일개 신생아중환자실 반코마이신 저항 장구균(VRE)의 유행 양상과 조절
Colonization Rate and Control of Vancomycin-Resistant Enterococci in the Neonatal Intensive Care Unit
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목 적:부산대학교병원 신생아 중환자실에서 2006년3월 VRE 유행이 나타나 입원 환아를 대상으로 대변VRE 감시 배양을 시행하였다. 본 연구는 VRE 감염의정착정도를 파악하고, 위험인자를 분석하여 향후 VRE의출현을 예방하고자 본 연구를 시행하였다. 방 법: 2006년 3월부터 2007년 3월까지 본원 신생아 중환자실 환아 192명을 대상으로 주 1회 대변 감시배양 검사를 시행하였다. VRE가 분리된 환아의 위험인자를 규명하고자 성별, 재태 기간, 기저 질환, 이전 치료에 사용된 항생제의 종류, 침습적 처치의 유무 등을 의무기록을 바탕으로 후향적으로 조사하였다. 결 과:총 192명의 환아 중 VRE 양성군은 48명(25%), VRE 음성군은 189명(75%)이었다. VRE 양성 환아 중 본원 출생아는 12명(25.0%), 타병원 출생아는 36명(75.0%)이었다. VRE 양성 환아의 기저 질환으로는선천성 심질환이 25명(52.1%)으로 VRE 양성 빈도가유의하게 높았다(P =0.005). 항생제 중 VRE 양성군에서 3세대 cephalosporin 사용(45.8% vs. 15.3%, P <0.001)과 vancomycin 사용(95.8% vs. 40.9%, P <0.05)의 기왕력이 통계적으로 유의하게 높음을 알 수 있었다. 또한 VRE 양성군에서 중심 정맥 도관(41.7% vs. 15.3%, P <0.001)이나 인공 호흡기(41.7% vs 25.0%,P =0.017)를 사용한 예가 많았고, 수술 여부(41.7% vs 16.7%, P =0.001)나 흉관 삽입의 기왕력(10.4% vs 2.7%, P =0.021)이 통계적으로 유의하게 높았다. VRE 양성군 48명 중 11명(22.9%)에서 VRE 음전을 확인 하였고 VRE의 음전기간의 중앙값은 101일 이었다. 결 론: VRE 감염은 신생아 중환자실에서 중요한 원내 감염으로 부각되고 있다. 이러한 VRE 집락을 차단하기 위해서는 철저한 감염 관리와 격리를 해야 하며 침습적인 기구의 사용 및 불필요한 항생제의 사용을 줄이려는 노력이 필요하다.
Abstract
Purpose:Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). Methods:We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. Results:The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. Conclusion:VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.
참고문헌 (29)
- Murray BE, "The life and times of the Enterococcus", Clin Microbial Rev, 3, pp.46~65 (1990)
- 이화윤, "신생아에서 Vancomycin 내성 장구균의 감시 및 위험인자 분석", Korean Journal of Pediatrics, 48(9), pp.946~952 (2005), 대한소아과학회
- Weinsten JW, "Resistant enterococci : A prospective study of prevalence, incidence, and factors associated with colonization in a university hospital", Infect Control and Epidemiol, 17, pp.36~41 (1996)
- Bae SJ, "A case of vancomycin-resistant enterococcal sepsis in neonate", Korean J Pediatr Infect Dis, 6, pp.261~266 (1999)
- Kim DR, "Rectal surveillance culture of vancomycinresistant enterococci (VRE) colonization among patients hospitalized in the intensive care unit (ICU)", Korean J Infect Dis, 31, pp.203~209 (1999)
- Moellering RC Jr, "Enterococcus sepsis, Streptococcus bovis and Leuconostoc. In : Mandell, Douglas, and Bennet's principles and practice of infectious disease", pp.1826~1835 (1995)
- Leclercq R, "Plasmidmediated resistance to vancomycin and teicoplanin", N Engl J Med, 319, pp.157~161 (1998)
- Cheong HJ, "Nationwide questionnaire survey for the prevalence, detection method, and infection control program of VRE among hospitals", Korean J Infect Dis, 33, pp.78~87 (2001)
- Park JW, "Susceptibility test of vancomycin-resistant enterococci", Korean J Infect Dis, 24, pp.133~137 (1992)
- Kim WJ, "The changing molecular epidemiology and establishment of epidemicity of vancomycin-resistant enterococci at one hospital over a 6-year period", J Infec Dis, 179, pp.163~171 (1999)
- Cheong HJ, "Colonization rate, risk factor for acquisition and genetic diversity of vancomycin-resistant enterococci isolated from rectal culture of patients in Intensive Care Units from ten large hospitals in Korea", Korean J Infect Dis, 34, pp.276~284 (2002)
- Hospital Infection Control Practice Advisory Committes (HICPAC), "Recommendations for preventing the spread of vancomycin resistance", Infect Contral Hosp Epidemiol, 10, pp.105~113 (1995)
- 이동우, "소아 환아에서 분리된 Vancomycin 내성 장구균에 대한 임상적 고찰", 소아감염, 8(2), pp.199~205 (2001), 한국소아감염병학회
- Dobson SR, "Enterococcal sepsis in neonates : features by age at onset and occurrence of focal infection", Pediatrics, 85, pp.165~171 (1990)
- Uttley AH, "Vancomycin- resistant enterococci", Lancet, 1, pp.57~58 (1988)
- Gold HS, , N Engl J Med, 167, pp.1220~1223 (1993)
- Fuller RE, "Treatment of vancomycin- resistant enterococci with a focus on Quinupristin- Dalfopristin", Pharmacotherapy, 16, pp.584~592 (1996)
- Noskin GA, "Vancomycin-resistant enterococci : Clinical, microbiologic, and epidemiologic features", J Lab Clin Med, 130, pp.14~20 (1997)
- Chung SH, "Colonization features of intestinal vancomycin- resistant enterococci", KONIS, 3, pp.41~47 (1998)
- Park JH, "Clinical observations of a vancomycin-resistant enterococcal outbreak in the neonatal intensive care unit", Proceeding of the 13th Annual Fall Meeting of the Korean Society of Pediatric Infectious Disease, pp.277~ (1999)
- Gordts B, "Vancomycin-resistant enterococci colonizing the intestinal tracts of hospitalized patients", J Clin Microbiol, 33, pp.2842~2846 (1995)
- Malik RK, "Epidemiology and control of vancomycin- resistant enterococci in a regional neonatal intensive care unit", Pediatr Infect Dis J, 18, pp.352~356 (1999)
- de Vera ME, "Antibiotic-resistant enterococci and the changing face of surgical infections", Arch Surg, 131, pp.338~342 (1996)
- Rao GG, "Vancomycin-resistant gram-positive cocci : risk factors for faecal carriage", J Hosp Infect, 35, pp.63~69 (1997)
- Andrew DL, "Relative importance of oral versus intravenous vancomycin exposure in the development of vancomycin- resistant enterococci", J Infect Dis, 173, pp.1292~1293 (1996)
- Rawlings JS, "Expected duration of hospital stay of low birth weight infants : graphic depiction in relation to birth weight and gestational age", J Pediatr, 123, pp.307~309 (1993)
- Manso EG, "Vancomycin-resistant enterococci", Lancet, 342, pp.616~617 (1993)
- Chow JW, "Clonal spread of vancomycin-resistant enterococcus faecium between patients in three hospitals in two states", J Clin Microbiol, 31, pp.1609~1611 (1993)
- Montecalvo MA, "National history of colonization with vancomycin-resistant enterococcus faecium", Infect Control Hosp Epidemiol, 16, pp.680~685 (1995)