척수손상 환자의 요로감염 원인균과 항생제 감수성
Causative Organisms and Antimicrobial Susceptibility of Urinary Tract Infection of Spinal Cord Injured Patients
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목 적:척수손상 환자에서 요로감염의 흔한 원인균과 항생제 감수성을 조사하여 요로감염의 예방과 치료에 도움을 주고자 한다. 재료 및 방법:부산 척수장애 협회에 등록된 환자 중 이번 연구 참여에 동의한 34명에 대해 2006년 7월에 직접 방문하여 증상, 투약, 배뇨방법, 정기적인 외래 진료 유무 등에 관한 설문조사와 채뇨를 시행하였으며, 부산지역 4개 대학병원에서 2004년 1월부터 2005년 12월까지 요배양 및 항생제 감수성 검사를 시행한 적이 있는 척수손상 환자 111명의 의무 기록을 통해 배뇨방법, 정기적인 외래 진료 유무, 요로감염의 원인 균종 및 항생제 감수성을 조사하였다. 결 과:척수손상 환자의 요로감염 유병률은 48.3%로 나타났으며, 원인균주는 Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae 순으로 검출되었다. 그리고 항생제 감수성 검사에서 imipenem을 제외할 경우 Escherichia coli와 Klebsiella pneumoniae에서는 amikacin이, Pseudomonas aeruginosa에서는 ceftazidime이 가장 높게 분석되었고, ciprofloxacin에 대한 감수성은 감소하는 경향을 보였다. 결 론:요로감염에 대한 일차선택 약제로 감수성이 낮은 ciprofloxacin의 사용은 제한하는 것이 이번 연구의 결과와 부합할 것으로 판단되며, 요로감염의 원인균은 시간이 지날수록 다양해지고, 빈도 및 항생제 감수성 또한 변하므로 향후 지속적인 감시와 그에 따른 대처가 필요할 것으로 생각한다.
Abstract
Background:To provide useful information on the choice of adequate drugs in the treatment of urinary tract infection (UTI) in spinal cord injury patients. Materials and Methods:The subjects were 34 spinal cord injured patients who were registered in Busan Spinal Cord Disabled Person Society and 111 patients with spinal cord injury who were admitted in 4 university hospitals in Busan between January 2004 and December 2005. We collected the patient's urine in July 2006 and performed comprehensive chart reviews of these patients. We studied the incidence of UTI, commonly cultured organisms, antimicrobial sensitivities, voiding methods and follow-up. Results:The incidence of UTI was 48.3% of 145 patients. The most common causative organism of UTI was Escherichia coli (27.1%), followed by Pseudomonas aeruginosa (22.9%) and Klebsiella pneumoniae (8.3%). Antimicrobial sensitivities of imipenem, amikacin and ceftazidime to Escherichia coli were respectively 100%, 92.3%, 80.8%. The sensitivities of Pseudomonas to the same agents were 63.6%, 31.8 %, 45.5% respectively. Ciprofloxacin showed decreased sensitivities of 38.5%, 31.8% respectively for Escherichia coli and Pseudomonas aeruginosa. Conclusion:Our results implied decreasing susceptibility of ciprofloxacin, so it can be recommended to restrict the use of ciprofloxacin as a primary empirical antibiotic for UTI of spinal cord injured patients. Causative organisms of UTI are becoming more diverse. Also the incidence and antimicrobial sensitivities are changing as well. Therefore continuous observation with the appropriate treatment is needed.
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