단일기관에서 조사한 신생아 및 소아 칸디다혈증의 역학적 특성
Epidemiology of Candidemia in Neonates and Children: A Single Center Experience from 2001 to 2006
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목 적:최근 신생아 및 소아 칸디다혈증의 위험인자에 따른 원인균의 변화를 알아보고자 하였다. 방 법:2000년 9월부터 2006년 8월까지 세브란스병원에 입원했던 만 15세 미만의 소아들 중 혈액배양검사에서 칸디다균속이 동정된 환아들의 의무기록을 후향적으로 분석하였다. 결 과:혈액배양검사에서 칸디다가 동정된 환아는 모두 39명이었으며, 이들의 연령 중앙값은 4개월, 남녀비는 2:1이었고 사망률은 33%였다. 원인균으로는 Candida albicans가 22예(56%), Candida parapsilosis가 9예(23%), Candida glabrata가 6예(15%), 그리고 Candida tropicalis, Candida famata가 각각 1예씩(3%) 분리되었고, Non-albicans 칸디다들에 의한 칸디다혈증의 비율은 2001년 13%에서 2006년 91%로 점차 증가하는 추세를 보였다(P=0.01). 생후 1개월 미만의 신생아가 12명이었고, 이 중 58%에서 칸디다혈증의 원인균으로 C. parapsilosis가 동정되어 1개월 이상의 소아의 경우(7%)보다 유의하게 흔히 검출되었다(P=0.001). C. albicans가 분리되었던 환아 22명 중 55%에서 칸디다혈증 발병 전 2주 이내에 외과적 시술을 시행받은 경력이 있어 다른 균주들의 경우(18%)에 비해 높은 비율을 보였다(P<0.05). C. parapsilosis가 분리되었던 환아 9명 중 78%가 미숙아로 출생하여 다른 균주들의 경우(27%)에 비해 높은 비율을 보였다(P=0.015). C. glabrata가 분리되었던 환아 6명 중 67%에서 칸디다혈증 발병 전 2주 이내에 호중구감소증이 있어 다른 칸디다균들의 경우(12%)보다 높은 비율을 보였다(P=0.011). 결 론:신생아 및 소아 칸디다혈증에서 C. albicans는 외과적 시술을 받은 환아들에서 많이 분리되었으며, C. parapsilosis는 생후 1개월 미만의 신생아, 특히 미숙아에서, C. glabrata는 호중구감소증 환아들에서 많이 분리되었다.
Abstract
Purpose:We evaluated epidemiological and clinical features of candidemia in neonates and children. Materials and Methods:We retrospectively reviewed the medical charts of hospitalized neonates and children with positive blood cultures for Candida species from September 1, 2000 through August 31, 2006. Results:Among 39 total neonates and children with candidemia, the median age was 4 months (interquartile range, 1-28) and overall mortality was 33%. Candida species included: Candida albicans (56%), Candida parapsilosis (23%) and Candida glabrata (15%). There was a tendency of proportional increase of candidemia due to non-albicans species (13% in 2001 vs 91% in 2006; P=0.01). Compared with children older than 1 month of age, the proportion of C. parapsilosis was significantly higher in neonates with candidemia (58% vs 7%; P=0.001). C. albicans was isolated more commonly from those who had undergone surgical intervention before candidemia (55% vs 18%; P＜0.05). C. parapsilosis was isolated more commonly from premature neonates (78% vs 27%; P=0.015). C. glabrata was isolated more commonly from those who had neutropenia before candidemia (67% vs 12%; P=0.011). Conclusion:Candidemia by C. albicans was more commonly in surgical patients; by C. parapsilosis in premature neonates; by C. glabrata in neutropenic patients.
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