신생아에서 칸디다 패혈증에 합병된 신균종의 임상적 특징 및 예후
Clinical Features and Outcomes of Renal Mycetoma Complicated by Candida Sepsis in Newborn Infants
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목적: 칸디다 패혈증 환아에서 신장은 전신의 침습 염증반응에의해 잘 침범되는 부위에 해당하며 신균종을 합병하기 쉽다. 이 연구는 칸디다 패혈증을 가진 신생아에서 합병할 수 있는 신균종의 위험인자와 임상적 특징, 치료에 따른 경과 및 예후 등에 대한 조사를 통해서 칸디다 신균종 관리에 도움을 주고자 시행하였다. 방법: 2002년 1월부터 2010년 12월까지 일개 대학병원 신생아 집중치료실에 입원했던 환아 중 칸디다 패혈증이 확진된 환아를 대상으로 의무기록과 초음파 영상소견을 후향적으로 연구하였다. 칸디다 패혈증을 동반하였으나 감염 2개월 내에 신 초음파검사를 시행하지 못한 경우는 임상소견의 비교 대상에서 제외하였다. 결과: 연구기간 중 총 69례의 칸디다 패혈증이 발생하였다. 원인균주는 C. albicans가 34례(49.2%)로 가장 많았고 C. parapsilosis는 29례(42%)로 두 번째 흔한 균주이나 최근 증가하는 추세였다. 감염초기에 초음파검사를 시행한 42명의 환아 중 신균종은 8례(19.1%)에서 합병되었다. C. albicans 패혈증을 가진 군에서 non-albicans 감염군보다 신균종의 동반율이 높았으나 통계적 유의성은 없었다. 신균종 동반 여부에 따른 칸디다 패혈증의 두 군간 비교에서 동반군과 비동반군의 주산기 소견은 비슷한 분포를 보였다. 칸디다 뇨증의빈도는 동반군이 비동반군보다 높았고(P<0.01), 칸디다 혈증의 기간도 동반군이 더 길었으나 통계적 의미는 없었다. 항 진균요법의 기간은 동반군이 비동반군보다 더 길었다(P<0.001). 초음파검사에서 진균구 병변의 호전에는 중앙값 2개월(범위: 2-4개월)이 걸렸고 완전소실에는 중앙값 5개월(범위: 3-9개월)이 소요되었다. 결론: 칸디다 패혈증 환아에서 칸디다 뇨증의 동반은 신균종 합병의 초기소견이 될 수 있으며, 진균구는 항 진균요법 후 장기간 지속되므로 주기적인 추적관찰이 필요하다.
Abstract
Purpose: The kidney is a common site of end organ involvement in patients with candidemia. This study was undertaken to investigate clinical features and outcomes of renal mycetoma complicated by Candida sepsis in neonates. Methods: A retrospective analysis of the medical records and radiologic images was conducted in a neonatal intensive care unit over a 9-year period (2002-2010). Results: During the study period, there were 69 episodes of Candida sepsis. C. albicans was the most common pathogen (49.2%),and C. parapsilosis was the second (42%), but emerging. Of the 42 patients who underwent ultrasound examination in early phase of infection, renal mycetoma was observed in 8 cases (19.1%). Renal mycetoma was more frequently developed in patients with C. albicans sepsis than those with non-albicans candidemia, but the result was not significant. The demographic characteristics of the two groups of patients who had Candida sepsis (with renal mycetoma vs. without renal mycetoma) were similar. Candiduria was more common in the mycetoma group (P<0.01). In addition, the duration of antifungal medication was longer in patients with mycetoma (P<0.001). On follow-up ultrasounds, improvement and resolution of renal echogenic lesions took a median time of 2and 5 months respectively for the mycetoma group. Conclusion: Candiduria may be an initial sign of renal mycetoma complicated by Candida sepsis in newborn infants. Echogenic foci on the renal ultrasound are persistent for a considerable period after antifungal therapy, and therefore follow-up evaluations are important.
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