극소 저출생 체중아에서 병원 감염 패혈증의 위험인자
Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants
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목 적:병원 감염 패혈증에 취약한 극소 저출생 체중아에서 병원 감염 패혈증의 발생빈도, 위험인자 분석을 통해서 병원 감염 패혈증의 감소 방안을 모색하고자 하였다. 방 법:2002년 1월부터 2009년 6월까지 7년 6개월 동안 을지의과대학교 대전을지병원과 노원을지병원 신생아 중환자실에 입원한 출생체중 1,500 g 미만의 극소 저출생 체중아 중 출생후 72시간 이상 입원치료를 받았던 총 341명을 대상으로 의무기록을 후향적으로 분석하여, 병원 감염 패혈증의 발생빈도, 원인균, 위험인자, 결과 등을 조사하였다. 결 과:병원 감염 패혈증의 발생빈도는 16.1% 였고, 평균 발병시기는 21.5±15.9일이었으며, 원인균으로는 Staphylococcus aureus (21.3%), Klebsiella pneumoniae (14.7%), Coagulase negative staphylococcus (9.8%), Enterococcus spp. (9.8%) 순이었다. 위험인자의 다변량 분석에서 의미 있는 위험요인으로 재태기간(odds ratio [OR], 0.87; 95% CI, 0.83-0.91), 5일 이상 UAC를 삽입하는 경우(OR, 2.2; 95% CI, 1.15-4.46), 5일 이상 UVC를 삽입하는 경우(OR, 2.1; 95% CI, 1.11-4.16), 말초동맥관을 삽입하는 경우(OR, 2.1; 95% CI, 1.14-4.04), 정맥관 지방유제 투여(OR, 4.3; 95% CI, 1.13-14.32)로 나타났다. 결 론:극소 저출생 체중아의 병원 감염 패혈증을 줄이기 위해서는 제대관을 통한 카테터 삽입을 비롯한 침습적 시술을 최대한 줄이고, 정맥영양을 통한 영양공급을 최대한 단시간에 마치기 위한 방안을 모색해야 할 것으로 사료된다.
Abstract
Purpose:This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. Methods:A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. Results:The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5±15.9 days (mean±SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15- 4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3; 95% CI, 1.13-14.32) were identified as risk factors. Conclusion:The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.
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