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국민건강보험 청구 자료를 이용한 국내 의료기관 Clostridioides difficile 감염 추이 분석

The Trend of Clostridioides difficile Infection in Korean Hospitals with the Analysis of Nationwide Sample Cohort

김영아|박윤수|손강주
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2020.12|Annals of Clinical Microbiology|제23권 제4호|pp. 1-9|DOI 10.5145/ACM.2020.23.4.3

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Cohort studiesTrendInfectionsRateClostridioides difficile

초록

배경: Clostridioides (Clostridium) difficile는 항균제를 복용한 환자에서 설사를 동반하는 질환을 일으키는 중요한 병원감염균이지만 국내 감염의 현황은 잘 알려져 있지 않다. 방법: 장기간의 국내 C. difficile 감염 추이를 국민건강보험공단의 표본코호트를 이용하여 분석하였다. 분석에는 사회경제적 변수, 질병 중증도 및 의료기관 특성을 포함하였다. 결과: C. difficile 감염률은 2006년 0.030%에서 2015년 0.317%로 크게 증가하였다. 연령에 따라서도 차이를 보여 50세 미만은 0.033%인데 비해 70-79세 0.412% 및 80세 이상 0.758%로 고령에서 발생률이 높았다. Charlson comorbidity index가 0점이 0.048%인데 비해 3 이상인 경우 0.378%로 감염률은 중증도가 높은 경우 높았다. 의료기관 종별로도 차이를 보여 상급종합병원은 0.270%인데비해 일반병원(정신병원 포함)에서는 0.056%였다. 결론: 고령과 중증도가 높은 환자를 중심으로 국내 C. difficile 감염이 적지 않으며, 꾸준히 증가하고 있음을 알 수 있었다.

Abstract

Background: Clostridioides (Clostridium) difficile is an important pathogen that causes diarrhea in people who take antibiotics. The recent status of C. difficile infection is not wellknown in Korea. Methods: The long-term trend of C. difficile infection in Korean hospitals was analyzed using a nationwide sample cohort. The data also included sociodemographic characteristics, disease severity, and healthcare facilities. C. difficile infection was defined by the prescription of oral vancomycin or all metronidazole prescriptions under C. difficile infectious disease code (A047). Results: The rate of C. difficile infection has steadily increased from 0.030% in 2006 to 0.317% in 2015. The increased rate correlated to age (0.033% for <50 years, 0.421% for 70-79 years, and 0.758% for >80 years of age) and the Charlson comorbidity index score (0.048% for zero versus 0.378% for three or more points). It differed by the type of medical institution (0.270 % at referral hospitals versus 0.056 % at general hospitals and mental hospitals). Conclusion: The rate of C. difficile infection in Korea is significant in patients with advanced age and disease severity. The results show that C. difficile infection trend has been increasing steadily in Korea.

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