Etiology of Bacteremia in Children With Hemato-Oncologic Diseases From 2013 to 2023: A Single Center Study
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목적: 본 연구는 2013년부터 2023년까지 최근 10년간 분당서울대학교병원 소아 혈액종양 환자들에게 발생한 균혈증 발생 숫자를 확인하고, 원인균 발생 빈도 및 분포와 이들의 항생제 감수성을 분석하면서 경험적 항생제를 선택하는 데에 필요한 치료 지침의 기초 자료로 활용하고자 수행되었다. 방법: 2013년 1월부터 2023년 7월까지 분당서울대학교병원에 입원한 환자 중 기저혈액종양질환이 있으면서 혈류감염이발생한 환자들을 대상으로 후향적 의무기록 분석을 하였다. 결과: 10년의 연구 기간동안 총 74명의 환자에게서 98례의 혈류감염이 확인되었고, 이 중 그람 양성균, 그람 음성균, 진균이 각각 57.1% (n=56), 38.8% (n=38), 4.1% (n=4)이었다. 가장 흔한 그람 양성균은 coagulase-negative staphylococci (n=21, 21.4%) 와 Staphylococcus aureus (n=14, 14.3%) 였고, 가장 흔한 그람 음성균은 Klebsiella species (n=16, 16.3%) 와 Escherichia coli (n=10, 10.2%) 였다. 전체 사망한 환자들 중 균혈증 발생으로부터 30일 이내로 사망한 사례는 총 6건 (6.1%) 이었다. 결론: 본 연구는 혈액종양질환을 진단받은 소아 환아들에게서 발생한 균혈증의 원인균 분포 및 각 원인균의 항생제 분포를분석하였다. 연구결과를 토대로, 연구자들은 현재 사용하는 경험적 항생제 가이드라인을 유지할 수 있다는 점을 알 수 있었다. 소아 혈액종양질환 환아들에게서 발생한 균혈증에서 사용해야 할 적절한 경험적 항생제는 각 기관별로 조사한 항생제 감수성 양상에 기초하여 결정되어야 하며, 지속적인 모니터링은 반드시 이루어져야 한다
Abstract
Purpose: This study aimed to identify the pathogens of bloodstream infection in children with underlying hemato-oncologic diseases, analyze susceptibility patterns, compare temporal trends with those of previous studies, and assess empirical antimicrobial therapy. Methods: Retrospective review study of children bacteremia in hemato-oncologic diseases was conducted at Seoul National University Bundang Hospital from January 2013 to July 2023. Results: Overall, 98 episodes of bacteremia were observed in 74 patients. Among pathogens isolated, 57.1% (n=56) were Gram-positive bacteria, 38.8% (n=38) were Gram-negative bacteria, and 4.1% (n=4) were Candida spp. The most common Gram-positive bacteria were coagulase-negative staphylococci (n=21, 21.4%) and Staphylococcus aureus, (n=14, 14.3%) whereas the most common Gram-negative bacteria were Klebsiella pneumoniae (n=16, 16.3%) and Escherichia coli (n=10, 10.2%). The susceptibility of Gram-positive bacteria to penicillin, oxacillin, and vancomycin was 11.5%, 32.7%, and 94.2%, respectively and the susceptibility of Gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin was 68.6%, 80%, 97.1%, 82.9%, and 91.4%, respectively. Methicillin-resistant S. aureus was detected in 1 strain and among Gram-negative strains, extended spectrum β-lactamase accounted for 28.9% (12/38). When analyzing the antibiotic susceptibility and empirical antibiotics, the mismatch rate was 25.5% (n=25). The mortality rate of children within 30 days of bacteremia was 7.1% (n=7). Conclusions: Empirical antibiotic therapy for bacteremia in children with hemato-oncologic diseases should be based on the local antibiogram in each institution and continuous monitoring is necessary.
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