DOI QR코드

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단일 2차 기관에서 소아 마이코플라스마 폐렴 환자의 치료를 위한 스테로이드 사용 현황과 효과

Current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital

  • 유수지 (한림대학교 강남성심병원 소아청소년과) ;
  • 최성은 (한림대학교 강남성심병원 소아청소년과) ;
  • 전지영 (한림대학교 강남성심병원 소아청소년과) ;
  • 안요한 (한림대학교 강남성심병원 소아청소년과) ;
  • 조기영 (한림대학교 강남성심병원 소아청소년과) ;
  • 이용주 (한림대학교 강남성심병원 소아청소년과) ;
  • 성태정 (한림대학교 강남성심병원 소아청소년과) ;
  • 이건희 (한림대학교 강남성심병원 소아청소년과)
  • Yoo, Susie (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Choi, Seong Eun (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Chun, Jiyoung (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Ahn, Yo Han (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Cho, Ky Young (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Lee, Yong Ju (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Sung, Tae Jung (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital) ;
  • Lee, Kon Hee (Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital)
  • 투고 : 2017.07.27
  • 심사 : 2017.09.16
  • 발행 : 2018.03.31

초록

Purpose: Steroids can be used as an adjuvant therapy in the management of mycoplasma pneumonia, but no definite guidelines for the use of steroids have been established. The purpose of this study was to analyze the current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital in Korea. Methods: We retrospectively reviewed the medical records of 152 patients who were admitted due to mycoplasma pneumonia. The patients were divided into 3 groups as follows: those who did not use steroids (81 patients, 53%), those who used steroids after their fever subsided (42 patients, 28%) and those who used steroids during fever (29 patients, 19%). Results: In decreasing order of values, the duration of fever during hospitalization ($60.0{\pm}40.2hours$ vs. $37.3{\pm}28.5hours$ vs. $29.7{\pm}29.5hours$, P= 0.006) and duration of hospitalization ($5.9{\pm}1.7days$ vs. $5.0{\pm}1.4days$ vs. $4.0{\pm}1.5days$, P< 0.001) were reported in the group which received steroids during fever, the group which received steroids after the fever subsided and the group which did not receive steroids. In the group which received steroids during fever, patients with early steroid use (within 24 hours) had a shorter fever duration in the hospital (12.0 hours vs. 73.5 hours, P< 0.001) and a hospitalization duration (5.0 days vs. 6.5 days, P= 0.007) than those with late steroid use (after 24 hours). Conclusion: Steroids were used in 47% of patients with mycoplasma pneumonia. The patients who received early steroids had a shorter fever duration and a shorter hospital stay than those who received late steroids.

키워드

참고문헌

  1. Yu J. Clinical issues regarding increased macrolide-resistant Mycoplasma pneumoniae in children. Allergy Asthma Respir Dis 2017;5:1-2. https://doi.org/10.4168/aard.2017.5.1.1
  2. Kim JH, Kim JY, Yoo CH, Seo WH, Yoo Y, Song DJ, et al. Macrolide resistance and its impacts on M. pneumoniae pneumonia in children: comparison of two recent epidemics in Korea. Allergy Asthma Immunol Res 2017;9:340-6. https://doi.org/10.4168/aair.2017.9.4.340
  3. Kim EK, Youn YS, Rhim JW, Shin MS, Kang JH, Lee KY. Epidemiological comparison of three Mycoplasma pneumoniae pneumonia epidemics in a single hospital over 10 years. Korean J Pediatr 2015;58:172-7. https://doi.org/10.3345/kjp.2015.58.5.172
  4. Kim JH, Chae SA, Lee DK. Clinical findings of Mycoplasma pneumonia in children, from 1998 to 2003. Korean J Pediatr 2005;48:969-75.
  5. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect 2008;56:326-31. https://doi.org/10.1016/j.jinf.2008.02.018
  6. He J, Liu M, Ye Z, Tan T, Liu X, You X, et al. Insights into the pathogenesis of Mycoplasma pneumoniae (Review). Mol Med Rep 2016;14:4030-36. https://doi.org/10.3892/mmr.2016.5765
  7. Balish MF, Santurri RT, Ricci AM, Lee KK, Krause DC. Localization of Mycoplasma pneumoniae cytadherence-associated protein HMW2 by fusion with green fluorescent protein: implications for attachment organelle structure. Mol Microbiol 2003;47:49-60.
  8. Prince OA, Krunkosky TM, Krause DC. In vitro spatial and temporal analysis of Mycoplasma pneumoniae colonization of human airway epithelium. Infect Immun 2014;82:579-86. https://doi.org/10.1128/IAI.01036-13
  9. Grosshennig S, Schmidl SR, Schmeisky G, Busse J, Stulke J. Implication of glycerol and phospholipid transporters in Mycoplasma pneumoniae growth and virulence. Infect Immun 2013;81:896-904. https://doi.org/10.1128/IAI.01212-12
  10. Hardy RD, Coalson JJ, Peters J, Chaparro A, Techasaensiri C, Cantwell AM, et al. Analysis of pulmonary inflammation and function in the mouse and baboon after exposure to Mycoplasma pneumoniae CARDS toxin. PLoS One 2009;4:e7562. https://doi.org/10.1371/journal.pone.0007562
  11. Lynch M, Taylor TK, Duignan PJ, Swingler J, Marenda M, Arnould JP, et al. Mycoplasmas in Australian fur seals (Arctocephalus pusillus doriferus): identification and association with abortion. J Vet Diagn Invest 2011; 23:1123-30. https://doi.org/10.1177/1040638711425699
  12. Hong KB, Choi EH, Lee HJ, Lee SY, Cho EY, Choi JH, et al. Macrolide resistance of Mycoplasma pneumoniae, South Korea, 2000-2011. Emerg Infect Dis 2013;19:1281-4. https://doi.org/10.3201/eid1908.121455
  13. Xin D, Mi Z, Han X, Qin L, Li J, Wei T, et al. Molecular mechanisms of macrolide resistance in clinical isolates of Mycoplasma pneumoniae from China. Antimicrob Agents Chemother 2009;53:2158-9. https://doi.org/10.1128/AAC.01563-08
  14. Morozumi M, Iwata S, Hasegawa K, Chiba N, Takayanagi R, Matsubara K, et al. Increased macrolide resistance of Mycoplasma pneumoniae in pediatric patients with community-acquired pneumonia. Antimicrob Agents Chemother 2008;52:348-50. https://doi.org/10.1128/AAC.00779-07
  15. Lee E, Cho HJ, Hong SJ, Lee J, Sung H, Yu J. Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children. Korean J Pediatr 2017;60:151-7. https://doi.org/10.3345/kjp.2017.60.5.151
  16. Jackson MA, Schutze GE; Committee on infectious diseases. The use of systemic and topical fluoroquinolones. Pediatrics 2016;138(5). pii: e20162706.
  17. Youn YS, Lee KY. Mycoplasma pneumoniae pneumonia in children. Korean J Pediatr 2012;55:42-7. https://doi.org/10.3345/kjp.2012.55.2.42
  18. Busson L, Van den Wijngaert S, Dahma H, Decolvenaer M, Di Cesare L, Martin A, et al. Evaluation of 10 serological assays for diagnosing Mycoplasma pneumoniae infection. Diagn Microbiol Infect Dis 2013;76:133-7. https://doi.org/10.1016/j.diagmicrobio.2013.02.027
  19. You SY, Jwa HJ, Yang EA, Kil HR, Lee JH. Effects of methylprednisolone pulse therapy on refractory Mycoplasma pneumoniae pneumonia in children. Allergy Asthma Immunol Res 2014;6:22-6. https://doi.org/10.4168/aair.2014.6.1.22
  20. Shin JE, Cheon BR, Shim JW, Kim DS, Jung HL, Park MS, et al. Increased risk of refractory Mycoplasma pneumoniae pneumonia in children with atopic sensitization and asthma. Korean J Pediatr 2014;57:271-7. https://doi.org/10.3345/kjp.2014.57.6.271
  21. Oh JW. The efficacy of glucocorticoid on macrolide resistant Mycoplasma pneumonia in children. Allergy Asthma Immunol Res 2014;6:3-5. https://doi.org/10.4168/aair.2014.6.1.3
  22. Lee KY, Lee HS, Hong JH, Lee MH, Lee JS, Burgner D, et al. Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children. Pediatr Pulmonol 2006;41:263-8. https://doi.org/10.1002/ppul.20374
  23. Luo Z, Luo J, Liu E, Xu X, Liu Y, Zeng F, et al. Effects of prednisolone on refractory mycoplasma pneumoniae pneumonia in children. Pediatr Pulmonol 2014;49:377-80. https://doi.org/10.1002/ppul.22752
  24. Seo YH, Kim JS, Seo SC, Seo WH, Yoo Y, Song DJ, et al. Predictive value of C-reactive protein in response to macrolides in children with macrolide-resistant Mycoplasma pneumoniae pneumonia. Korean J Pediatr 2014;57:186-92. https://doi.org/10.3345/kjp.2014.57.4.186
  25. Gardiner SJ, Gavranich JB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. Cochrane Database Syst Rev 2015;1:CD004875.