신생아 패혈증의 원인 병원체에 대한 조사

박용훈,김경아,신손문,문한구 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.1

전국의 신생아 수련 병원에 설문지를 보내어 각 병원의 1997년 1월부터 12월까지 출생한 신생아 중 패혈증으로 진단되고 혈액 배양 검사에서 균이 검출된 경우, 병록지를 통해 후향적 조사를 실시하였고, 37개 병원에서 참여해 34.9%의 응답율을 나타내었으며, 결과는 다음과 같다. 1) 신생아 패혈증의 발생빈도는 평균 0.73%(0~2.95%)였고, 남녀 비는 1.15:1이었다. 2) 신생아 패혈증의 원인균은 candida류를 포함하여 64종의 균이 검출되었다. 가장 흔한 원인균은 S. aureus였고, S. epidermidis, CONS의 순으로 많았다. 3) 조기 신생아 패혈증의 가장 흔한 원인균은 S. aureus였으며 CONS와 S. epidermidis가 그 다음으로 많았다. 후기 신생아 패혈증도 S. aureus가 가장 많이 검출되었고, S. epidermidis, CONS의 순으로 많았다. 4) 신생아 패혈증에 관련된 산모의 위험 인자는 조기 파수가 104명(21.8%)으로 가장 많았고, 그외에 난산, 태아의 빈맥, 융모양막염, 산모감염의 순이었다. 5) 신생아 패혈증과 연관된 국소 감염의 분포는 73명(26.1%)의 환아에서 폐렴이 동반되어 가장 많은 빈도를 보였고, 요로 감염, 뇌막염, 관절염의 순으로 많았다. 6) 신생아의 병원내 감염의 가장 흔한 원인균으로는 S. epidermidis가 가장 많았고, S. aureus, Entero-bacter의 순이었다. 7) 도관과 관련된 신생아 패혈증의 원인균은, S. aureus,가 가장 많았고, S. epidermidis, Enterobacter의 순으로 많았다. Candida는 8례에서 발견되었다. 8) 그람 양성균이 항생제에 대한 반응검사에서 Penicillin이나 oxacillin에 대해 S. aureus, S. epidermidis, CONS 모두 30% 이하의 감수성을 보였다. Vacomycin에 대해서는 S. aureus, CONS, Enterococcus 각각 1례에서 내성을 나타내었다. 9) 그람 음성균의 항생제에 대한 반응검사에서 Gentamicin에 대해서 60% 정도의 감수성을 나타내었고, amikacin에 대해서는 80% 이상의 감수성을 보였다. Piperacillin과 aztreonam에 대해서 Pseudomonas가 100%의 감수성, ticarcillin에 대해서는 Klebsiella가 100%의 감수성을 나타내었다. A nationwide survey was conducted to investigate the annual occurrence rate of neonatal sepsis, maternal risk factors in neonatal sepsis, localized infection in neonates, causative organisms in nosocomial infection and the most common causative organism for neonatal sepsis in Korea. Clinical and bacteriological data were collected from 37 neonatal units to perform retrospective review of the medical records of the newborn infants who were confirmed as having neonatal sepsis and whose blood culture was collected to isolate organisms for one year study period from January to December in 1997. 78,463 neonates were born at 37 hospital in 1997, and 20,869 neonates were admitted to the neonatal units. During this period, 772 episodes of neonatal sepsis were recorded in 517 neonates. The occurrence rate of neonatal sepsis was 0.73%(0∼2.95%). Male to female ratio was 1.15:1, and 303 cases(42.1%) were born prematurely. The main pathogens of early onset of sepsis were S. aureus(20%), S. epidermidis(14.4%) and coagulase negative staphylococcus(14.4%). Gram negative bacilli including Enterobacter spp (7.2%), E. coli(5.1%), Klepstella(4.5%), Pseudomonas(3.7%) and Enterobacter faectum(3.6%) accounted for 24.1% of sepsis. Group B beta-hemolytic streptococcus were isolated only in two cases. Common obstetric factors were PROM(21.1%), difficulty delivery(18.7%), fetal tachycardia(5.3%), chorioamnionitis(4.9%), and maternal fever(4.7%). The main pathogens of late-onset sepsis were S. aureus(22.3%), S. epidermidis(20.4%) and CONS(9.9%). There were 6 cases (1.0%) of Candida sepsis. Frequent focal infections accompanying sepsis were pneumonia(26.1%), urinary tract infection(10.5%), meningitis(8.2%), and arthritis(3.6%). S. epidermidia(22.0%) and s. aureus(21.7%) were also the most common pathogens in 373 nosocomial infection.

Positive Maternal C-Reactive Protein Predicts Neonatal Sepsis

전지현,남궁란,박민수,박국인,이철 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.1

Purpose: To evaluate the diagnostic performance of maternal inflammatory marker:C-reactive protein (CRP) in predicting early onset neonatal sepsis (that occurring within 72 hours after birth). Materials and Methods: 126 low birth weight newborns (gestation 32±3.2 wk, birth weight 1887±623 g) and their mothers were included. Neonates were divided into sepsis group (n=51) including both proven (positive blood culture) and suspected (negative blood culture but with more than 3 abnormal clinical signs), and controls (n=75). Mothers were subgrouped into CRP positive ≥1.22 mg/dL (n=48) and CRP negative <1.22 mg/dL (n=78) group, determined by Receiver Operating Characteristic curves, and odds ratio was calculated for neonatal sepsis according to maternal condition. Results: Maternal CRP was significantly higher in neonatal sepsis group than in control (3.55±2.69 vs. 0.48±0.31 mg/dL, p=0.0001). Maternal CRP (cutoff value >1.22 mg/dL) had sensitivity 71% and specificity 84% for predicting neonatal sepsis. Maternal CRP positive group had more neonatal sepsis than CRP negative group (71% vs. 29%, p<0.001). Odds ratio of neonatal sepsis in maternal CRP positive group versus CRP negative group was 10.68 (95% confidence interval: 4.313-26.428, p<0.001). Conclusion: The risk of early onset neonatal sepsis significantly increased in the case of positive maternal CRP (≥1.22 mg/dL). In newborn of CRP positive mother,the clinician may be alerted to earlier evaluation for possible neonatal infection prior to development of sepsis.

Neonatal sepsis-causing bacterial pathogens and outcome of trends of their antimicrobial susceptibility a 20-year period at a neonatal intensive care unit

Song Woo Sun,Park Hye Won,Oh Moon Youn,Jo Jae Young,Kim Chae Young,Lee Jung Ju,Jung Euiseok,Lee Byong Sop,Kim Ki-Soo,Kim Ellen Ai-Rhan 대한소아청소년과학회 2022 Clinical and Experimental Pediatrics (CEP) Vol.65 No.7

Background: Due to increases in the number of infants born with younger gestational age (GA) and lower birth weight, the incidence of neonatal sepsis is increasing. We investigated the changes in the prevalence of bacterial pathogens, their antimicrobial susceptibility, and sepsis-related mortality during 20 years at a neonatal intensive care unit.Purpose: We investigated the changes in the prevalence of bacterial pathogens, their antimicrobial susceptibility, and sepsis-related mortality during 20 years at a neonatal intensive care unit.Methods: The study period was divided into two 10-year phases (1998–2007 vs. 2008–2017). Medical records were reviewed to gather data on demographics, causative microbial pathogens, incidence of multidrug-resistant organisms, antimicrobial susceptibility, and rates of sepsis-related mortality.Results: In both study phases, the most common pathogens for neonatal sepsis were coagulase-negative <i>Staphylococcus</i> (CoNS) (28.6%) and <i>Enterobacter cloacae</i> (16.1%) for early-onset sepsis (EOS, ≤72 hours after birth) and CoNS (54.7%) and <i>Staphylococcus aureus</i> (12.9%) for late-onset sepsis (LOS, >72 hours after birth). CoNS and <i>S. aureus</i> showed 100% sensitivity to vancomycin in both phases. The susceptibility of <i>S. aureus</i> to oxacillin increased from 19.2% to 57.9% in phase II than phase I. <i>K. pneumonia</i> and <i>E. cloacae</i> showed increases in its susceptibility to gentamicin, cefotaxime and ceftriaxone in phase II than phase I. In both phases, the most common pathogens that caused sepsis-related death were <i>K. pneumoniae</i> (18.2%) and <i>Pseudomonas aeruginosa</i> (13.6%). Sepsis-related mortality rate was higher in infants with GA <37 weeks than those with GA over 37 weeks (<i>P</i>=0.016). In addition, the mortality rate of neonatal sepsis caused by gram-negative bacteria was significantly higher than that caused by gram-positive bacteria (<i>P</i><0.001).Conclusions: CoNS was the most common pathogen for EOS and LOS. While we found significant changes in antimicrobial sensitivities over time. GA below 37 weeks and gram-negative organisms are associated with mortality rate.

단일 신생아중환자실에서 경험한 10년간의 신생아 패혈증의 원인균 및 항생제 감수성 변화

박혜원,구소은,이병섭,김기수,피수영,김애란,임진아 대한신생아학회 2009 Neonatal medicine Vol.16 No.2

Purpose : To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. Methods : We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. Results : Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late- onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. Conclusion : The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.

비타민 D 농도와 신생아 조기 패혈증의 연관성에 대한 체계적 문헌고찰 및 메타분석

이소연,김하은,안숙희 한국임상약학회 2018 한국임상약학회지 Vol.28 No.1

Background: Vitamin D has been associated with sepsis in pediatric and adult patients. The association with neonates is unclear. This systematic review and meta-analysis examined the effect of neonatal and maternal vitamin D levels on neonatal early-onset sepsis. Methods: We searched studies published up to November 2017 in PubMed/Medline, Embase, and the Cochrane Library databases. All studies that reported 25-hydroxyvitamin D levels in neonates with or without early-onset sepsis were included. Meta-analysis was performed using RevMan 5.3 software. Results: Four studies were eligible. The weighted mean difference of 25-hydroxyvitamin D levels in neonates with early-onset sepsis and controls was -7.27 ng/mL (95% confidence interval = -7.62, 6.92). Maternal vitamin D levels in neonates with early-onset sepsis were significantly lower than those in controls (weighted mean difference -7.24 ng/mL, 95% confidence interval -8.45, -6.03). All neonates with early onset sepsis had vitamin D deficiency (25hydroxyvitamin D <20 ng/mL). Conclusion: Lower neonatal and maternal 25-hydroxyvitamin D levels were associated with neonatal early-onset sepsis. Vitamin D supplementation during pregnancy may be helpful to prevent neonatal early-onset sepsis. The effects of vitamin D supplementation on early-onset sepsis in neonates warrant further study.

신생아 패혈증의 조기진단을 위한 interleukin-6와 C-반응 단백 검사의 유용성

김천수 한국모자보건학회 2005 한국모자보건학회지 Vol.9 No.2

Objectives : Neonatal sepsis remains a major cause of mortality in newborn infants. This study was undertaken to seach for parameters with interleukin-6(IL-6) and C-reactive protein(CRP) that could be helpful in the early diagnosis of neonatal sepsis. Methods : Twenty one newborns with sepsis whose duration in the clinical symptoms was less than 24 hours after onset of infection were compared with 20 neonates who were ruled out infection as control. Serum IL-6 were sequentially checked using enzyme immunoassay kit on day 0 and 2. Also, CRP were sequentially checked by nephelometry on day 0, 2 and 10. Results : Between sepsis and control group, demographic characteristics such as gestational age and birth weight were similar distribution. The common pathogens of sepsis in 21 patients were S. aureus(29%) and others such as C. albicans, K. pneumoniae, S. epidermidis, S. agalactiae etc. Level of IL-6 on day 0(150±158pg/mL) was significantly higher than day 2(34±27pg/mL) in the sepsis group(p<0.005). Also, level of IL-6 on both day 0 and 2 in the sepsis group was significantly higher than the control group(p<0.001).Level of CRP on day 2(4.2±3.6㎎/dL) was significantly higher than day 0(1.4±1.6㎎/dL) in the sepsis group(p<0.005). Also, level of CRP on both day 0 and 2 in the sepsis group was significantly higher than the control group(p<0.005) and level on day 10 was significantly lower with clinical improvement of sepsis than day 2(p<0.001). IL-6 was superior to CRP on day 0, but CRP was superior to IL-6 on day 2 in the diagnostic validity, and combined use of IL-6 and CRP showed the most sensitivity and negative predictive value. Conclusions : Serum IL-6 value is a sensitive parameter for diagnosis of neonatal sepsis at the early phase. Also, the combination and IL-6 and CRP considers to be a effective method for the early diagnosis.

Comparison of the accuracy of neutrophil CD64 and C-reactive protein as a single test for the early detection of neonatal sepsis

Choo, Young-Kwang,Cho, Hyun-Seok,Seo, In-Bum,Lee, Hyeon-Soo The Korean Pediatric Society 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.1

Purpose: Early identification of neonatal sepsis is a global issue because of limitations in diagnostic procedures. The objective of this study was to compare the diagnostic accuracy of neutrophil CD64 and C-reactive protein (CRP) as a single test for the early detection of neonatal sepsis. Methods: A prospective study enrolled newborns with documented sepsis (n=11), clinical sepsis (n=12) and control newborns (n=14). CRP, neutrophil CD64, complete blood counts and blood culture were taken at the time of the suspected sepsis for the documented or clinical group and at the time of venipuncture for laboratory tests in control newborns. Neutrophil CD64 was analyzed by flow cytometry. Results: CD64 was significantly elevated in the groups with documented or clinical sepsis, whereas CRP was not significantly increased compared with controls. For documented sepsis, CD64 and CRP had a sensitivity of 91% and 9%, a specificity of 83% and 83%, a positive predictive value of 83% and 33% and a negative predictive value of 91% and 50%, respectively, with a cutoff value of 3.0 mg/dL for CD64 and 1.0 mg/dL for CRP. The area under the receiver-operating characteristic curves for CD64 index and CRP were 0.955 and 0.527 ($P$ <0.01), respectively. Conclusion: These preliminary data show that diagnostic accuracy of CD64 is superior to CRP when measured at the time of suspected sepsis, which implies that CD64 is a more reliable marker for the early identification of neonatal sepsis as a single determination compared with CRP.

Comparison of the accuracy of neutrophil CD64 and C-reactive protein as a single test for the early detection of neonatal sepsis

Young Kwang Choo,Hyun-Seok Cho,서인범,이현수 대한소아청소년과학회 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.1

Purpose: Early identification of neonatal sepsis is a global issue because of limitations in diagnostic procedures. The objective of this study was to compare the diagnostic accuracy of neutrophil CD64 and C-reactive protein (CRP) as a single test for the early detection of neonatal sepsis. Methods: A prospective study enrolled newborns with documented sepsis (n=11), clinical sepsis (n=12) and control newborns (n=14). CRP,neutrophil CD64, complete blood counts and blood culture were taken at the time of the suspected sepsis for the documented or clinical group and at the time of venipuncture for laboratory tests in control newborns. Neutrophil CD64 was analyzed by flow cytometry. Results: CD64 was significantly elevated in the groups with documented or clinical sepsis, whereas CRP was not significantly increased compared with controls. For documented sepsis, CD64 and CRP had a sensitivity of 91% and 9%, a specificity of 83% and 83%, a positive predictive value of 83% and 33% and a negative predictive value of 91% and 50%,respectively, with a cutoff value of 3.0 mg/dL for CD64 and 1.0 mg/dL for CRP. The area under the receiver-operating characteristic curves for CD64 index and CRP were 0.955 and 0.527 (P<0.01), respectively. Conclusion: These preliminary data show that diagnostic accuracy of CD64 is superior to CRP when measured at the time of suspected sepsis, which implies that CD64 is a more reliable marker for the early identification of neonatal sepsis as a single determination compared with CRP.

극소저출생체중아에서 신생아 패혈증의 원인균 및 항생제 감수성의 변화

김경남,박호진 대한신생아학회 2008 Neonatal medicine Vol.15 No.1

Purpose : To set up an appropriate treatment plan for neonatal sepsis by investigating changes in pathogens and antibiotic sensitivities. Methods : The medical records of very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) of the Eulji University Hospital between January 2000 and June 2006 were retrospectively reviewed. The culture reports were analyzed for causative microorganisms and antibiotic sensitivities. Results : Among 164 neonates, 19 neonates (11.6%) had 26 episodes of culture-proven sepsis. Very late onset sepsis was the most common type. The dominant pathogens of sepsis included Klebsiella pneumoniae, Streptococcus spp., coagulase negative Staphylococcus and Enterobacter spp., and were mostly multi-drug resistant. Conclusion : For the appropriate treatment of neonatal sepsis, proper use of antibiotics through the periodic review and understanding of changes of the microorganisms and antimicrobial sensitivities is necessary to prevent multi-drug resistant microorganisms and to avoid excessive use of broad-spectrum empiric antibiotics.

Disrupted Pathways Associated with Neonatal Sepsis: Combination of Protein-protein Interactions and Pathway Data

Xin Qiao,Silian Zhu,Shujiao Zhang,Hongmei Dong 한국바이오칩학회 2017 BioChip Journal Vol.11 No.1

To identify disrupted pathways associated with neonatal sepsis, we performed a research based on the combination of protein-protein interactions (PPIs) and pathway data. Firstly, a total of 23,292 genes, 787,896 PPIs and 1,675 human pathways were obtained, respectively. Then, under the threshold value of false discovery rate (FDR)<0.05 and a delta cut-off value >4.36, a total of 986 differentially expressed genes (DEGs) were identified. In the following, by degree centrality for the objective PPI network, 20 hub genes were obtained. Finally, pathway enrichment analysis and randomization tests indicated that pathways of gene expression, immune system and innate immune system were with remarkable significance in neonatal sepsis. Therefore, in the present study, we presented a novel pathway method, and we successfully identified several pathways in neonatal sepsis, which might be underlying indicators in the detection and treatment of neonatal sepsis.