메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염에 대한 전환요법으로서의 경구 Rifampin의 유용성
The Usefulness of Oral Rifampin as Switch Therapy for the Soft Tissue and Bone Infections Caused by Methicillin-Resistant Staphylococcus aureus
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목 적 : 메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염의 치료 시 glycopeptide약물의 정주 요법에 이은 경구 항생제로의 처방 전환이 요구되는 경우가 많으나 마땅한 경구 약제의 선택이 어려운 실정이다. 이에 경구 rifampin을 메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염에 사용하여 치료한 경우를 분석하여 그 유용성 정도와 실패한 경우 실패의 위험인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월부터 2004년 9월까지 메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염 환자를 대상으로 rifampin을 그 치료 목적으로 사용한 44명의 환자를 의무 기록과 X선 사진을 통해 후향적으로 분석하였다. 기초 자료를 분석하였고 감염이 재발하여 치료 실패로 판정된 환자들에 대해 치료 실패의 원인이 될 만한 주요 변수에 대한 Chi-square 검증과 로지스틱 회귀분석을 시행하였다. 결 과 : 치료 후 재발은 20.5% (8/39)였으며 재발 예와 사망에 대한 위험요소에 대한 단변량 분석에서 고관절 보형물이 있는 경우 흔하였으나 통계적 차이에는 미치지 못하였다(P=0.065). 고관절 보형물 외에 동반된 질환들, 쇼크의 동반, 균혈증의 동반, 경구 시 ciprofloxacin과 rifampin의 병합 복용 기간 등을 혼란 변수로 사용한 다변량 로지스틱 회귀분석에서는 고관절 보형물 만이 통계적으로 유의하였다(P=0.044). 결 론:메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염에 rifampin과 다른 약제를 병합하여 치료하는 경우 재발은 적었다. 치료 실패의 경우는 고관절 부위 감염과 같이 보형물을 쉽게 제거하기 어려운 상황과 관계되는 것을 보여준다.
Abstract
Background : Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. Materials and Methods : We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. Results : The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. Conclusion : Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.
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