부산 지역 신생아에서 발생한 세균성 수막염의 원인균에 관한 연구

김성헌,박희주,박수은,홍유라,이영아,신종범,Kim, Seong Heon,Park, Hee Ju,Park, Su Eun,Hong, Yu Ra,Lee, Young Ah,Shin, Jong Beom 대한소아감염학회 2007 Pediatric Infection and Vaccine Vol.14 No.1

목 적 : 신생아의 세균성 수막염은 이환률과 사망률이 높으며 생존한 경우에도 신경학적 후유증의 빈도가 높은 질환으로 알려져 있다. 본 연구에서는 1997년부터 2005년까지의 부산 지역에서 발생하였던 신생아 세균성 수막염의 임상 양상에 대하여 알아보고자 하였다. 방 법 : 1997년 1월부터 2005년 12월까지 부산지역 4개 대학 병원 소아과에서 세균성 수막염으로 입원한 환자 중에서 생후 60일 미만의 21명의 신생아를 대상으로 하여 수막염의 발생시기, 주 증상, 원인 균주, 합병증 등을 조사하였다. 이들 중 뇌척수액 배양에서 균주가 동정되었거나, 뇌척수액 검사에서 백혈구가 30개 이상이며, 혈액 배양에서 균주가 동정되었던 경우만 대상으로 하였고, S. epidermidis가 동정된 경우와 원내 감염 및 선천성 기형은 제외 하였다. 결 과 : 대상 환아 중 남아는 11명, 여아는 10명이었으며, 미숙아가 1명이었다. 발생 시기는 생후 2-3주가 7례로 가장 많았으며 생후 1-2주가 6례, 4주 이상의 경우가 5례였고, 1주 미만의 경우는 3례로 빈도가 가장 낮았다. 입원 당시의 주 증상으로는 발열이 18례, 경련이 8례, 수유 불량, 기면, 구토, 보챔 등의 순이었다. 원인 균주로는 GBS가 11례로 가장 많았으며, E.coli와 Klebsiella pneumoniae가 각각 3례를 차지하였고, S. pneumoniae가 2례, Listeria monocytogens와 Enterobacter cloacae가 각각 1례였다. 치료 결과 생존한 환아가 18명, 사망한 환아는 3명이었고, 생존한 환아 중 1례에서 정신지체, 발달 지연, 경련성 질환 등의 장애가 발생하였다. 결 론 : 배양 검사로 확진된 신생아기에 발생한 뇌수막염의 원인균으로는 알려진 사실과 같이 GBS가 가장 흔했다. 외국과 비교하여 현재 국내 배양 검사의 민감도를 생각해 볼 때 향후 민감도의 질적 향상이 필요하며 국내의 발생률 및 임상양상에 대하여 장기간의 추적 검사를 통한 대규모의 전향적인 연구가 필요할 것으로 생각된다. Purpose : Neonatal bacterial meningitis has been known that its mortality and morbidity is high and its neurologic complications are common. This study was performed to review of the etiology of neonatal bacterial meningitis in Busan, Korea. Methods : We retrospectively analyzed 21 medical records of patients who were diagnosed neonatal bacterial meningitis in four university hospitals in Busan from January 1997 to December 2005. We analyzed age at onset of symptoms, symptoms at admission, causative organisms, and complications. Results : There were 11 male patients and 10 female patients. One premature neonate was included. 7 patients had symptoms at 2-3 weeks after birth and 6 patients at 1-2 weeks after birth. 18 cases had fever, 8 cases had seizure and some had poor feeding, lethargy and irritability. The most common organism causing neonatal bacterial meningitis was Group B streptococcus (GBS). 11 cases were due to GBS, 3 cases due to E. coli, 3 cases were due to Klebsiella pneumoniae, and 2 cases due to Streptococcus pneumoniae. one Listeria monocytogenes and one Enterobacter cloacae were included. 18 patients were alive and 3 patients died. Mental retardation, developmental delay and epilepsy occurred in a living patient. Conclusions : Although this was a retrospective study, we found that Group B streptococcus (GBS) was the most common organism causing neonatal bacterial meningitis and this data is nearly same as others in the world.

신생아에서 세균성과 무균성 수막염의 비교

조성대(Sung Dae Cho),강빈(Ben Kang),박소현(So Hyun Park),성현우(Hyun U Sung),전용훈(Yong Hoon Jun),홍영진(Young Jin Hong),손병관(Byong Kwan Son),권영세(Young Se Kwon) 대한소아신경학회 2012 대한소아신경학회지 Vol.20 No.1

Purpose : This study was aimed to evaluate the clinical features of bacterial and aseptic meningitis in neonates. Methods : Seventy seven neonates who diagnosed with meningitis at Inha University Hospital from June 1996 to August 2010 were enrolled in this study. The subjects were classified into either bacterial or aseptic meningitis and their medical records were retrospectively analyzed. Results : Among the 77 cases, 18 cases were bacterial and 59 cases were aseptic. The main symptoms of both groups were fever, moaning in order. In bacterial meningitis, Group B streptococci (GBS) was the most common causative organism (12/18. 75%). In peripheral blood exam, patients with bacterial meningitis were more likely to show leukocytosis (WBC >20,000/㎣) and leukopenia (WBC <5,000/㎣) than those with aseptic meningitis. CRP was also significantly increased in the group of bacterial meningitis. In CSF analysis, 61.2% revealed pleocytosis more than 1,000/㎣ in bacterial meningitis and 8.5% did in aseptic meningitis. CSF glucose were <40 ㎎/㎗ in 72.2% of the group of bacterial meningitis and 35.6% of the group of aseptic meningitis. Mean CSF protein was 289.6±221.2 ㎎/㎗ in bacterial meningitis and 107.6±73.9 ㎎/㎗ in aseptic meningitis. Abnormal radiologic findings were found in 44.4% of bacterial meningitis and 8.4% of aseptic meningitis. The treatments were empirically initiated with ampicillin and cefotaxime in 60 cases, ampicillin and aminoglycosides in 12 cases. Conclusion : Although the clinical features of bacterial and aseptic meningitis are similar, peripheral blood and CSF exams revealed significant differences. Based on these differences, appropriate antibiotic treatment can be selected before the identification of causative agents. 목적 : 신생아 수막염을 세균성과 무균성으로 나누어 임상 양상을 확인하고자 하였다. 방법 : 1996년 6월부터 2010년 8월까지 인하대병원 신생아 집중치료실에서 수막염으로 진단된 생후 4주 미만의 환아 77명을 대상으로 하였다. 혈액 및 뇌척수액 검사 결과에 따라 세균성과 무균성으로 나누어 의무기록을 후향적으로 분석하였다. 결과 : 대상 환아 77명 중 세균성은 18명, 무균성은 59명이었으며, 발병 시 증상은 두 군에서 모두발열, 끙끙거림 순으로 나타났다. 세균성의 원인균으로는 GBS가 12례(75%)로 가장 많았고, coagulase 음성 포도상 구균, E. coli, H. influenzae, K. pneumoniae가 각각 1례(6%)씩 나타났다. 말초혈액검사에서는 세균성에서 백혈구감소증과 백혈구증가증이 무균성보다 많았으며 CRP는 세균성에서 유의하게 높았다. 뇌척수액검사에서는 백혈구수 1,000/㎣ 이상이 세균성에선 61.2% 무균성에선 8.5%였고, 당 40 ㎎/㎗ 이하가 세균성에서는 72.2%, 무균성에서는 35.6%를 보였으며 단백질은 세균성에선 평균 289.6±221.2 ㎎/㎗, 무균성에선 평균 107.6±73.9 ㎎/㎗로 나타났다. 투여한 항생제는 ampicillin과 cefotaxime이 60례, ampicillin과 aminoglycoside가 12례에서 확인되었다. 뇌 영상학적 검사에서 이상소견은 세균성은 44.4%, 무균성은 8.4%에서 나타났다. 결론 : 세균성 수막염과 무균성 수막염은 증상은 비슷하였으나, CBC, CRP 등의 혈액검사와 뇌척수액 검사 에서 유의한 차이가 있음을 알 수 있었고, 이를 근거로 균동정이 확인되기 전까지 적절한 항생제 투여여부를 결정할 수 있다.

국내 여성 질-회음부에서 분리된 Group B Streptococcus (GBS) 보균율 및 항균제 감수성

이선화,박경운,이혜경,김미영,김진용,김진용,권원경,박이선 대한임상미생물학회 2009 Annals of clinical microbiology Vol.12 No.4

Background: Group B Streptococcus (Streptococcus agalactiae, GBS) is a major cause of severe infections in neonates, including bacteremia, pneumonia, and meningitis, and is generally vertically transmitted from a colonized, pregnant woman to her infant. Penicillin is the drug of choice to treat GBS infections, because GBS strains are uniformly susceptible to penicillin. Recently, however, penicillin resistant GBS strains have been reported and the rates of erythromycin and clindamycin resistance have increased. We evaluated the perineal colonization rates and antimicrobial susceptibility of GBS strains isolated from pregnant and non-pregnant women. Methods: The antibiotic susceptibilities of a total of 180 GBS strains isolated from two university hospitals and one reference laboratory between May 2008 and January 2009 were determined using disk diffusion and broth microdilution methods. The presence of erythromycin resistance genes was confirmed by PCR. Results: The average colonization rate of pregnant women was 5.5%. The overall colonization rates of pregnant and non-pregnant women ranged between 5.5% and 7.5%. All 180 GBS strains were susceptible to penicillin. Fifty strains (27.8%) were resistant to erythromycin, whereas 78 (41.1%) were resistant to clindamycin. The ermB gene was identified in 40 isolates and 44 isolates had constitutive macrolidelincosamide- streptogramin B resistance phenotypes. Conclusion: Our findings indicate an increased GBS colonization rate and an increase in macrolide resistance in GBS strains in recent years, emphasizing the need for further surveillance and continual monitoring of antimicrobial susceptibility.

Survival of an emerging foodborne pathogen: Group B Streptococcus (GBS) serotype III sequence type (ST) 283—under simulated partial cooking and gastric fluid conditions

Ye Htut Zwe,Zhu Hui Esther Goh,Man Ling Chau,Kyaw Thu Aung,육현균 한국식품과학회 2019 Food Science and Biotechnology Vol.28 No.3

Group B Streptococcus (GBS) was previouslynot known to be transmitted through food, but an outbreakinvestigation in Singapore in 2015 documented for the firsttime an association between GBS Type III Sequence Type283 infection and consumption of raw fish dishes. As verylittle is known about the survival of GBS during heattreatment and the stomach transit, its survival under simulatedconditions was studied, in comparison with that ofEscherichia coli O157:H7 and Listeria monocytogenes. The mean D-values of four GBS strains ranging from 0.72to 0.88 min in neutral pH tryptone soy broth at 56.4 C and0.44–1.43 min at pH 2.35 at 37 C in simulated gastricfluid, were significantly lower (p\0.05) than those ofE. coli O157:H7 and L. monocytogenes. This study suggestspossible factors other than acid or heat resistance ofGBS to be instrumental to its pathogenicity.

한국인 임산부에서의 Group B streptococci 감염에 대한 연구

박이석(Lee Suk Park),서경(Kyung Seo),김세광(Sei Kwang Kim),박용원(Yong Won Park),정현용(Hyun Yong Jung),정윤섭(Yun Sop Chong),이경원(Kyung Won Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

Objective: To evaluate the degree of streptococcal colonization in Korean pregnant women. Methods: The study comprised of 153 singleton pregnant women who visited Severance Hospital for delivery, and their neonates. Specimens for GBS culture were collected by a sterile cotton swab from lower vagina and cervix of pregnant women, and from ear canal and throat of neonates. They were first cultured for 48 hours in Todd-Hewitt broth and then subcultured onto Tryptose blood agar plates(Difco). Group B streptococci were confirmed by the presence of β-hemolysis and a positive reaction with Phadebact group B Streptococci reagent(Karo Biodiagnostics AB, Huddinge, Sweden). Results: The prevalence of positive cultures in pregnant women and neonates were 2.61%(4/153) and 0%(0/4), respectively. In the study population there was a case of suspicious group B streptococcual sepsis in an infant whose mother was colonized. Conclusions: In our study the GBS colonization rate in Korean pregnant women was significantly lower than that of other countries. The reason for this difference may be associated with a racial differences, or social factors such as socio-economic status or a life style.