동종 조혈 모세포 이식 환자에서 감염증의 양상에 대한 고찰
Profiles of infectious complications on the outcomes for the recipients of allogeneic hematopoietic stem cell transplantation
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목적 : 조혈 모세포 이식을 받은 환자의 감염증의 양상을 분석하고, 감염증이 사망률에 미치는 영향과 사망률에 대한 위험인자의 예측 근거를 제시 하고자 한다. 방법 : 1996년 2월에서 2003년 10월까지 본원에서 동종 조혈 모세포 이식을 받은 환자를 대상으로 후향적으로 조사하였다. 결과 : 총 139명의 환자들이 조혈 모세포 이식을 시행 받았으며, 연령의 중앙값은 33.9세였고 추적관찰기간의 중앙값은 18.8개월이었으며, 감염성 합병증의 평균 발생 빈도는 3.24±3.00회/인이었다. 총 450회의 감염증이 관찰되었고, 이 중 미생물학적으로 확인된 감염이 41.6%였으며 임상적으로 확인된 감염증은 34.0%, 불명열이 24.4%를 차지하였다. 감염성 합병증은 대부분 조기 회복기에 발생하였으며 전체의 39.6%가 이 시기에 발생하였고, 만기 회복기, 중간 회복기 순으로 각각 32.4%, 24.4%를 차지하였다. 미생물학적으로 확인된 감염의 187개의 사례 중에 세균감염이 94회였고, Coagulase- negative staphylococci가 15회로 가장 많이 분리되는 균종이었다. 미생물학적으로 확인된 감염 중 바이러스 감염은 78회로 41.7%를 차지하였으며, CMV감염증이 가장 많았다. 진균의 경우 전체 미생물학적으로 확인된 감염 중 7.5%를 차지하였으며, 이 중 Aspergillus spp.가 가장 많았다. 감염과 연관되어 사망한자 19명 중 12명(63.2%)이 만기 회복기에 발생하였다. 감염성 사망률에 대한 위험요인으로는 기저 질환의 위험도, 호중구 감소 기간, 조혈 모세포 생착 실패, 급성/만성 이식 편대 숙주 반응등이 통계적으로 유의하게 나왔다(p<0.05).
Abstract
Background : We wanted to investigate the effect of infectious complications on the outcome of patients who received allogeneic hematopoietic stem cell transplantation (HSCT), and we determined the risk factors for predicting infectious complication and the mortality in allogeneic HSCT recipients. Methods : We enrolled all the patients who underwent allogeneic HSCT at Samsung Medical Center from February 1996 to October 2003. Results : A total of 139 patients were enrolled. A total of 450 infectious episodes were observed in 131 allogeneic recipients (90.8%). Infectious complications occurred in the allogeneic recipients [3.243.00 episodes/patient]. Microbiologically documented infection (MDI), clinically documented infection (CDI), and unknown fever (UF) accounted for 41.6%, 34.0% and 24.4%, respectively, of the total infections. Pneumonia (15.1%) was the most common infection. Among the 187 MDIs, bacterial infection, viral infection and fungal infection accounted for 50.3%, 39.6%, and 7.5%, respectively. Twelve of 24 deaths in the late post-transplantation period were related with infection. The statistically significant risk factors for infection related to mortality, by multivariate analysis, were the underlying disease risk, the duration of neutropenia, the failure of stem cell engraftment, acute GVHD, MDI, UF, the number of infectious episodes, bacteremia, fungemia, pneumonia, genitourinary tract infections, S. aureus, E. coli, Pseudomonas spp., Aspergillus spp., Non-albicans candida and CMV diseases. Conclusions : The incidence of fungal infections was still low in our institute, even though prophylaxis for fungal infections was not applied, except for gargling with nystatin. In addition, most of them were non-albican Candida and Aspergillus species. Therefore, routine fluconazole prophylaxis may not be needed in our institute.(Korean J Med 72:200-208, 2007)
참고문헌 (21)
- 김홍빈, "골수 이식 후 발생하는 감염증: 1985-1996", 감염, 31, pp.341~347 (1985)
- 신완식, "골수이식 후 감염의 분석", 대한조혈모세포이식학회지, 3, pp.87~98 (1998)
- Gratwohl A, "Autologous hematopoietic stem cell transplantation for autoimmune diseases", Bone Marrow Transplant, 35, pp.869~879 (2005)
- Dykewicz CA, "Summary of the guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients", Clin Infect Dis, 33, pp.139~144 (2001)
- Ninin E, "Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants", Clin Infect Dis, 33, pp.41~47 (2001)
- Saavedra S, "Infectious complications in patients undergoing unrelated donor bone marrow transplantation: experience from a single institution", Clin Microbiol Infect, 8, pp.725~733 (2002)
- Robert H. Rubin, "Clinical approach to infection in the compromised host", pp.2002, Kluwer academic
- Ljungman P, "Definition of cytomegalovirus infection and disease in transplant recipients", Clin Infect Dis, 34, pp.1094~1097 (2002)
- Yoo JH, "Infectious complications and outcomes after allogeneic hematopoietic stem cell transplantation in Korea", Bone Marrow Transplant, 34, pp.497~504 (2004)
- Auner HW, "Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma", Ann Hematol, 81, pp.374~377 (2002)
- Busca A, "Infectious complications following nonmyeloablative allogeneic hematopoietic stem cell transplantation", Transpl Infect Dis, 5, pp.132~139 (2003)
- Leather HL, "Infections following hematopoietic stem cell transplantation", Infect Dis Clin North Am, 15, pp.483~520 (2001)
- Tabbara IA, "Allogeneic hematopoietic stem cell transplantation: complications and results", Arch Intern Med, 162, pp.1558~1566 (2002)
- Dykewicz CA, "Preventing opportunistic infections in bone marrow transplant recipients", Transpl Infect Dis, 1, pp.40~49 (1999)
- Einsele H, "Infectious complications after allogeneic stem cell transplantation: epidemiology and interventional therapy strategies--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)", Ann Hematol, 82(Suppl 2), pp.175~185 (2003)
- Sullivan KM, "Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines and beyond", Hematology Am Soc Hematol Educ Program, pp.392~421 (2001)
- Cordonnier C, "Mycobacterial infection: a difficult and late diagnosis in stem cell transplant recipients", Clin Infect Dis, 38, pp.1229~1236 (2004)
- Lee J, "Tuberculosis in hematopoietic stem cell transplant recipients in Korea", Int J Hematol, 79, pp.185~188 (2004)
- "질병관리본부"[URL]
- Ljungman, P, "Treatment of adenovirus infections in the immunocompromised host", Eur J Clin Microbiol Infect Dis, 23, pp.583~588 (2004)
- "Report on state of the art in blood and marrow tranplantation -Part I of the IBMTR/ABMTR summary slides with guide. IBMTR/ABMTR newsletter 10: 7-10" (2003)[URL]