단일 3차 의료기관 집중치료실에서 발생한 다약제내성 Acinetobacter baumannii의 4례
Four Children with Multidrug-resistant Acinetobactor baumanii Infections in the Intensive Care Units of a University Hospital
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Acinetobactor baumanii는 기회 감염균으로 carbapenem의 사용이 증가하면서 MDRAB와 같은 내성균으로 출현하고 있다. 저자들은 경희의료원에서 carbapenem 을 투약받지 않았더라도 집중치료실에 장기간 입원하여 기관삽관과 인공호흡기 치료를 받거나 침습적인 수술을 받아 도관을 유지하는 환아에서 MDRAB가 동정되었다는 것을 확인하였다. carbapenem을 사용하지 않았더라도 장기간 집중치료실에 입원할 것으로 예상되는 환자들에게 원내전파를 통한 감염을 최소화하기 위하여 원내 감염관리에 최선을 다해야 할 것이기에 이상의 증례를 통하여 보고한다.
Abstract
The Multidrug-resistant Acinetobactor baumanii (MDRAB) is an opportunistic pathogen. Patients with long periods of hospital stay and/or under intensive care unit (ICU) receiving invasive management are more susceptible to this pathogen. In this report, four children with MDRAB infection are reviewed and described their clinical characteristics. There had been concurrent outbreaks of MDRAB infection in adult patients in the ICU at this period of time. The first child had received a craniotomy and epidural hematoma evacuation. The second child was admitted for status epilepticus with hydrocephalus. The third child had pneumonia with status epilepticus with hydrocephalus. The fourth child had poor activity due to hypoxic ischemic encephalopathy and convulsive disorder. Except the fourth child, all had not been exposed to carbapenem prior to infection of MDRAB. That imply the cause of MDRAB infections may be associated with invasive management and prolonged hospitalization together with the previous exposure to carbapenem in our cases. We would like to emphasize the importance and minimizing the spread of hospital infection in patients under prolonged intensive care management regardless of the use of carbapenem.
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