Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Stenotrophomonas maltophilia and Ventilator-Associated Pneumonia in Critically Ill Pediatric Patients: a Retrospective Analysis at a Single Center

소아 환자에서 Stenotrophomonas maltophilia와 인공 환기요법 관련 폐렴에 관한 연구

  • Lee, Byung-Kee (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Choi, Soo-Han (Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital) ;
  • Kim, Soo Jin (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Cho, Joong Bum (Department of Critical Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Ae, Hong (Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Yoo, So-young (Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Kim, Ji Hye (Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Lee, Nam Young (Department of Laboratory Medicine and Genetics, Sungkyunkwan University School of Medicine, Samsung Medical Center) ;
  • Kim, Yae-Jean (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
  • 이병기 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 최수한 (한림대학교 동탄성심병원 소아청소년과) ;
  • 김수진 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 조중범 (성균관대학교 의과대학 삼성서울병원 중환자의학과) ;
  • 어홍 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 유소영 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김지혜 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 이남용 (성균관대학교 의과대학 삼성서울병원 진단검사의학과) ;
  • 김예진 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Received : 2015.03.02
  • Accepted : 2015.05.07
  • Published : 2015.08.25
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Abstract

Purpose: Ventilator-associated pneumonia (VAP) is a serious threat in critically ill pediatric patients. Data regarding Stenotrophomonas maltophilia VAP in pediatric population is limited. We evaluated the clinical data of S. maltophilia associated VAP in critically ill pediatric patients. Methods: A retrospective chart review was performed in pediatric patients 18 years old or younger who developed S. maltophilia associated VAP at Samsung Medical Center, Seoul Korea from January 2008 to December 2012. Results: A total of 31 patients were identified S. maltophilia associated VAP. Median age was 8 months (range, 0.5 month to 16.6 years) and 13 patients were male (40.6%). Underlying illnesses were cardiologic diseases (n=11, 34.4%), hematologic oncologic malignancies (n=7, 25%), neurologic diseases (n=4, 12.5%), pulmonary diseases (n=3, 9.4%), and others (n=4, 12.5%). The median duration of ventilator use before S. maltophilia VAP diagnosis was 14 days (range, 4-256 days). Overall mortality at 30 days was 12.5% (4/32). Conclusions: S. maltophilia should be also considered as a possible pathogen for VAP in critically ill pediatric patients. Empiric antibiotic choice should include agents that are active against S. maltophilia in patients who are deteriorating on broad spectrum beta-lactam antimicrobial agents.

목적: 인공 환기요법 관련 폐렴은 중증 소아 환자에게 있어서 심각한 위협이 될 수 있다. 소아 환자에서 Stenotrophomonas maltophilia에 의한 인공 환기요법 관련 폐렴에 대한 연구는 부족한 실정이다. 본 연구는 소아 중환자에서 S. maltophilia에 의한 인공 환기요법 관련 폐렴의 임상적 특성을 알아보고자 하였다. 방법: 2008년 1월 1일부터 2012년 12월 31일까지 삼성서울병원 소아중환자실에 입원한 S. maltophilia로 인한 인공 환기요법 관련 폐렴에 걸린 18세 이하 소아들의 의무 기록을 기초로 한 후향적 연구를 시행하였다. 결과: S. maltophilia로 인한 인공 환기요법 관련 폐렴으로 진단 받은 총 31명의 환자가 연구 대상에 포함되었다. 연령 중앙값은 8개월(범위, 0.5개월-16.6세)이고, 남자는 13명(40.6%)이었다. 환자들의 만성질환 분포는 심혈관질환(n=11, 34.4%), 혈액종양질환(n=7, 25.0%), 신경질환(n=4, 12.5%), 호흡기질환(n=3, 9.4%) 그리고 기타(n=4, 12.5%)이었다. 인공 환기요법 관련 폐렴을 진단하기 전 인공 환기요법을 하였던 기간의 중앙값은 14일(범위, 4-256일)이었다. S. maltophilia 인공 환기요법 관련 폐렴후 30일 이내 사망률은 12.5% (4/32) 이었다. 결론: S. maltophilia는 중증 소아 환자에서 인공 환기요법 관련 폐렴의 원인균으로 반드시 고려되어야 할 대상이다. 경험적 광범위 베타-락탐 항생제를 사용하고 있음에도 불구하고 환자 상태가 나빠지고 있다면, 항생제 선택에서 S. maltophila의 감염을 고려해야 할 것으로 사료된다.

Keywords

References

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