최근 20년(1997년-2016년) 동안 단일 3차 의료기관의 뇌척수액배양에서 분리된 세균과 진균의 분리 추이
Trend of Bacteria and Fungi Isolated from Cerebrospinal Fluid Culture in a Tertiary Care Hospital During Recent Two Decades (1997-2016)
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배경: 세균성 수막염은 사망률과 이환율이 높기 때문에 임상적으로 매우 중요하고 폐렴구균과 헤모필루스 인플루엔자에 대한 예방접종이 도입되면서 역학이 크게 변화하고 있는 질환이다. 따라서 뇌척수액배양에서 분리되는 균주들에 대한 지속적인 관심과 연구가 필요한 상황이다. 방법: 저자들은 1997년부터 2016년까지 단일 3차 기관의 뇌척수액배양에서 분리한 균주들을 대상으로 연도별, 월별, 성별, 연령별로 분석하였다. 결과: 총 38,450건의 뇌척수액 검체 중에서 504균주(1.3%)가 분리되었고, 1997-2006년과 2007-2016년의 각 10년 동안의 분리율은 1.3%-3.1%와 0.4%-1.5% 범위였다. 균종별로는 coagulase-negative staphylococci (CoNS) (31.9%)이 가장 많이 분리되었고 뒤를 이어 Staphylococcus aureus (9.5%), Streptococcus pneumoniae (7.5%), Acinetobacter baumannii (5.8%), Mycobacterium tuberculosis (5.8%)순으로 분리되었다. 월별 분리율은 5월과 7월이 가장 높았으며 2월과 12월에 적게 분리되었다. 성별에 따른 분리율은 남녀비가 1.5:1로 나타났으며, S. pneumoniae, Enterococcus faecium, Escherichia coli는 소아와 성인에서 비슷한 비율로 분리되었고 S. aureus, E. faecalis, A. baumannii, Pseudomonas aeruginosa, M. tuberculosis, Cryptococcus neoformans는 성인에서 더 많이 분리되는 양상이었다. 결론: 최근 20년동안 뇌척수액배양 양성률은 점차 감소하는 경향을 보였으며 5월과 7월에 가장 많은 균주가 분리되었다. 남성에서는 CoNS, S. aureus, S. pneumoniae가 흔한 균종이었고 여성에서는 CoNS, S. aureus, M. tuberculosis 순서로 분리되었다. 1세 미만 소아에서 많이 분리된 균종은 Group B Streptococcus였고 성인에서는 S. aureus와 C. neoformans가 많이 분리되었다. [Ann Clin Microbiol 2017;20:81-89]
Abstract
Background: Meningitis is a clinically important disease because of its high mortality and morbidity. The epidemiology of this disease has changed remarkably due to the introduction of pneumococcal vaccines and Haemophilus influenzae type b (Hib) conjugate vaccine. Therefore, it is required to continuously monitor and research the organisms isolated from cerebrospinal fluid (CSF) cultures. Methods: We analyzed trends of bacteria and fungi isolates obtained from CSF cultures between 1997 and 2016 in a tertiary care hospital according to year, month, gender, and age. Results: Out of a total of 38,450 samples, we identified 504 (1.3%) isolates. The isolation rate in the first tested decade (1997-2006) ranged from 1.3% to 3.1%, while that in the second decade (2007-2016) ranged from 0.4% to 1.5%. The most common organisms was coagulase-negative staphylococci (CoNS) (31.9%), followed by Staphylococcus aureus (9.5%), Streptococcus pneumoniae (7.5%), Acinetobacter baumannii (5.8%), and Mycobacterium tuberculosis (5.8%). Monthly isolation rates were highest in May and July and lowest in February and December. Male to female ratio was 1.5:1. The isolation rates of S. pneumoniae, Enterococcus faecium, and Escherichia coli were similar in children and adults, but those of S. aureus, E. faecalis, A. baumannii, Pseudomonas aeruginosa, M. tuberculosis, and Cryptococcus neoformans were higher in adults than in children. Conclusion: During the last two decades, the isolation rate of CSF culture per year has decreased, with monthly isolation rates being highest in May and July. CoNS, S. aureus, and S. pneumoniae were most common in males, whereas CoNS, S. pneumoniae, and M. tuberculosis were most common in females. While Group B Streptococcus was most common in infants younger than 1 year, S. aureus and C. neoformans were more common in adults. (Ann Clin Microbiol 2017;20:-89)
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