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메티실린 저항성에 따른 황색포도알균 각막염에 대한 임상분석

Clinical Analysis of Staphylococcus aureus Keratitis according to Methicillin-resistance

이상범|안장환
대한안과학회 (The Korean Ophthalmological Society)|2017.08|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제58권 제8호|pp. 885-895

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Methicillin-resistantClinical outcomeAntibiotics susceptibilityMethicillin-sensitiveStaphylococcus aureus keratitis
주제분류안과학

초록

목적: 황색포도알균 각막염에서 메티실린 저항성과 감수성 균주 간의 임상양상과 항생제감수성, 치료성적을 비교해보고자 하였다. 대상과 방법: 1998년부터 2014년까지 황색포도알균 각막염으로 진단받고 2개월 이상 추적 관찰했던 46명 환자의 의무기록을 후향적으로 분석하였다. Methicillin-resistant Staphylococcus aureus (MRSA)와 methicillin-sensitive Staphylococcus aureus (MSSA) 두 군으로 나누어 역학적 특성과 선행요인, 초기 임상양상, 항생제감수성, 치료성적을 비교 분석하였고 로지스틱 회귀분석을 통해 시력호전불량 위험인자를 확인하였다. 결과: 전체 46안 중 MRSA는 15안(33%), MSSA는 31안(67%)이었다. 남자(61%)와 60세 이상(48%)에서 흔했고, 선행요인으로 안구표면질환/안수술력과 외상이 많았다. MRSA 감수성은 vancomycin (100%)에서 높았고, oxacillin (0%)과 gentamicin (13.3%), trimethoprim/ sulfamethoxazole (53.3%)에서 낮았다. Fluoroquinolone은 81.3% (MRSA 64.3%, MSSA 94.4%; p=0.064)의 감수성을 보였다. 초기 임상소견은 두 군 간에 유의한 차이가 없었다. 교정시력 0.5 이상의 비율은 초진 시 24.4%에서 치료 후 44.4%로 유의하게 증가하였다(p=0.046). 시력과 합병증, 수술 여부를 종합한 치료성적은 두 군 간에 유의한 차이가 없었다. 시력호전불량 위험인자는 전체 군에서 초진 교정시력 0.1 미만(p=0.033)이 확인되었다. 결론: 황색포도알균 각막염 중 MRSA는 33%를 차지하였다. 치료 후 교정시력 0.5 이상의 비율은 전체 안에서 증가하였다. 두 군 간에 항생제감수성을 제외한 역학적 특성과 선행요인, 초기 임상양상, 치료성적 등은 유의한 차이가 없었다. 메티실린 저항성뿐만 아니라 임상 경과에 영향을 미치는 여러 요소를 종합적으로 고려한 치료 접근이 바람직할 것으로 생각된다.

Abstract

Purpose: This study analyzed clinical characteristics of Staphylococcus aureus keratitis according to methicillin-resistance. Methods: The authors performed a retrospective chart review of 46 isolates in 46 eyes with Staphylococcus aureus keratitis that were followed up for more than 2 months between January 1998 and December 2014. Comparative analyses of the epidemiology, predisposing factors, initial clinical manifestations, antibiotics susceptibility and clinical outcome between methicillin-resistant Staphylococcus aureus (MRSA) keratitis and methicillin-sensitive Staphylococcus aureus (MSSA) keratitis were performed. Risk factors of poor visual outcome were analyzed using logistic regression analysis. Results: Among 46 eyes, MRSA was present in 15 eyes (33%) and MSSA in 31 eyes (67%). Male (61%) and older than 60 year-old group (48%) were common. Ocular surface disease/ocular surgery history and trauma were more common as a predisposing factor. Vancomycin was 100% sensitive to both the MRSA and MSSA groups. Antibiotics susceptibility to MRSA was significantly low in the oxacillin (0%), gentamicin (13.3%) and trimethoprim/sulfamethoxazole (53.3%) groups. Sensitivity to fluoroquinolone was 81.3% (MRSA 64.3% vs. MSSA 94.4%; p = 0.064). There were no differences in early corneal findings between the groups. The ratio of BCVA 0.5 or more was 24.4% initially and increased to 44.4% after treatment among all eyes (p = 0.046). Risk factors for poor visual outcomes included a BCVA less than 0.1 at initial evaluation (p = 0.033). Conclusions: Among eyes with Staphylococcus aureus keratitis, 33% were MRSA. The ratio of BCVA 0.5 or more increased after treatment among all eyes. There were no differences between MRSA and MSSA eyes in terms of epidemiology, predisposing factors, initial clinical manifestations or clinical outcome, except for antibiotic susceptibility. For positive patient outcomes, a treatment approach considering methicillin-resistance as well as various factors affecting clinical course is recommended.

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