Pediatric Infection and Vaccine

  • 제17권1호
  • /
  • Pages.36-48
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  • 2010
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지

2005-2008년 단일 기관의 소아 혈액 종양 환자에서의 균혈증 양상: 소아 혈액 종양 환자에서의 균혈증

Bloodstream Infections in Children with Cancer between 2005 and 2008 in a Single Center

  • 김지혜 (한양대학교 의과대학 소아과학교실) ;
  • 김형진 (한양대학교 의과대학 소아과학교실) ;
  • 임연정 (한양대학교 의과대학 소아과학교실) ;
  • 이영호 (한양대학교 의과대학 소아과학교실) ;
  • 오성희 (한양대학교 의과대학 소아과학교실)
  • Kim, Ji Hye (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Kim, Hyung Jin (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Lim, Yeon Jung (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Lee, Young Ho (Department of Pediatrics, Hanyang University School of Medicine) ;
  • Oh, Sung Hee (Department of Pediatrics, Hanyang University School of Medicine)
  • 투고 : 2009.12.28
  • 심사 : 2010.02.23
  • 발행 : 2010.06.25
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초록

목 적 : 항암 화학 요법을 받는 소아 혈액 종양 환아들에서의 균혈증은 예후에 큰 영향을 미칠 수 있어 이에 대한 신속한 경험적인 항생제 치료는 매우 중요하다. 이러한 경험적 치료의 근거를 마련하기 위하여 소아 혈액 종양 환아들의 균혈증의 임상 양상, 검사 소견, 위험 인자, 원인균의 분포 및 임상경과에 대한 최근 경향에 대한 정보를 파악하고자 하였다. 방 법: 2005년 7월부터 2008년 6월까지 한양대학교병원 소아청소년과 혈액 종양 분과에서 치료받은 환아들에게서 발생한 총 212 발열례의 의무 기록을 후향적으로 분석하였다. 이들을 균혈증이 발생한 군과 균혈증이 발생하지 않은 군으로 나눠서 호중구 감소증 여부 및 정도, 이식 여부 및 종류, 중심 정맥관 유무 및 종류 등을 비교하였고, 원인균의 종류, 항생제 감수성 및 임상경과를 조사하였다. 결 과: 3년 동안 총 63명의 소아 혈액 종양 분과 환아에서 212 발열례가 발생하였으며, 40례(18.9%)에서 균혈증이 발생하였다. 발열례 중 호중구 감소증이 동반된 경우는 157례였고 37례(23.6%)의 균혈증이 발생하였다. 동정된 총 균주는 45균주로 그람 양성균 23균주(51.1%), 그람 음성균 20균주(44.4%), 진균 2균주(4.4%)였다. 그람 양성균 중 가장 흔하게 분리된 균주는 Coagulase-negative Staphylococcus (46.7%)였으며, 그람 음성균 중에는Acinetobacter species (15.6%)가 가장 분리율이 높았다. 호중구 감소증이 있는 환자들에 게서 호중구 감소증이 없는 환자들보다 균혈증이 유의하게 많이 발생하였다(P =0.002). 13례의 균혈증은 이식을 시행받은 환자들에게 발생하였으며, 호중구 감소증을 보인 환자 중에서 이식환자가 이식을 받지 않은 환자보다 균혈증이 많이 발생하였다(P =0.008). 제대혈이식을 시행받은 군에서 기타 다른 형태의 이식을 받은 군에 비해 균혈증의 발생률이 유의하게 많았다(P =0.001). 균혈증 환자들의 사망률은 균에 따른 차이를 나타내지 않았다. 하지만 다제내성균의 경우에는 사망률이 상대적으로 높은 경향을 보였지만 이는 통계적 유의성은 없었다. (P =0.335). 중심 정맥관을 지닌 환자에서 발열이 발생한 경우 Chemoport를 지닌 환자에서 Hickman 도관을 지닌 환자에서보다 균혈증의 발생이 많았으며(P =0.029), Chemoport를지닌군에서 그람 양성균이, Hickman 도관을 지닌 군에서는 그람 음성군이 유의하게 많은 비율로 배양되었다(P =0.001). 항생제 감수성 검사에서 그람양성균은 모두 penicillin과 oxacillin에 내성을 보였고, vancomycin과 teicoplanin에는 모두 감수성을나타내었다. 그람 음성균에서는 amikacin, gentamicin, imipenem, piperacillin/tazobactam에 대한 내성률이 각각 45.0%, 30.0%, 20.0% 및 20.0%였다. 결 론 : 본 연구는 소아 혈액 종양 환자들에서 발열례의 균혈증의 빈도 및 감염원의 분포와 호중구 감소, 이식, 및 중심 정맥관의 종류가 균혈증 발생에 미치는 영향과, 동정된 원인균의 항생제 내성률을 밝혔으며 이러한 자료는 향후 발열을 동반한 호중구 감소증을 가지는 환자에서 적절한 경험적 항생제 선택에 고려되어야 할 것이다.

Purpose : In children on anticancer chemotherapy, bloodstream infections (BSIs) are a major cause of morbidity and mortality. We investigated febrile episodes and bloodstream infections in pediatric cancer patients to guide proper selection of empiric antibiotics for febrile pediatric hemato-oncologic patients. Methods : All febrile episodes treated in the division of hematology-oncology, the department of pediatrics, Hanyang University Hospital, between July 2005 and June 2008 were reviewed. Episodes with and without bloodstream infections were compared. Results : Forty cases (18.9%, 25 patients) of BSI occurred in 212 febrile episodes (63 patients). Thirty-seven cases (23.6%, 22 patients) of BSI occurred in 157 febrile episodes with neutropenia (54 patients). Microorganisms identified in BSI corresponded to 23 gram-positive bacteria (51.2%), 20 gram-negative bacteria (44.5%), and 2 fungi (4.4%). Rates of BSI between those who had received umbilical cord blood transplantation and those who had received transplantation from other source were significantly different (55.0% vs. 7.7%, P =0.001). No differences in mortality rate were observed among organisms in BSI patients. For febrile episodes the rate of BSI was higher among those with Chemoport than those with Hickman catheter (P =0.029) and gram-positive pathogens were more likely to be associated with Chemoport (P =0.001). Conclusion : The study showed the rate of BSI, distribution of pathogens with regard to neutropenia, transplantation, central venous catheters, and antimicrobial susceptibility of pathogens in order to help guide in the choice of optimal empiric antibiotics in pediatric febrile neutropenic hemato-oncologic patients.

키워드

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