COPD 급성악화 시 항생제 사용의 임상적 지표와 검사실 지표의 병용

COPD 급성악화의 외래환자에서 시행된 항생제와 대조군의 비교연구²⁹에서 대조군의 특징만 보면, type 1 환자의 CRP는 42 mg/L, type 2는 22 mg/L, type 3는 21 mg/L였다³². Type 1의 치료실패율은 33.3%, 가래 화농성이 있는 type 2와 type 3의 치료실패율은 20.3%이었지만, 화농성 가래가 없는 경우 type 2와 type 3의 치료실패율은 5.6%였 다. 항생제를 사용하지 않은 대조군의 치료실패 예측인자는 CRP 상승(≥40 mg/L)과 가래 화농성이었다. 또한 대조군 의 치료 실패율은 CRP 상승과 화농성 가래가 있는 경우 64%, CRP 상승만 있고 화농성 가래가 없는 경우는 26%, CRP ＜40 mg/L와 화농성 가래는 12%, CRP ＜40 mg/L와 가래 화농성 없는 경우는 2.7%로 급성악화의 외래환자에게 CRP 상승과 가래 화농성이 없다면 항생제 처방이 필요하지 않으며, CRP와 Anthonisen 분류를 병용하는 것이 세균성 악화를 구별하고, 비세균성 악화에서 항생제 처방 없이 급성악화를 치료할 수 있는 쉽고 간편한 지표임을 제시하였다³².

7. 결론

COPD 세균성 악화 시 항생제는 반드시 필요하며, 비세균성 악화 시 항생제 투여는 항생제 오남용, 내성균 발생, 부작용 증가, 의료비용 증가를 유발하므로, 세균성 악화를 명확하게 구별하여 항생제를 투여하는 것이 효과적인 치료를 위해 중요하겠다. 진료현장에서는 COPD 지침서에 근거한 항생제 처방을 위한 노력이 필요하며, 이를 위해서 는 객관적이고 사용하기 쉬운 임상적, 검사실 지표가 필요하다. 현재까지는 COPD 급성악화 시 가래색의 변화, 가래 화농성뿐만 아니라, CRP 변화 등을 병용한다면 세균성 악화를 구별하는데 유용할 것으로 보이지만, 쉽고, 간편하고, 빠르고, 객관적이고, 정확한 생체표지자에 대한 추가 연구가 필요하겠다.

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