3개월 미만 영아의 발열에 대한 원인 및 임상양상에 대한 단일기관 연구; 2008-2010
Etiology and Clinical Manifestations of Fever in Infants Younger than 3 Months Old: A Single Institution Study, 2008-2010
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목 적:본 연구는 발열로 내원한 3개월 미만 영아에서, 그 임상 양상과 원인균을 확인함으로써 심각한 세균감염의 고위험군을 구분하는 데 도움이 되고자 하였다. 방 법: 2008년 1월부터 2010년 12월까지 발열을 주소로 서울대학교병원 응급실에 내원하거나 입원치료 받았던 3개월 미만 영아 313명의 의무기록을 후향적으로분석하였다. 대상 환자들의 임상 양상, 검사 결과 및 원인 균주 등의 자료를 수집하였으며, 심각한 세균 감염의위험 요인을 평가하였다. 그람 염색과 세균 배양, 바이러스 배양, 항원 검사, 또는 중합효소연쇄반응 검사를 시행하였을 때 임상적으로 의미 있는 검체에서 양성으로 확인된 경우 원인 균주로 채택하였다. 결 과:전체 313례 중 127례(40.6%)에서 미생물학적 원인이 확인되었으며, 세균 감염이 39례, 바이러스 감염이 88례를 차지하였다. 세균 감염의 원인 균주로는Escherichia coli (66.7%)와 Streptococcus agalactiae (12.8%)가 가장 많았고, 바이러스 감염은 엔테로바이러스(33.7%), 호흡기 세포융합 바이러스(19.8%), 라이노바이러스(18.8%) 순으로 흔하게 나타났다. 심각한 세균감염군(39례)은 심각한 세균 감염이 아닌 군(274례)에비하여 백혈구 수(14,473±6,824/mm3 vs. 11,254±5,775/mm3, P=0.002)와 C-반응단백(6.32±8.51 mg/L vs. 1.28±2.35 mg/L, P<0.001)이 유의하게 높게 나타났다. 심각한 세균 감염의 위험 인자로는 남자(OR 3.7,95% CI 1.5-8.9), 신경계 증상이 있는 경우(OR 4.8,95% CI 1.4-16.8), 가족 중 호흡기 증상이 없는 경우(OR 3.6, 95% CI 1.2-11.3) 등이 있었다. 결 론:본 연구를 통해 발열로 내원한 3개월 미만 영아에서의 흔한 원인 균주 및 심각한 세균 감염의 위험 인자를 확인할 수 있었다. 이것은 향후 발열로 내원한 영아에 대한 치료 방침의 결정에 기초적인 자료가 될 것으로생각된다.
Abstract
Purpose : The purpose of this study is to investigate clinical features and causative organisms in febrile infants younger than three months, to help identification of high risk patients for serious bacterial infection (SBI). Methods : A total of 313 febrile infants younger than three months, who had visited Seoul National University Children’s Hospital from January 2008 to December 2010 were included. Clinical features, laboratory findings, causative organisms,and risk factors of SBI were analyzed by retrospective chart review. Causative bacterial or viral pathogens were identified by gram stain and cultures, rapid antigen tests, or the polymerase chain reaction from clinically reliable sources. Results : Among 313 infants, etiologic organisms were identified in 127 cases (40.6%). Among 39 cases of bacterial infections,Escherichia coli (66.7%) and Streptococcus agalactiae (12.8%) were common. Enterovirus (33.7%), respiratory syncytial virus (19.8%), and rhinovirus (18.8%) were frequently detected in 88 cases of viral infection. Patients with SBI (39 cases) showed significantly higher values of the white blood cell count (14,473±6,824/mm3 vs. 11,254±5,775/mm3, P =0.002) and the Creactive protein (6.32±8.51 mg/L vs. 1.28±2.35 mg/L, P <0.001) than those without SBI (274 cases). The clinical risk factors for SBI were the male (OR 3.7, 95% CI 1.5-8.9), the presence of neurologic symptoms (OR 4.8, 95% CI 1.4-16.8), and the absence of family members with respiratory symptoms (OR 3.6, 95% CI 1.2-11.3). Conclusion : This study identified common pathogens and risk factors for SBI in febrile infants younger than three months. These findings may be useful to guide management of febrile young infants.
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