본문 바로가기
KERD
논문KCI 등재

혈장응고효소 양성 여부에 따른 포도알균 각막염의 임상 분석

Clinical Analysis of Staphylococcus Keratitis According to Coagulase Positivity

이상범|조찬호|최남현
대한안과학회 (The Korean Ophthalmological Society)|2019.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제60권 제10호|pp. 935-945

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

StaphylococcusAntibiotic susceptibilityKeratitisCoagulase
주제분류안과학

초록

목적: 포도알균 각막염을 혈장응고효소 유무에 따라 두 군(coagulase negative Staphylococcus [CNS], coagulase positive Staphylococcus [CPS])으로 나누어 임상분석을 시행하였다. 대상과 방법: 영남대학교병원에서 20년간(1998-2017) 입원 치료한 감염각막염 환자 중 배양검사에서 포도알균이 동정된 138안(CNS 94안, CPS 44안)을 대상으로 두 군 간의 역학, 선행인자, 임상양상, 항생제 감수성 및 치료 결과를 비교 분석하였다. 불량한 임상결과는 최종교정시력 0.1 미만, 치료 후 시력저하, 합병증 발생, 수술 치료 중 하나 이상 해당되는 경우로 정의하였으며, 그 위험인자는 전체 군을 기준으로 다변량분석을 통해 분석하였다. 결과: 가장 흔한 선행인자로 CNS는 각막외상(47.9%), CPS는 안구표면질환(31.8%)이었다. 두 군 간의 평균 연령, 성별, 안구표면질환, 상피결손 크기 및 전방축농은 차이가 없었다. 메티실린 감수성은 CNS에서 유의하게 낮았으며(39.4%:72.7%, p<0.001), 불량한 임상결과는 CPS에서 다소 많았다(28.0%:43.9%, p=0.076). 불량한 임상결과의 유의한 위험인자는 초진시력 0.1 미만, 상피결손 5 mm2 이상, 10일 이상의 증상지속기간, 그리고 전방축농이었다. 결론: 두 군 간에 역학, 임상양상의 차이는 없었으며, 선행인자와 메티실린 감수성의 차이를 보였다. CNS보다 CPS에서 치료 결과가 다소 나빴지만 유의하지 않았다. 불량한 임상결과는 혈장응고효소 양성보다 긴 증상지속기간, 불량한 초진 임상양상과 더 관계 있었다.

Abstract

Purpose: To analyze clinical aspects in a cohort of patients with Staphylococcus keratitis according to coagulase positivity (coagulase negative Staphylococcus [CNS], coagulase positive Staphylococcus [CPS]). Methods: Epidemiology, predisposing factors, clinical characteristics, treatment outcomes, and antibiotic susceptibility were comparatively analyzed in 138 cases of culture-proven Staphylococcus keratitis (94 eyes with CNS and 44 eyes with CPS) over 20 years (1998-2017) at Yeungnam University Hospital. Poor clinical outcomes were defined as a final corrected visual acuity <0.1, a decreased visual acuity after treatment, complications, or surgical treatment. Risk factors for poor clinical outcomes were evaluated in the total cohort and analyzed using multivariate logistic regression. Results: The most common predisposing factors were corneal trauma in the CNS group (47.9%) and previous ocular surface disease in the CPS group (31.8%). No significant differences were observed in mean age, sex, previous ocular surface disease, epithelial defect size, and hypopyon between the two groups. Methicillin susceptibility (39.4% vs. 72.7%, p < 0.001) was significantly lower in the CNS group, and poor clinical outcomes (28.0% vs. 43.9%, p = 0.076) were more common in the CPS group. The significant risk factors for poor clinical outcomes were initial best-corrected visual acuity <0.1, epithelial defect size ≥ 5 mm2, symptom duration ≥10 days, and hypopyon. Conclusions: No significant differences were observed in epidemiological factors and initial clinical characteristics between the two study groups, but predisposing factors and methicillin susceptibility differed between the two groups. Treatment outcomes were relatively worse in the CPS group than in the CNS group, but the difference was not statistically significant. Poor clinical outcomes were more associated with long symptom duration and poor initial clinical characteristics than with coagulase positivity.

참고문헌 (45)

  1. Savini V., "Pet-to-man travelling staphylococci: a world in progress" (2018), Academic press
  2. Needham CA, "Incidence, adherence, and antibiotic resistance of coagulase-negative Staphylococcus species causing human disease", Diagn Microbiol Infect Dis, 2, pp.293~299 (1984)
  3. Huebner J, "Coagulase-negative staphylococci : role as pathogens", Annu Rev Med, 50, pp.223~236 (1999)
  4. Teterycz D, "Outcome of orthopedic implant infections due to different staphylococci", Int J Infect Dis, 14, pp.e913~918 (2010)
  5. Mukerji N, "Technique of area measurement of epithelial defects", Cornea, 22, pp.549~551 (2003)
  6. Thornsberry C, "NCCLS standards for antimicrobial susceptibility tests", Lab Med, 14, pp.549~553 (1983)
  7. Green MD, "Clinical outcomes of keratitis", Clin Exp Ophthalmol, 35, pp.421~426 (2007)
  8. Lichtinger A, "Shifting trends in bacterial keratitis in Toronto : an 11-year review", Ophthalmology, 119, pp.1785~1790 (2012)
  9. Orlans HO, "In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK : a 10-year review", Eye, 25, pp.489~493 (2011)
  10. Politis M, "Trends of bacterial keratitis culture isolates in Jerusalem; a 13- years analysis", PLoS One, 11, pp.e0165223~ (2016)
  11. Tewari A, "Epidemiological and microbiological profile of infective keratitis in Ahmedabad", Indian J Ophthalmol, 60, pp.267~272 (2012)
  12. Ng AL, "Predisposing factors, microbial characteristics, and clinical outcome of microbial keratitis in a tertiary centre in Hong Kong : a 10-year experience", J Ophthalmol, 2015, pp.769436~ (2015)
  13. Bourcier T, "Bacterial keratitis : predisposing factors, clinical and microbiological review of 300 cases", Br J Ophthalmol, 87, pp.834~838 (2003)
  14. Schaefer F, "Bacterial keratitis : a prospective clinical and microbiological study", Br J Ophthalmol, 85, pp.842~847 (2001)
  15. 장영식, "Staphylococcus epidermidis 각막염의 역학조사", 대한안과학회지, 43(4), pp.4~671 (2002), 대한안과학회
  16. Graham JE, "Ocular pathogen or commensal : a PCR-based study of surface bacterial flora in normal and dry eyes", Invest Ophthalmol Vis Sci, 48, pp.5616~5623 (2007)
  17. 정진구, "메티실린 감수성 표피포도알균(MSSE) 각막염과 메티실린 내성 표피포도알균(MRSE) 각막염의 비교 연구", 대한안과학회지, 52(8), pp.930~935 (2011), 대한안과학회
  18. Manikandan P, "Speciation of coagulase negative Staphylococcus causing bacterial keratitis", Indian J Ophthalmol, 53, pp.59~60 (2005)
  19. Ong SJ, "Staphylococcus aureus keratitis:a review of hospital cases", PLoS One, 8, pp.e80119~ (2013)
  20. 김부기, "표피포도알균 각막염의 임상양상과 예후", 대한안과학회지, 52(1), pp.14~22 (2011), 대한안과학회
  21. Kim DN, "The antimicrobial activity of lysozime against the microorganisms causing conjunctivitis and", or keratitis, 1997, pp.2, 85~90
  22. O'Callaghan RJ, "The pathogenesis of Staphylococcus aureus eye infections", Pathogens, 7 (2018)
  23. Wallang BS, "Ring infiltrate in staphylococcal keratitis", J Clin Microbiol, 51, pp.354~355 (2013)
  24. Saber H, "A review of Staphylococcal cassette chromosome mec(SCCmec)types in coagulase-negative staphylococci(CoNS)species", Malays J Med Sci, 24, pp.7~18 (2017)
  25. Vuong C, "Staphylococcus epidermidis infections", Microbes infect, 4, pp.481~489 (2002)
  26. Lowy FD, "Staphylococcus epidermidis infections", Ann Intern Med, 99, pp.834~839 (1983)
  27. Ekstedt RD, "Studies on staphylococci. II. Effect of coagulase on the virulence of coagulase negative strains", J Bacteriol, 80, pp.496~500 (1960)
  28. Wu PZ, "Comparison of potential pathogenic traits of staphylococci that may contribute to corneal ulceration and inflammation", Aust N Z J Ophthalmol, 27, pp.234~236 (1999)
  29. Dajcs JJ, "Corneal virulence of Staphylococcus aureus in an experimental model of keratitis", DNA Cell Biol, 21, pp.375~382 (2002)
  30. Murray PR, "Medical microbiology. Staphylococcus and related gram-positive cocci" (2015), Elsevier
  31. Kumar A, "Staphylococcus aureus protein A induced inflammatory response in human corneal epithelial cells", Biochem Biophys Res Commun, 354, pp.955~961 (2007)
  32. Rhem MN, "The collagen-binding adhesin is a virulence factor in Staphylococcus aureus keratitis", Infect Immun, 68, pp.3776~3779 (2000)
  33. Pinna A, "Identification and antibiotic susceptibility of coagulase negative staphylococci isolated in corneal", external infections, 1999, pp.83, 771~773
  34. 윤제환, "세균각막염 원인균주의 항생제 감수성과 초기 항생제 선택의 적절성", 대한안과학회지, 54(1), pp.38~45 (2013), 대한안과학회
  35. Goldstein MH, "Emerging fluoroquinolone resistance in bacterial keratitis : a 5-year review", Ophthalmology, 106, pp.1313~1318 (1999)
  36. Alexandrakis G, "Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones", Ophthalmology, 107, pp.1497~1502 (2000)
  37. Kowalski RP, "Gatifloxacin and moxifloxacin : an in vitro susceptibility comparison to levofloxacin, ciprofloxacin, and ofloxacin using bacterial keratitis isolates", Am J Ophthalmol, 136, pp.500~505 (2003)
  38. Afshari NA, "Trends in resistance to ciprofloxacin, cefazolin, and gentamicin in the treatment of bacterial keratitis", J Ocul Pharmacol Ther, 24, pp.217~223 (2008)
  39. Walvick MD, "Ophthalmic methicillin-resistant Staphylococcus aureus infections : sensitivity and resistance profiles of 234 isolates", J Community Health, 36, pp.1024~1026 (2011)
  40. Blanco AR, "Susceptibility of methicillin-resistant staphylococci clinical isolates to netilmicin and other antibiotics commonly used in ophthalmic therapy", Curr Eye Res, 38, pp.811~816 (2013)
  41. John JF, "History and evolution of antibiotic resistance in coagulase-negative staphylococci : Susceptibility profiles of new anti-staphylococcal agents", Ther Clin Risk Manag, 3, pp.1143~1152 (2007)
  42. Chavan SP, "Clinical and antimicrobial profile of coagulase negative staphylococci in a tertiary care hospital", Int J Res Med Sci, 5, pp.3420~3425 (2017)
  43. Nayak N, "Slime production as a virulence factor in Staphylococcus epidermidis isolated from bacterial keratitis", Indian J Med Res, 111, pp.6~10 (2000)
  44. Ahn M, "Clinical aspects and prognosis of mixed microbial(bacterial and fungal)keratitis", Cornea, 30, pp.409~413 (2011)
  45. Miedziak AI, "Risk factors in microbial keratitis leading to penetrating keratoplasty", Ophthalmology, 106, pp.1166~1170 (1999)

관련 논문AI추천

배양 양성 여부에 따른 세균각막염의 임상분석김도연, 이상범, 조찬호대한안과학회 · 대한안과학회지2019 · 제60권 제11호메티실린 저항성에 따른 황색포도알균 각막염에 대한 임상분석안장환, 이상범대한안과학회 · 대한안과학회지2017 · 제58권 제8호표피포도알균 각막염의 임상양상과 예후김부기, 유인천, 이동욱, 조남천대한안과학회 · 대한안과학회지2011 · 제52권 제1호국내 미생물 각막염의 10년 추세김은철, 김현승, 나경선, 박찬준, 변용수, 윤혜연, 이현수, 정소향, 조양경, 황형빈대한안과학회 · 대한안과학회지2024 · 제65권 제3호시력 결과가 불량하였던 세균각막염의 균주 분포와 임상 특징이상범, 임지남, 조찬호대한안과학회 · 대한안과학회지2022 · 제63권 제7호그람양성세균각막염에 대한 임상적, 미생물학적 분석: 15년 연구김미래, 이상범대한안과학회 · 대한안과학회지2014 · 제55권 제10호

이 간행물의 다른 논문 (14건)

라식수술 후 3% 디쿠아포솔나트륨 사용이 눈물막 안정성에 미치는 효과김종구, 최재호, 최태훈, 김세경, 최철명, 성 산, 김창환pp. 915-921발광다이오드 각막형태분석기와 샤임플러그 전안부사진기의 각막난시 및 각막고위수차 비교김다영, 김효원, 이로운, 하민지, 정소향pp. 922-928서로 다른 두 가지 스펙트랄 도메인 빛간섭단층촬영기를 이용한 눈물띠의 반복성과 재현성 비교전루민, 한경은, 김진하, 최규룡pp. 929-934펨토초레이저 백내장수술에서 활모양각막절개술 시행의 장기간 임상결과방찬우, 최재원, 한상엽pp. 946-9522형 미숙아망막병증의 발생 후 진행에 관련된 위험인자 분석장지웅, 한가희pp. 953-958
원문 보기