Colistin 내성 Acinetobacter baumannii 감염의 위험인자
Risk Factors Associated With Colistin-Resistant Acinetobacter baumannii Infection
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Acinetobacter baumannii는 의료관련 감염의 중요한 원인균이며, 거의 모든 약제에 내성을 보이며, 최근에는 colsitin에도 내성인 균주가 보고되고 있다. 본 연구에서는 colistin 내성과 감수성 A. baumannii 감염 환자군의 비교를 통해 colistin 내성 A. baumannii 감염의 위험인자를 파악하고자 하였다. Colistin 내성 A. baumannii가 분리된 51예와 colistin 감수성 A. baumannii 균주가 분리된 환자 100예를 대상으로 후향적으로 의무기록을 검토하였다. 단변량 분석에서는 호흡기계 질환의 기왕력(P = 0.017), 균 분리전 재원 기간(P = 0.004), 중환자실 입원력(P = 0.020), 이전의 기계 호흡(P =0.003), 기관절개술(P = 0.043), 혈액투석(P = 0.002), colistin 사용력(P = 0.000), carbapenem 계열 항균제 사용력(P = 0.000), teicoplanin 사용력(P = 0.004), 중복 감염(P = 0.035)이 colistin 내성군과 감수성군에서 차이에서 차이를 보였다. 다중회귀분석에서는 teicoplanin 사용력(Odds ratio [OR], 3.140; 95% confidence interval [CI], 0.529-18.650; P = 0.208), 이전의 혈액투석(OR, 2.722; 95% CI, 0.851-8.709), 호흡기계 질환의 기왕력(OR, 2.286; 95% CI, 0.998-5.283), carbapenem 계열 항균제 사용력(OR, 0.199; 95% CI, 0.863-5.603), 중복 감염(OR, 1.706; 95% CI, 0.746-3.898), 이전의 기계 호흡(OR, 1.614; 95% CI, 0.684-3.809), 중환자실 입원력(OR, 1.387; 95% CI, 0.560-3.435), 이전의 기관절개술(OR, 1.102; 95% CI, 0.344-3.527)이 colistin 내성군에서 위험도가 높았으나, 모두 통계학적으로 유의하지는 않았다. Colistin 사용력의 경우 다중회귀분석에서 증명할 수 없었지만, 위험인자일 가능성을 배제할 수 없다.
Abstract
Acinetobacter baumannii is an important cause of healthcare-associated infections and is resistant to almost all antimicrobial agents, with strains recently reported to be resistant to colsitin. In this study, we aimed to identify the risk factors associated with colistin-resistant A. baumannii infections by comparing colistin-resistant and -susceptible A. baumannii isolates. We retrospectively reviewed the medical records of 51 and 100 cases in which colistinresistant and -susceptible A. baumannii were isolated, respectively. Univariate analysis showed that compared with patients with colistin-sensitive infections, patients with colistinresistant A. baumanni infections had a combined pulmonary disease (P = 0.017), were admitted to intensive care unit (P = 0.020), and had prior mechanical ventilation (P = 0.003), tracheostomy (P = 0.043), percutaneous drainage (P = 0.070), hemodialysis (P = 0.002); use of colistin (P = 0.000), carbapenem (P = 0.000), and teicoplanin (P = 0.004); and co-infection (P = 0.035). Multivariate analysis indicated that eight variables were related to the likelihood of colistin-resistant A. baumanni infections: use of teicoplanin (Odds ratio [OR]: 3.140, 95% confidence interval [CI]: 0.529–18.650), prior hemodialysis (OR: 2.722, 95% CI: 0.851–8.709), combined pulmonary disease (OR: 2.286, 95% CI: 0.998–5.283), prior use of carbapenem (OR: 0.199, 95% CI: 0.863–5.603), co-infection (OR: 1.706, 95% CI: 0.746–3.898), prior mechanical ventilation (OR: 1.614, 95% CI, 0.684–3.809), intensive care unit admission (OR: 1.387, 95% CI: 0.560–3.435), and prior tracheostomy (OR: 1.102, 95% CI: 0.344–3.527); however, no statistical differences were observed. Although colistin use could not be proven in multivariate analysis, the possibility of being a risk factor cannot be ruled out.
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