16년간 단일기관에서 시행된 소아 간이식 후 세균 감염 합병증의 특징
Bacterial Infections after Liver Transplantation in Children: Single Center Study for 16 Years
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목적: 16년 간 단일기관에서 시행된 간이식 후 소아에서 발생한 세균 감염 합병증의 빈도와 특징을 분석하기 위해 시행되었다. 방법: 2000년 1월부터 2015년 6월까지 서울대학교병원에서 간이식을 시행 받은 207명 소아 중 다장기 이식이나 2번 이상의 간이식을 시행 받은 18명을 제외한 189명이 연구에 포함되었다. 감염 증상과 더불어 병원체가 증명된 세균 감염 만을 대상으로 하여 감염성 질환의 종류 및 발생 시기 등을 조사하였다. 결과: 189명의 간이식 소아의 중간연령은 24개월(2개월–16세)이었으며, 수술 후 1년 간 추적 관찰 하였다. 총 87명(46.0%)에서 132건(0.7건/명)의 세균 감염이 발생하였다. 균혈증(n=39, 29.5%), 복막염(n=28, 21.2%), 요로감염(n=25, 18.9%), 폐렴(n=20,15.2%)의 순이었다. 그람양성균이 66건(50%), 그람음성균이 66건(50%)에서 확인되었다. 세균 감염은 이식 후 1개월 이내에 84건(63.6%), 1–6개월에 32건(24.2%), 6개월 이후에 16건(12.1%)으로 이식 초기에 유의하게 많았다(P<0.05). 가장 흔한 그람양성균은 Staphylococcus aureus (n=20, 15.2%) 와 Enterococcus species (n=20, 15.2%) 였으며, 그람음성균은 Klebsiella species (n=18, 13.6%), Enterobacter species (n=13, 9.8%), Escherichia coli (n=11, 8.3%) 순으로 많았다. 이 중 7명(41%)이 감염성 합병증으로 사망하였다(균혈증 4명, 복막염 1명, 폐렴 2명). 결론: 지난 16년 간 본 기관에서 소아에게 시행한 간이식 후 발생한 감염성 합병증의 빈도와 종류는 기존의 연구들과 비슷하였다. 간이식 후 소아에서 세균 감염 합병증은 이식 후 1개월 이내에 가장 많이 발생하며, 1개월이 지난 후에도 중증의 세균 감염으로 인한 사망률이 높아 6개월 전까지는 면밀한 세균 감염 합병증의 진단 및 치료가 필수적이다. 본 연구를 통해 향후 간이식의 예후 향상을 위한 연구의 토대가 될 것을 기대한다.
Abstract
Purpose: Survival after liver transplantation (LT) has improved over the years, but infection is still a major complication. We aimed to identify the characteristics of bacterial infections in pediatric LT recipients. Methods: This study is a retrospective review of 189 consecutive children undergoing LT between 2000 and 2015 at a single center. In this study, the incidence of infection was determined for the following periods: within 1 month, between 1–5 months, and between 6–12 months. Patients who underwent liver transplants more than once or multiple organ transplants were excluded. Results: All patients had received postoperative antibiotic for 3 days. Only the maintenance immunosuppression with oral tacrolimus and steroids were performed. As a result, 132 bacterial infections developed in 87 (46.0%) patients (0.70 events per person-year). Bacterial infections occurred most frequently within the first month (n=84, 63.6%) after LT. In the pathogens, Staphylococcus aureus (15.2%), Enterococcus species (15.2%), and Klebsiella species (13.6%) were most common. Regarding the organ infected, bloodstream was most common (n=39, 29.5%), followed by peritoneum (n=28, 21.2%), urinary tract (n=25, 18.9%), and lungs (n=20, 15.2%). We changed prophylactic antibiotics from ampicillin-sulbactam to piperacillin-tazobactam at 2011, October, there were no significant effects in the prevalence of antibiotics resistant bacterial infections. The 1-year mortality was 9.0% (n=17), in which 41.2% (n=7) was attributable to bacterial infection; septicemia (n=4), pneumonia (n=2), and peritonitis (n=1). Conclusions: The incidence and type of bacterial infectious complications after LT in pediatric patients were similar to those of previous studies. Bacterial complications affecting mortality occur within 6 months after transplantation, so proper prophylaxis and treatment in this period may improve the prognosis of LT.
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