포도알균 균혈증 환자에서 사망 예측 위험인자
Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia
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목 적 : 황색포도알균은 중증 감염의 흔한 원인이며, 사망하거나 합병증이 발생하는 경우가 종종 있다. 본 연구를 통해 황색포도알균 균혈증 환자에서 임상적 결과에 영향을 미칠 수 있는 위험인자를 확인해 보고자 한다. 재료 및 방법 : 본 연구는 2003년 1월부터 2005년 12월까지 3년간 168 명의 환자에서 발생한 황색포도알균 균혈증에 대해 후향적 의무기록 조사를 바탕으로 이루어졌다. 성별, 나이, 기저 질환, 황색포도알균 균혈증의 원발 병소, 항생제 사용력과 미생물학적 특징에 대한 자료를 모았으며, 균혈증 발생 당시 질환의 중증도는 acute physiology score (APS)와 APACHE II 점수(acute physiology and chronic health evaluation II system, APACHE II score)를 이용하여 측정하였다. 결과는 균혈증 발생 12 주 후 사망과 생존으로 나누어 분석하였다. 결 과 : 황색포도알균 균혈증 발생 12 주 후 97명의 환자가 생존하였으며, 51명이 사망하였다. 사망 환자 군이 나이가 더 많았으며(66.4±13.6 vs. 59.5±14.9세, P=0.007), APACHE II 점수(17.5±6.3 vs. 13.5±5.1, P<0.001)와 APS (11.1±5.5 vs. 8.0±4.3, P<0.001)가 높았다. 병원 내 감염에 의한 황색포도알균 균혈증 환자[36 (70.62%) vs. 49 (50.5 %), P=0.030]와 제거 불가능한 원발 병소를 지닌 경우[46 (90.2%) vs. 66 (68.0%), P=0.005] 사망위험성이 높았다. 다변량 분석에 의하면 병원 내 감염[adjusted odds ratio (OR)=2.93]과 제거 불가능한 원발 병소(adjusted OR=5.74), 높은 APACHE II 점수(adjusted OR=1.22)에 의해 황색포도알균에 의한 사망률이 증가하였다 결 론 : 본 연구에서 병원 내 감염과 제거 불가능한 원발 병소, 높은 APACHE II 점수가 황색포도알균 균혈증에 의한 사망과 관련된 위험인자이다. 반면, 메티실린 내성과 초기 부적절한 항생제 사용은 황색포도알균 균혈증의 사망률과 연관성이 없었다.
Abstract
Background : Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB). Materials and Methods : Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB. Results : A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4±13.6 vs. 59.4±14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5±6.3 vs. 13.5±5.1, P<0.001) and the acute physiology score (11.1±5.5 vs. 8.0±4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB [46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93], ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted OR=1.22) lead to higher mortality rate from SAB. Conclusion : Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB.
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