최근 5년(2006-2010)간 소아 혈액 종양 환자에서 발생한 균혈증의 원인균 및 임상 양상: 단일기관 연구 = Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study

다국어 초록 (Multilingual Abstract)

Purpose : This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. Methods : A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. Results : A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9 %). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6 % vs. 22.0%, P=0.04). Conclusion : This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.

참고문헌 (Reference)

1 Elder JS, "Urinary tract infections, In Nelson textbook of pediatrics. 19th ed" Saunders Elsevier 1829-, 2011

2 Baskin MN, "The prevalence of serious bacterial infections by age in febrile infants during the first 3 months of life" 22 : 462-466, 1993

3 Baker MD, "The efficacy of routine outpatient management without antibiotics of fever in selected infants" 103 : 627-631, 1999

4 Nelson DS, "Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department" 90 : 5-10, 1992

5 Byington CL, "Serious bacterial infections in febrile infants 1 to 90 days old with and without viral infections" 113 : 1662-1666, 2004

6 Levine DA, "Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections" 113 : 1728-1734, 2004

7 신승한, "Risk Factors for Serious Bacterial Infection in Febrile Young Infants in a Community Referral Hospital" 대한의학회 24 (24): 844-848, 2009

8 Titus MO, "Prevalence of serious bacterial infections in febrile infants with respiratory syncytial virus infection" 112 : 282-284, 2003

9 Bachur RG, "Predictive model for serious bacterial infections among infants younger than 3 months of age" 108 : 311-316, 2001

10 Bressan S, "Predicting severe bacterial infections in well-appearing febrile neonates: laboratory markers accuracy and duration of fever" 29 : 227-232, 2010

11 Kourtis A, "Practice guidelines for the management of febrile infants less than 90 days of age at the ambulatory network of a large pediatric health care system in the United States: summary of new evidence" 43 : 11-16, 2004

12 Baraff LJ, "Practice guideline for the manage ment of infants and children 0 to 36 months of age with fever without source" 22 : 1198-1210, 1993

13 Huppler AR, "Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature" 125 : 228-233, 2010

14 Baskin MN, "Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone" 120 : 22-27, 1992

15 Baker MD, "Outpatient management without antibiotics of fever in selected infants" 329 : 1439-1441, 1993

16 Yarden-Bilavsky H, "Month-by-month age analysis of the risk for serious bacterial infections in febrile infants with bronchiolitis" 50 : 1052-1056, 2011

17 Baraff LJ, "Management of infants and young children with fever without source" 37 : 673-679, 2008

18 Dagan R, "Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis" 107 : 855-860, 1985

19 DeAngelis C, "Iatrogenic risks and financial costs of hospitalizing febrile infants" 137 : 1146-1149, 1983

20 Baker MD, "Evaluation and management of infants with fever" 46 : 1061-1072, 1999

21 이준호, "Etiology of Invasive Bacterial Infections in Immunocompetent Children in Korea (1996-2005): A Retrospective Multicenter Study" 대한의학회 26 (26): 174-183, 2011

22 Nah SY, "Etiology and clinical features of acute viral lower respiratory tract infection in apparently healthy children" 39 : 1690-1699, 1996

23 Dagan R, "Epidemiology and laboratory diagnosis of infection with viral and bacterial pathogens in infants hospitalized for suspected sepsis" 115 : 351-356, 1989

24 Pulliam PN, "C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection" 108 : 1275-1279, 2001

25 Putto A, "C reactive protein in the evaluation of febrile illness" 61 : 24-29, 1986

26 Libster R, "Breastfeeding prevents severe disease in full term female infants with acute respiratory infection" 28 : 131-134, 2009

27 Gómez B, "Blood culture and bacteremia predictors in infants less than three months of age with fever without source" 29 : 43-47, 2010

28 The WHO Young Infants Study Group, "Bacterial etiology of serious infections in young infants in developing countries: results of a multicenter study" 18 : 17-22, 1999

29 Dagan R, "Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections" 112 : 355-360, 1988

30 권정현, "2002-2006년 서울지역 입원 환자에서의 급성 바이러스성하기도염의 역학조사" 대한 소아알레르기 호흡기학회 18 (18): 26-36, 2008