학교실) ;
  • 손동우 (가천대학교 의학전문대학원 소아과학교실) ;
  • 차한 (가천대학교 의학전문대학원 소아과학교실) ;
  • 전인상 (가천대학교 의학전문대학원 소아과학교실)
  • Received : 2011.09.14
  • Accepted : 2011.10.04
  • Published : 2011.12.25
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Abstract

Purpose : Hospital associated infection (HAI) caused by multidrug-resistant (MDR) microorganisms has been recognized as an important issue in the world, especially in critically ill patients such as the patients admitted in the intensive care unit. There are fewer papers about MDR-HAI in pediatric patients compared to adult patients. In this study, we investigated the incidence and associated factors of MDR-HAI in children admitted to the intensive care unit (ICU) of a university hospital. Methods : We retrospectively evaluated 135 children who were admitted in ICU for at least 3 days between January 2009 and December 2010. HAI cases were divided into MDR-HAI group and non-MDR-HAI group. Clinical characteristics and various associated factors were compared between those groups. Results : In 39 patients, 45 cases of ICU-related HAI were developed. ICU-related HAI incidence was 47.7 per 1000 patientdays. Thirty-six cases (80.0%) were MDR-HAI. Acinetobacter baumannii was isolated more commonly in MDR-HAI group. And the followings were found more frequently in MDR-HAI group than non-MDR-HAI group: medical condition as an indication for ICU admission, mechanical ventilation, urinary catheterization and previous use of broad-spectrum antibiotics. Among the risk factors, previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. Conclusion : ICU-related HAI incidence was higher than previously reported. Previous use of broad-spectrum antibiotics was the independent risk factor for MDR-HAI. To investigate the characteristics of MDR-HAI in children admitted in ICU, further studies with a larger sample size over a longer period of time are warranted.

목 적 : 집중 치료를 받고 있는 환자들에서 MDR-HAI이 전세계적으로 중요한 문제로 인식되고 있다. 그러나 이와 관련하여 소아 환자들을 대상으로 한 연구는 성인에 비해 상대적으로 부족하다. 본 연구에서는 단일 대학병원 중환자실에 입원한 소아환자를 대상으로 MDR-HAI의 발생률과 연관인자를 알아보고자 하였다. 방 법: 2009년 1월부터 2010년 12월까지 본원 환자실에서 3일 이상 입원치료 하였던 135명의 소아 환자를 대상으로 입원기록을 후향적으로 검토하였다. 원내감염을 MDR-HAI과 non-MDR-HAI의 두 군으로 나누어 각각 임상적 특징과 여러 연관인자들을 비교하였다. 결 과: 39명의 환자에서 45례의 중환자실내 원내감염이 발생하였다. 원내감염의 발생률은 중환자실 재원 1,000일당 47.7이었다. 45례 원내감염 중 36례(80.0%)가 다제 내성균에 의한 감염이었다. A. baumannii는 MDR-HAI군에서 더 흔하게 검출되었다(54.5% vs. 8.3%; P=0.007). 중환자실 입원 적응증 중 내과적 질환, 인공 호흡기 치료, 도뇨관 삽입, 이전 광범위 항생제 사용은 MDR-HAI군에서 통계적으로 유의하게 높았다. 회귀분석 결과 이전 광범위 항생제 사용만이 MDR-HAI의 독립적 위험인자였다. 결 론 : 중환자실내 원내감염의 발생률은 이전에 보고된 것보다 높았으며, 이전 광범위 항생제 사용이 MDR-HAI의 독립적 위험인자였다. 향후 중환자실에 입원한 소아 환자에게 발생한 MDR-HAI의 정확한 특징을 확인하기 위해 추가적인 연구가 필요할 것으로 생각된다.

Keywords

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