[논문]신생아 집중치료실에서 침습 칸디다 감염의 예방

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doi:10.14776/kjpid.2011.18.1.15

[국내논문] 신생아 집중치료실에서 침습 칸디다 감염의 예방
Prevention of Invasive Candida Infections in the Neonatal Intensive Care Unit 원문보기

소아감염 = Korean journal of pediatric infectious diseases, v.18 no.1, 2011년, pp.15 - 22

Abstract ▼ AI-Helper

Invasive Candida infections (ICI) have become the third most common cause of late-onset infection among premature infants in the neonatal intensive care unit (NICU). Risk factors include birth weight less than 1,000 g, exposure to more than two antimicrobials, third generation cephalosporin exposure, parenteral nutrition including lipid emulsion, central venous catheter, and abdominal surgery. Candida colonization of the skin and gastrointestinal tract is an important first step in the pathogenesis of invasive disease. Strict infection control measures against the infection should be done in the NICU. The following practices are likely to contribute to reducing the rate of ICI: (1) restriction of broad-spectrum antibiotics, antacids and steroid; (2) introduction of early feeding and promoting breast milk. Fluconazole prophylaxis may be an effective control measure to prevent Candida colonization and infections in individual units with high incidence of fungal infection. In addition, there is a need of further data including the development of resistant strains and the effect on long-term neurodevelopmental outcomes of infants exposed to drugs before the initiation of routine application of antifungal prophylaxis in the NICU.

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문제 정의

저자는 NICU에서 병원감염으로 흔히 발생하는 침습칸디다 감염의 예방을 위한 일반적인 조치 및 항진균제예방요법에 대해서 최근에 이루어진 연구를 중심으로 알아보고자 한다.

성능/효과

다기관연구에 따르면 의료 종사자의 손에서 채취한 검체의 29 %에서 칸디다 집락형성이 관찰된다고 한다22). 균주에따른 빈도는 손 검체의 19%에서 C. parapsilosis가 검출되었고, 5%에서 C. albicans, 2%에서 C. lusitaniae, 1%에서 C. guilliermondii, 1% 미만에서 C. glabrata와 C. tropicaE 검출되는 양상이었다. 칸디다는 근무자의 손을 통해서 소량의 포자만으로 NICU 내 수평 전파가 가능하므로 의료 종사자는 환아 접촉 전후에 철저한손씻기와 적절한 무균 장갑의 착용을 실행해야 한다23).
메타 분석에 따르면 ELBWI에서 fluconazole 예방요법이 침습 칸디다 감염을 약 88% 감소시키는데 비해 nystatin 요법은 약 55% 줄이는 효과가 있는 것으로 추정된다. 26).

후속연구

이러한 조치는 개별 NICU에서 azoles 내성 균주의 집락형성을 억제하고 fluconazole에 대한 칸디다의 노출기간을 제한함으로써 내성 균주의 출현을 억제하는데 도움이 된다42). Cochrane 자료에 따르면 VLBWI에서 fluconazole 예방요법은 침습 칸디다 감염을 줄이는 것으로 나타났으나 (비교 위험도: 0.23; 95% 신뢰 구간: 0.11-0.46)43), 예방요법 후 아기의 신경 발달에 대한 영향이나 내성균 출현 등에 관한 대규모의 추가 연구가 필요한 실정이다.
칸디다 감염의 빈도가 높은 개별 NICU에서 fluconazole 예방요법은 집락형성과 침습감염을 줄이는데 효과적이며 3㎎/㎏/dose, 주 2회, 생후 4-6주 또는 정맥도관이 필요한 시점까지 투여하는 방법이 추천된다4). 부가적으로 항진균 예방요법의 일상 적용에 앞서 객관적 자료를 얻기 위한 대규모의 추가적 연구가 필요하며, 내성균주의 출현이나 약물 투여를 받은 아기의 신경발달에 대한 장기적 영향 등에 대한 조사가 포함되어야 한다.

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저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

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용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

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