입원 치료를 시행한 고령 감염각막염 환자의 원인균, 임상 양상 및 위험 인자
Analysis on Elderly Inpatients with Infectious Keratitis: Causative Organisms, Clinical Aspects, and Risk Factors
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목적: 입원치료를 시행한 감염각막염에서 60세 이상 환자군(I군)의 진단별 발생빈도, 미생물학적 특성, 임상적 양상 및 위험 인자가 60세 미만 환자군(II군)과 어떤 차이를 보이는지 알아보고자 하였다. 대상과 방법: 2004년 1월부터 2008년 12월까지 영남대학교병원 안과에 입원 치료한 감염각막염 255안(남/여: 158/97안, I/II: 116/139안) 의 의무기록을 후향적으로 조사하였다. 결과: 세균/진균/헤르페스 각막염의 비율은 I군 42/31/27%와 II군 74/8/17%로 나타나 구성비에서 I군에서 상대적으로 세균에 대한 진균 의 비율이 높았다(p＜0.001). 그람 양/음성균의 분포는 I군 43/30%, II군 48/46%로 I군에서 상대적으로 그람양성균의 비율이 높았다(p = 0.025). 그람양성균은 두 군 모두 표피포도알균(I/II: 9/10안), 그람음성균은 I군 엔테로박터 속(6안)과 II군 녹농균(9안), 진균은 두 군 모두 칸디다 속(6/2안)이 가장 흔히 동정되었다. I군에서 과거 안수술의 병력(I/II: 23/9%)과 고혈압(26/7%), 당뇨(17/7%), 1주 지나서 의 내원(43/16%), 초진시력 0.1 미만(54/32%), 전방축농(28/15%), 상피재생 시간(16/10일), 각막천공(18/5%), 수술치료(23/7%), 최종시 력 0.1 미만(36/14%) 등의 빈도가 유의하게 높아 임상양상이 나쁘고 치료성적이 불량하였다. 시력호전실패의 위험 인자로 I군에서 진균 각막염, II군에서 안수술 및 안표면 질환의 과거력으로 나타났다. 결론: 고령의 환자에서 감염각막염의 임상양상이 더 나쁘고 치료성적도 불량함을 고려하여, 초기부터 보다 정확한 감별 진단과 적절한 치료 선택을 위한 노력이 필요할 것이라 생각된다.
Abstract
Purpose: To investigate the difference of the epidemiological, microbiological, and clinical characteristics and risk factors of inpatients with infectious keratitis between an elderly group (group I ≥ 60 years) and a younger group (group II < 60 years). Methods: A retrospective chart review of 255 eyes (male/female: 158/97 eyes, I/II: 116/139 eyes) with infectious keratitis hospitalized at Yeungnam University Hospital between January 2004 and December 2008 was performed. Results: The proportion of bacterial/fungal/herpes viral keratitis was 42/31/27% in group I and 74/8/17% in group II. The proportion of fungal keratitis in relation to bacterial keratitis was higher in group I, as compared to group II (p < 0.001). The ratio of Gram-positive/negative bacteria was 43/30% in group I and 48/46% in group II. The proportion of Gram-positive bacteria in relation to Gram-negative bacteria was higher in group I, as compared to group II (p = 0.025). The most commonly isolated microorganisms were Staphylococcus epidermidis (I/II: 9/10 eyes) among Gram-positive bacteria, Enterobacter species (I: 6 eyes) and Pseudomonas aeruginosa (II: 9 eyes) among Gram-negative bacteria, and Candida species (I: 6 eyes, II: 2 eyes) among fungi. Clinical aspects and treatment outcomes, such as previous ocular surgery (I/II: 23/9%), hypertension (26/7%), diabetes mellitus (17/7%), presentation at our clinic after 1 week (43/16%), initial visual acuity less than 0.1 (54/32%), hypopyon (28/15%), epithelial healing time (16/10 days), corneal perforation (18/5%), operative treatment (23/7%), and final visual acuity less than 0.1 (36/14%) were statistically significantly poorer in group I, as compared to group II. Risk factors for unimproved visual outcomes included fungal keratitis in group I and previous ocular surgery and ocular surface disease in group II. Conclusions: Considering that clinical aspects and treatment outcomes are poor in elderly inpatients with infectious keratitis, special efforts are necessary for a more accurate differential diagnosis and appropriate early treatment to achieve successful treatment outcomes
참고문헌 (34)
- Thylefors B, "Global data on blindness", Bull World Health Organ, 73, pp.115~121 (1995)
- Chirambo MC, "Blindness and visual impairment in southern Malawi", Bull World Health Organ, 64, pp.567~572 (1986)
- Chirambo MC, "Causes of blindness among students in blind school institutions in a developing country", Br J Ophthalmol, 60, pp.665~668 (1976)
- Brilliant LB, "Epidemiology of blindness in Nepal", Bull World Health Organ, 63, pp.375~386 (1985)
- Gilbert CE, "Cause of childhood blindness in East Africa: results in 491 pupils attending 17 schools for the blind in Malawi, Kenya and Uganda", Ophthalmic Epidemiol, 2, pp.77~84 (1995)
- Ormerod LD, "Causes and management of bacterial keratitis in the elderly", Can J Ophthalmol, 24, pp.112~116 (1989)
- Kumimoto DY, "Corneal ulceration in the elderly in Hyderabad", South India. Br J Ophthalmol, 84, pp.54~59 (2000)
- Butler TK, "Infective keratitis in older patients: a 4 year review, 1998-2002", Br J Ophthalmol, 89, pp.591~596 (2005)
- Kim YS, "The causative organisms and therapy of corneal ulcers", J Korean Ophthalmol Soc, 35, pp.1171~1177 (1994)
- Ahn M, "A clinical study on infectious corneal ulcer", J Korean Ophthalmol Soc, 37, pp.1538~1543 (1996)
- 한영호, "감염성 각막염의 역학조사(II): 다병원연구", 대한안과학회지, 42(2), pp.247~265 (2001), 대한안과학회
- Biemer JJ, "Antimicrobial susceptibility testing by the Kirby-Bauer disc diffusion method", Ann Clin Lab Sci, 3, pp.135~140 (1973)
- O’DAY DM, "Selection of appropriate antifungal therapy", Cornea, 6, pp.238~245 (1987)
- Thomas PA, "Fungal infections of the cornea", Eye, 17, pp.852~862 (2003)
- Ormerod LD, "Epidemiology of microbial keratitis in southern California. A multivariate analysis", Ophthalmology, 94, pp.1322~1333 (1987)
- Gudmundsson OG, "Factors influencing predilection and outcome in bacterial keratitis", Cornea, 8, pp.115~121 (1989)
- Van der Meulen IJ, "Age related risk factors, culture outcomes, and prognosis in patients admitted with infectious keratitis to two dutch tertiary referral centers", Cornea, 27, pp.539~544 (2008)
- Parmar P, "Microbial keratitis at extremes of age", Cornea, 25, pp.153~158 (2006)
- Bourcier T, "Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases", Br J Ophthalmol, 87, pp.834~838 (2003)
- Schaefer F, "Bacterial keratitis: a prospective clinical and microbiological study", Br J Ophthalmol, 85, pp.842~847 (2001)
- Saha R, "Mycological profile of infectious keratitis from Delhi", Indian J Med Res, 123, pp.159~164 (2006)
- Bhartiya P, "Fungal keratitis in Melbourne", Clin Experiment Ophthalmol, 35, pp.124~130 (2007)
- Rodman RC, "The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic", Ophthalmology, 104, pp.1897~1901 (1997)
- McDonnell PJ, "Empirical or culture-guided therapy for microbial keratitis? A plea for data", Arch Ophthalmol, 114, pp.84~87 (1996)
- McLeod SD, "The role of smears, cultures, and antibiotic sensitivity testing in the management of suspected infectious keratitis", Ophthalmology, 103, pp.23~28 (1996)
- McDonnell PJ, "Community care of corneal ulcers", Am J Ophthalmol, 114, pp.531~538 (1992)
- Allan BD, "Strategies for the management of microbial keratitis", Br J Ophthalmol, 79, pp.777~786 (1995)
- Laspina F, "Epidemiological characteristics of microbiological results on patients with infectious corneal ulcers: a 13-year survey in Paraguay", Graefes Arch Clin Exp Ophthalmol, 242, pp.204~209 (2004)
- Srinivasan M, "Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India", Br J Ophthalmol, 81, pp.965~971 (1997)
- Green M, "Risk factors and causative organisms in mibrobial keratitis", Cornea, 27, pp.22~27 (2008)
- Weksler ME, "Senescence of the immune system", Med Clin North Am, 67, pp.263~272 (1983)
- 조상현, "안구제거술에 이르게 되는 각막궤양들의 위험인자 분석", 대한안과학회지, 49(1), pp.34~39 (2008), 대한안과학회
- 박주홍, "입원 치료를 시행한 감염각막염의 분석: 미생물학적 원인, 임상 양상 및 위험 인자", 대한안과학회지, 50(8), pp.1152~1166 (2009), 대한안과학회
- 김우진, "세균각막염의 예후인자 및 항생제 감수성 변화에 대한 8년간의 고찰", 대한안과학회지, 50(10), pp.1495~1504 (2009), 대한안과학회