녹색 연쇄상구균 균혈증의 임상적 의의
Clinical Significance of Bacteremia Caused by Viridans Streptococci
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목 적 : 녹색 연쇄상구균이 혈액에서 동정 될 경우 임상적으로 의미없는 오염균에서부터 심내막염과 같은 침습성 감염질환까지 다양하게 나타날 수 있다. 하지만 녹색 연쇄상구균 균혈증의 임상적 의미를 연구한 자료가 지금까지 국내에서는 없는 실정이다.재료 및 방법 : 1997년부터 2003년까지 삼성서울병원에서 혈액내 녹색 연쇄상구균이 동정된 환자 95명을 대상으로 연구하였고, 녹색 연쇄상구균 균혈증의 임상적 의미를 나타낼 수 있는 모든 임상적, 미생물학적 자료를 분석하였다. 결 과 : 총 95명 중에서 임상적 의미가 있는 감염으로 치료가 필요한 경우는 76명(80%)이었고, 오염균이나 일시적인 균혈증으로 임상적인 의미가 없는 경우는 20%였다. 임상적으로 의미가 있는 감염에서 질환별로는 일차적 균혈증이 46명(48%)으로 가장 많았고, 복강 내 감염 14명(15%), 심내막염 8명(8%)순이었다. 일차적 균혈증은 항암치료후에 호중구감소증이 발생한 환자들에서 많이 관찰되었다. 심내막염인 경우 환자가 기저 심질환을 가지고 있지 않으면 드물었다. 임상질환별로 분리된 빈도가 높은 균주는 심내막염에서는 S. mitis (38%), 일차적 균혈증에서는 S. oralis (26%), 복강내 감염에서는 S. intermedius (29%) 였다. 분리된 녹색 연쇄상구균 중에서 페니실린에 비감수성인 경우는 38% 에 달했다.
Abstract
Background : Clinical significance of viridans streptococcal bacteremia may be variable from insignificant colonization to serious invasive diseases such as endocarditis. However, there have been no data on the clinical implications of viridans streptococcal bacteremia in Korea to date. Materials and Methods : We have analyzed 95 cases of viridans streptococcal bacteremia diagnosed at the Samsung Medical Center from 1997 to 2003. All available clinical and microbiological data were analyzed. Results : Of the total 95 cases, 76 (80%) had clinically significant infections, while 20% of cases were not associated with clinical diseases. Primary bacteremia was the most common disease (48%) followed by intra-abdominal infections (15%), and infective endocarditis (8%). Primary bacteremia was mostly observed in patients with neutropenia after anti-cancer chemotherapy. Infective endocarditis was unlikely if patients did not have underlying heart diseases. S. mitis, S. oralis, and S. intermedius were the most common etiologic agent in infective endocarditis, primary bacteremia, and intra- abdominal infection, respectively. Thirty-eight percent of isolates were not susceptible to penicillin. Conclusion : Viridans streptococcal bacteremia is likely to be associated with invasive clinical diseases, especially in patients with neutropenia, intra-abdominal diseases or underlying heart diseases. However, the presence of viridans streptococci in the blood cultures does not necessarily mean the possibility of infective endocarditis.
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