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소아청소년에서의 항생제 사용량 변화에 따른 그람음성 균주의 항생제 내성률 변화 양상

The Impact of Antibiotic Burden on the Selective Resistance of Gram Negative Bacteria in Children

Lee Jina|Park Sera|Lee Euntaek|So Hye Jin|Yoo Ree Nar
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)|2021.08|Pediatric Infection and Vaccine|제28권 제2호|pp. 82-91|DOI 10.14776/piv.2021.28.e11

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Anti-bacterial agentsDrug resistanceBacteremiaGram negative bacteriabacterial

초록

목적: 본 연구에서는 소아환자의 혈액에서 분리된 주요 그람음성 균주의 항생제 내성 양상을 파악하고 항생제 사용량과의관계를 알아보고자 하였다. 방법: 2014년 1월부터 2018년 6월까지 서울아산병원 어린이병원에 입원한 18세 이하의 소아청소년에서 발생한 그람음성 균주 균혈증 중 Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, 총 4가지 균주를 대상으로 항생제 내성 양상을 분석하였다. 또 원내에서 소아에게 주로 사용하는 정주용 항생제의 사용량과 항생제 내성률의 변화와의 관련성을 분석하였다. 결과: 본 연구 기간 동안 전체 혈액배양에서, K. pneumoniae (6.4%; 105/1,628), E. coli (5.6%; 91/1,628), P. aeruginosa (3.3%; 54/1,628) 및 A. baumannii (2.5%; 41/1,628)의 순으로 분리되었다. 2014–2018년에 분리된 E. coli와 K. pneumoniae의 광범위 cephalosporin 계열에 대한 내성률은 각각 49.3%와 54.4%였다. 2014년도에는 carbapenem에 내성을 보이는 E. coli 균종이 처음 출현하였고, 5년간의 내성률은 5.3%였다. 연구기간 동안 항생제 사용량과 항생제 내성률 사이의 상관관계를 분석하여, 3세대cephalosporin 사용량과 A. baumannii의 내성률(r 2 =0.96, P=0.004) 그리고 carbapenem의 사용량과 K. pneumoniae의 내성률(r 2 =0.79, P=0.045) 간에 양의 상관관계를 확인하였다. 결론: 국내 소아에서 발생한 그람음성균 균혈증 분석 시 3세대 및 4세대 cephalosporin에 대한 높은 내성률이 확인되며, carbapenem에 대한 내성도 확인되고 있다. 일부 항생제 사용량과 해당 약제에 대한 내성률에 선형 상관관계가 있었으며, 이는 항생제 사용량이 내성률에 영향을 미칠 수 있음을 시사한다. 이에 지속적인 원내 항생제 사용량 및 내성률에 대한감시가 필요하며, 적절한 항생제의 선택 및 관리는 내성균주 출현 예방 및 치료 성적 향상에 필수적이다.

Abstract

Background: The purpose of this study was to investigate the association between antibiotic use and the antimicrobial resistance of gram-negative bacteria isolated from blood cultures in a pediatric population. Methods: From January 2014 to June 2018, the antibiotic resistance pattern of Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa obtained from bacteremic patients aged ≤18 years hospitalized at Asan Medical Center Children's Hospital was analyzed and the parenteral antibiotic consumption data were retrieved. Results: During the study period, the blood culture was positive for K. pneumoniae (6.4%; 105/1,628), E. coli (5.6%; 91/1,628), P. aeruginosa (3.3%; 54/1,628), and A. baumannii (2.5%; 41/1,628), and the extended-spectrum antibiotic resistance rate of gram-negative bacteria was consistently high. The overall resistance rate of E. coli and K. pneumoniae to extendedspectrum cephalosporin was 49.3% and 54.4%, respectively. Carbapenem-resistant E. coli was first detected in 2014; its overall resistance rate to carbapenem was 5.3%. There was a linear correlation between the usage of 3rd generation cephalosporin and the resistance of A. baumannii (r 2 =0.96, P=0.004) and carbapenem usage and the resistance of K. pneumoniae (r 2 =0.79, P=0.045). Conclusions: A positive linear correlation was observed between antibiotic resistance and the corresponding antibiotic usage in 3rd generation cephalosporin resistant A. baumannii and carbapenem resistant K. pneumoniae. The judicious use of antibiotics in healthcare settings is important to minimize selection for extended-spectrum β-lactamase (ESBL) and carbapenem resistance in gram-negative bacteria.

참고문헌 (24)

  1. Ben-Ami R, "A multinational survey of risk factors for infection with extended-spectrum β-lactamase-producing enterobacteriaceae in nonhospitalized patients", Clin Infect Dis, 49, pp.682~690 (2009)
  2. Kim KG, "Prevalence and molecular epidemiology of ESBLs, plasmid-determined AmpC-type β-lactamases and carbapenemases among diarrhoeagenic Escherichia coli isolates from children in Gwangju, Korea : 2007–16", J Antimicrob Chemother, 74, pp.2181~2187 (2019)
  3. Morrissey I, "A review of ten years of the Study for Monitoring Antimicrobial Resistance Trends(SMART)from 2002 to 2011", Pharmaceuticals, 6, pp.1335~1346 (2013)
  4. 김서희, "항생제 사용량 변화에 따른 그람음성균주의 항생제 내성률의 변화 양상", Pediatric Infection and Vaccine, 22(3), pp.178~185 (2015), 대한소아감염학회
  5. Yoon EJ, "Carbapenemase-producing Enterobacteriaceae in South Korea : a report from the National Laboratory Surveillance System", Future Microbiol, 13, pp.771~783 (2018)
  6. Naas T, "Plasmid-mediated carbapenem-hydrolyzing β-lactamase KPC in a Klebsiella pneumoniae isolate from France", Antimicrob Agents Chemother, 49, pp.4423~4424 (2005)
  7. Hoenigl M, "Nosocomial outbreak of Klebsiella pneumoniae carbapenemase-producing Klebsiella oxytoca in Austria", Antimicrob Agents Chemother, 56, pp.2158~2161 (2012)
  8. Armenian SH, "Risk factors for mortality resulting from bloodstream infections in a pediatric intensive care unit", Pediatr Infect Dis J, 24, pp.309~314 (2005)
  9. Cordero L, "Enteric gram-negative bacilli bloodstream infections : 17 years' experience in a neonatal intensive care unit", Am J Infect Control, 32, pp.189~195 (2004)
  10. Smith TL, "Bloodstream infections in pediatric oncology outpatients : a new healthcare systems challenge", Infect Control Hosp Epidemiol, 23, pp.239~243 (2002)
  11. Hartman ME, "Trends in the epidemiology of pediatric severe sepsis", Pediatr Crit Care Med, 14, pp.686~693 (2013)
  12. 강지은, "최근 5년(2006-2010)간 소아 혈액 종양 환자에서 발생한 균혈증의 원인균 및 임상 양상: 단일기관 연구", Pediatric Infection and Vaccine, 19(3), pp.131~140 (2012), 대한소아감염학회
  13. Folgori L, "Epidemiology and clinical outcomes of multidrug-resistant, gram-negative bloodstream infections in a European tertiary pediatric hospital during a 12-month period", Pediatr Infect Dis J, 33, pp.929~932 (2014)
  14. Ben-David D, "Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections", Clin Microbiol Infect, 18, pp.54~60 (2012)
  15. Schwaber MJ, "Clinical and economic impact of bacteremia with extended-spectrum-β-lactamase-producing Enterobacteriaceae", Antimicrob Agents Chemother, 50, pp.1257~1262 (2006)
  16. Kim YK, "Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children : epidemiology and clinical outcome", Antimicrob Agents Chemother, 46, pp.1481~1491 (2002)
  17. Duncan RA, "Controlling use of antimicrobial agents", Infect Control Hosp Epidemiol, 18, pp.260~266 (1997)
  18. Lee J, "Control of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy", J Antimicrob Chemother, 60, pp.629~637 (2007)
  19. Lee J, "The impact of the increased use of piperacillin", tazobactam on the selection of antibiotic resistance among invasive Escherichia coli and Klebsiella pneumoniae isolates, 2013, pp.17, e638~e643
  20. Clinical and Laboratory Standards Institute (CLSI), "Performance standards for antimicrobial susceptibility testing; twenty-fourth informational supplement. CLSI document M100-S24", CLSI, ~ (2014)
  21. Goossens H, "Outpatient antibiotic use in Europe and association with resistance: a cross-national database study", Lancet, 365, pp.579~587 (2005)
  22. Willemsen I, "Correlation between antibiotic use and resistance in a hospital : temporary and ward-specific observations", Infection, 37, pp.432~437 (2009)
  23. Petrikkos G, "Differences in the changes in resistance patterns to third-and fourth-generation cephalosporins and piperacillin", tazobactam among Klebsiella pneumoniae and Escherichia coli clinical isolates following a restriction policy in a Greek tertiary care hospital, 2007, pp.29, 34~38
  24. de Araujo OR, "Cefepime restriction improves gram-negative overall resistance patterns in neonatal intensive care unit", Braz J Infect Dis, 11, pp.277~280 (2007)

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