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Distribution and Clinical Characteristics of FungalSpecies Isolated from Blood Cultures over a 7-yearPeriod at a Tertiary-care Hospital

이희주|서진태|양희영
대한임상미생물학회 (Korean Society of Clinical Microbiology)|2008.04|Annals of Clinical Microbiology|제11권 제1호|pp. 49-55

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참고문헌

키워드

MortalityFungemiaPredisposing factor

초록

배경: 지난 수십년간 증가하고 있는 진균혈증은 입원환자에 있어서 이환률과 사망률을 증가시키는 위험인자 중 하나로, 1980년대 이후 전세계적으로 침습적 진균 감염에 대한 연구가 활발하게 이루어지고 있다. 3차 의료기관인 경희의료원에서는 진균혈증의 빈도와 원인진균이 어떠한 분포를 보이며 임상적으로 어떠한 특성을 보이는지 분석하였다. 방법: 2000년 1월부터 2006년 12월까지 혈액배양검사에서 진균이 동정된 환자 139명의 의무기록지와 검사결과를 후향적으로 조사하여 분석하였다. 각 균종별 빈도, 년도간 분포, 기저질환, 입원 병동별 분포, 관련 선행인자, 치료에 쓰인 약제, 사망군 분석 등을 시행하였다. 결과: 진균혈증에서 가장 많이 발견된 원인 진균은 C. albicans (40.3%)였고, 그 다음이 C. tropicalis (24.5%)였다. 진균혈증의 추세는 2004년을 제외하고는 점차 증가하는 양상을 보였다. 환자 평균나이는 59세이고, 60세 이상의 환자가 61.8%를 차지하였다. 선행인자 분석에서 ICU환자가 60.4%, 기존에 항균제 치료를 받았던 환자가 89.2%, 중심정맥관을 가지고 있 는 환자는 78.4%였다. 항진균제로 치료 받은 98명의 환자에게 일차치료약제로 70.4%에서 fluconazole을 사용하였고, 29.6%에서 amphotericin B를 사용하였다. 진균혈증 환자 중 사망환자는 54명(38.9%)으로 높은 사망률을 보였으며, C. tropicalis는 16명(47.1%)으로 가장 높은 사망률을 보였고, C. parapsilosis 4명(22.2%)으로 가장 낮은 사망률을 보였다. 사망군과 관련된 선행인자의 단변량 분석에서 인공호흡기치료를 받은 경우만 통계적으로 유의한 결과를 보였다(P=0.008). 결론: 경희의료원에서의 7년간에 걸친 진균혈증 분석결과 C. albicans 외에 C. tropicalis가 제일 많이 검출되었고, 전체적 으로 높은 사망률을 보이면서 균종간 사망률 차이를 보였다.

Abstract

Background: Fungemia has increased over the past decade and is an important cause of significant morbidity and mortality. Since 1980, there has been an increase in the worldwide studies of nosocomial bloodstream fungal infections. We analyzed the distribution and the clinical characteristics of fungemia at a tertiary care hospital, Kyung Hee University hospital. Methods: We retrospectively reviewed medical records and laboratory findings of 139 patients who had fungemia from January 2000 to December 2006. We investigated the incidence of each fungal species, yearly occurrence, underlying diseases, hospitalized units, predisposing factors, use of the antifungal agents, mortality, and the characteristics of the expired group. Results: The most common species isolated was C. albicans (40.3%), followed by C. tropicalis (24.5%). Overall, fungemia occurrence showed an increasing trend during the study period, except for the year 2004. Common predisposing factors were previous antimicrobial therapy (89.2%), central venous catheter (78.4%), and ICU admission state at diagnosis (59.7%). among the 139 patients, 98 (70.5%) were treated. Primary choice of antifungal agents included fluconazole (70.4%) and amphotericin B (29.0%). Overall mortality was 38.9% with the highest rate (47.1%) in patients with C. tropicalis and the lowest one (22.2%) in patients with C. parapsilosis. Predisposing factors for mortality due to fungemia in the univariate analysis included only mechanical ventilation (P=0.008). Conclusion: Fungemia in the tertiary care hospital was caused predominantly by C. albicans and followed by C. tropicalis. The mortality rate was high and interspecies differences existed.

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