소아 패혈증 원인균 및 항균제 감수성의 변화양상

Abstract

[한글]

[영문]

Sepsis remains the leading cause of death in pediatrics, despite improvements in supportive treatment modalities such as antimicrobial drugs and intensive care ventilation therapy. Further, the incidence of sepsis is projected to increase in years to come, related to factors including a rise in immunosuppressed patient populations and more widespread use of invasive lines and procedures.In this study, to determine the changing patterns of antibiotic sensitivity and causative organisms in pediatric sepsis, we examine the 665 cases from 1991 to 2000 at the department of pediatrics, Severance hospital, in Seoul, Korea, and the clinical aspects and culture study results were retrospectively analyzed.The main pathogens of sepsis were S. epidermidis(42.4%), S. aureus, S. viridans, E. coli, Enterobacter, Klebsiella. Frequent focal infections accompanying with sepsis were gastroenteritis(13.6%), pneumonia, urinary tract infection, and underlying diseases were hemato-oncologic disease(21.2%), prematurity, cardiovascular disease, neurologic disease in high incidence order. Gram positive organisms in sepsis were increased from 1991(57.9%) to 2000(77.6%), however gram negative organisms were decreased from 1991(42.1%) to 2000(22.4%). The rate of S. aureus in gram positive sepsis was decreased from 1991(42.1%) to 2000(8.9%), however the rate of S. epidermidis was increased 1991(5.2%) to 2000(47.8%). Penicillin sensitivity rate of gram positive organisms was decreased from 1991(25.8%) to 2000(7.2%), and gentamicin sensitivity rate of gram negative organisms was decreased from 1991(69.2%) to 2000(50.0%) also. Sensitivity rates of penicillin were below 10% in S. aureus, S. epidermidis, CONS, and sensitivity rates of gentamicin were 18.2% - 61.5% in gram negative organisms. The most common combination of antibiotics used in sepsis was ampicillin and gentamicin. Gram positive organisms and S. epidermidis were increased and antibiotic sensitivity rates were decreased in pediatric sepsis.