지속성 균혈증 및 진균혈증 - 위험인자 및 임상적 중요성
Persistent bacteremia and fungemia-risk factors and clinical significance
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목적 : 지속성 혈류 감염은 사망률과 재원 기간을 증가시킨다는 이전의 보고는 있으나, 이에 대한 국내외의 연구는 많지 않다. 이에 저자들은 지속성 균혈증과 진균혈증을 보인 환자들에 대해 위험 인자와 임상적 중요성에 대해 연구하였다. 방법 : 환자-대조군 연구로 1999년 5월부터 2005년 2월까지 일개 대학 병원에 입원한 환자들에 대하여 후향적으로 의무 기록을 검토하여 지속성 혈류 감염의 정의에 합당한 환자를 선정하였다. 이후 지속성 혈류 감염 환자군의 혈액배양 검사 날짜와 동일한 날짜에 혈액배양 검사가 이루어진 환자 중 당일에만 양성 소견을 보이고 추적 배양검사 결과 음전된 환자를 대조군인 단기 혈류 감염 환자군으로 선택하여 두 군 간의 차이를 비교하였다. 결과 : 연구 기간 중 혈액배양 검사상 양성 소견을 보인 환자는 총 1,737명이었으며, 이 중 연구군이 된 지속성 환자군은 64명이었고, 대조군인 단기 환자군은 146명이었다. 지속성 혈류 감염을 보인 환자들은 1개월 이내의 항생제 사용력, 원내 감염, 농양, 혼합 균주에 의한 감염, Candida sp., 경험적 항생제가 감수성 검사 결과와 부합하지 않는 경우, 중심 정맥 도관 삽관, 처음 혈액배양 검사 당시 중환자실에 재원한 경우가 많았다. 이 중, 1개월 이내에 항생제 사용력(p=0.033), 원내 감염(p= 0.026), 농양(p=0.004), 혼합 균주에 의한 감염(p=0.001)은 다변량 분석상에서도 유의한 차이를 보이는 독립적인 연관성을 보였다. 예후의 비교에 있어서는 지속성 환자군이 단기 환자군에 비해 재원 기간이 길었으나(p=0.01), 사망률에 있어서는 차이를 보이지 않았다. 결론 : 지속성 혈류 감염을 가진 환자들에 대하여 1개월 이내 항생제 사용력, 원내 감염, 농양 존재, 혼합 균주에 의한 감염 여부에 대해 확인해 보아야 하며, 이외에도 원인균이 Candida sp.가 아닌지, 중심 정맥 도관을 가지고 있는지, 경험적 항생제의 선택이 적절하였는지, 처음 혈액배양 검사 당시 중환자실에 재원한 경력이 있는지 확인해 볼 필요가 있겠다.
Abstract
Background : Persistent bloodstream infection is known to cause high mortality and a prolonged hospital stay. We performed a study examining risk factors and the clinical significance of persistent bacteremia and fungemia. Methods : This was a case-controlled study. Medical records of patients with bacteremia or fungemia in one university hospital in Korea from May 1999 to February 2005 were retrospectively reviewed. Patients with persistent positive blood cultures regardless of antibiotic treatment for more than three days were assigned to the persistent group. Patients with positive blood cultures only on the same calendar days with the persistent group but negative on follow-up were assigned to the short-term group. Results : A total of 64 patients were enrolled in the persistent group, and 146 patients in the short-term group among 1,737 patients with positive blood cultures. The persistent group was associated with previous antibiotic usage within 1 month (p=0.033), nosocomial infection (p=0.026), having an abscess (p=0.008), and infection by mixed organisms (p=0.001), independently. Candida sp. as a causative organism, treatment with inappropriate empirical antibiotics, having a central venous catheter, or ICU care at the time of blood culture was higher in the persistent group as well. The persistent group had a prolonged number of hospital-days (p=0.010), but there was no difference in mortality between the two groups. Conclusions : Patients with a persistent bloodstream infection should be assessed about previous antibiotic usage within 1 month, nosocomial infection, having an abscess, infection by mixed organisms, Candida sp. as a causative organism, treatment with inappropriate empirical antibiotics, having central venous catheter, or ICU care at the time of blood culture.(Korean J Med 72:647-657, 2007)
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