국내 미생물 각막염의 10년 추세
Ten-year Trends in Infectious Keratitis in South Korea
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목적: 최근 10년간 미생물 각막염의 원인균과 항생제 감수성, 위험인자를 알아보고자 하였다. 대상과 방법: 익명화 데이터시스템에서 추출한 2012년부터 2021년까지 7개 대학병원에서 미생물 배양검사를 시행한 미생물 각막염환자의 데이터를 이용하여 원인균과 항생제 감수성을 분석하였다. 별개로 동일 기간, 한 기관의 의무기록을 후향적으로 분석하여 임상 양상 및 위험인자를 조사하였다. 결과: 1,837명의 미생물 각막염 데이터가 추출되었고, 배양 양성률은 46.0% (1,137/2,474)이고 가장 흔한 원인균은 coagulase negative Staphylococcus (CoNS) (27.8%)였다. 퀴놀론계 항생제에 대한 내성률은 그람양성균과 그람음성균에서 시간에 따른 통계적 변화가없었고, 그람음성균에서 세팔로스포린계 항생제에 대한 내성률의 증가가 관찰되었다. 288명의 후향적 의무기록 분석에서는 고연령군에서 초진 교정시력이 0.1 미만인 경우, 안과적 수술 과거력, 기존 안질환, 스테로이드 안약, 녹내장 안약 사용의 비율이 유의미하게높았다. 다변량 분석에서 수술적 치료가 필요한 중증 각막염의 위험인자로는 증상 내원 기간(증상 발생 후 본원 내원까지의 기간)이7일 이상인 경우와 기존 안질환이 있는 경우였다(p=0.048, 0.040). 결론: 최근 10년간 미생물 각막염에서 CoNS가 가장 흔한 균이었고 그람음성균에서 세팔로스포린계 항생제에 대한 내성률이 증가하였다. 기존 안질환이 있는 경우 수술적 치료까지 필요할 수 있으므로 이들 환자에서 미생물 각막염은 더욱 주의를 기울여야겠다.
Abstract
Purpose: This study investigated the causative microorganisms, antibiotic susceptibility, and risk factors of infectious keratitis over the past 10 years. Methods: Data from patients with infectious keratitis who underwent microbial culture tests from 2012 to 2021, obtained from anonymized data systems, were analyzed. Microbial culture results and antibiotic susceptibility profiles were examined. A retrospective analysis of the medical records of patients with infectious keratitis during the same period was conducted to investigate the clinical characteristics and risk factors. Results: Data from 1,837 cases of infectious keratitis were extracted from anonymized records. The culture positive rate among patients was 46.0% (1,137/2,474), with coagulase-negative Staphylococcus (CoNS) being the most common causative organism (27.8%). Increased resistance to cefazolin and cefotaxime was observed in gram-negative bacteria, while there were no significant temporal changes in quinolone resistance in gram-positive or negative bacteria. A retrospective medical record analysis of 288 cases revealed that older patients, as well as those with an initial corrected visual acuity < 0.1, a history of ocular surgery, pre-existing ocular conditions, prior steroid eye drops, or glaucoma eye drops, had significantly higher rates of culture positivity. Multivariate analysis identified risk factors for severe keratitis requiring surgical intervention as a symptom-to-presentation period of 7 days or longer (p = 0.048) and pre-existing ocular conditions (p = 0.040). Conclusions: CoNS was the most common microorganism causing infectious keratitis over the past decade. There has been an increase in resistance to cephalosporin antibiotics among gram-negative bacteria. Patients with pre-existing ocular conditions may require surgical intervention, so infectious keratitis in these patients requires greater attention.
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