The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Change of Clostridium difficile Colitis during Recent 10 Years in Korea

최근 10년간 Clostridium difficile 대장염의 임상 양상 변화

Lee, Yun-Jeong;Choe, Myeong-Gyu;Im, Cheol-Hyeon;Jeong, Ung-Ryong;Jo, Hyeon-Seon;Seong, Hye-Yeong;Nam, Gwan-U;Jang, Jae-Hyeok;Jo, Yu-Gyeong;Park, Jae-Myeong;Kim, Sang-U;Jeong, In-Sik
이윤정;최명규;임철현;정웅룡;조현선;성혜영;남관우;장재혁;조유경;박재명;김상우;정인식

  • Published : 20100000
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Abstract

Background/Aims: Our clinical experience and recent published literatures suggest that Clostridium difficile colitis (CDC) has become more common and potentially more pathogenic in recent years. The aim of study was to evaluate changes in the epidemiological features of CDC in hospitalized patients in Korea. Methods: We retrospectively reviewed all patients of CDC diagnosed at Kangnam St. Mary Hospital from 1998 to 2007. CDC was defined as having a positive C. difficile cytotoxicity assay, or endoscopic or pathologic evidence of CDC. Results: A total of 189 cases (male 73, female 116, mean age 63.3 years) of CDC were diagnosed during the study period. The prevalence of CDC increased from 1.9/10,000 patient admissions in 1998-1999 to 8.82/10,000 patient admissions in 2006-2007. One hundred sixty three indication for cases (86.2%) of patients identified a prior use of antibiotics in the 2 months preceding diagnosis. The most common antibiotic use was prophylactic use during perioperational period (33.3%) followed by pneumonia (23.3%). The overall response rate to initial antibiotics was 82.7%. One hundred seventy two (91%) patients were initially treated with metronidazole. The response rate was 84.3%. All patients with initial failure to metronidazole were successfully treated by vancomycin. The response rate of vancomycin as first treatment was 80%. Three deaths were associated with CDC despite the use of combinationof metronidazole and vancomycin. Conclusions: The prevalence of CDC in hospitalized patients in Korea significantly increased from 1998 to 2007.

목적: 최근 수년간의 임상 경험과 최근 발표들은 Clostridium difficile 대장염(CDC)이 더욱 흔해지고 병인성이 강해짐을 시사한다. 이 연구의 목적은 한국에서 입원 환자의 CDC의 역학적인 특징 변화를 조사하는 것이다. 대상 및 방법: 1998년 1월부터 2007년 12월까지 강남성모병원에서 CDC로 진단받은 환자를 전향 조사했다. Clostridium difficile 세포독성검사에서 양성이거나 내시경 또는 병리 증거가 존재할 경우 CDC로 정의했다. 결과: 연구 기간 동안 총 189명(남자 73명, 여자 116명)이 CDC로 진단되었다. 평균 연령은 63.3세였다. 65세 초과 환자는 103명(54.4%)이었다. 1998년부터 2007년까지 CDC의 유병률은 유의하게 증가했다. CDC의 유병률은 1997-1998년 입원환자 10,000명당 1.9명에서 2006-2007년 입원환자 10,000명당 8.82명으로 증가했다. 163건(86.2%)에서 진단 2개월 이내에 항생제 사용을 확인했다. 사용한 항생제는 평균 2.1종류였고 항생제 사용 기간은 평균 18.8일(1-240일)이었다. Cephalosporin이 가장 많은 131명(80.4%)에서 투여되었고, 다음으로 aminoglycoside는 85명(52.1%), fluoroquinolone은 24명(14.7%), macrolide는 20명(12.3%) 순으로 사용되었다. 가장 많은 항생제 사용 원인으로 수술 전후 예방적 투여(33.3%)와 폐렴(23.3%)이었다. CDC에 대한 초기 항생제 치료 반응률은 82.7% (153/ 184)였다. Metronidazole에 대한 반응률은 84.3% (145/172)였다. Metronidazole 초치료에 실패한 모든 환자는 vancomycin으로 성공적으로 치료되었다. Vancomycin으로 1차 치료 시 반응률은 80% (4/5)였다. 3명의 환자가 metronidazole과 vancomycin 복합 치료에도 불구하고 CDC와 관련하여 사망했다. 결론: 1998년부터 2007년까지 한국에서 입원 환자의 CDC 유병률이 유의하게 증가했다.

Keywords

References

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