영아 발열성 요로감염 환자의 항생제 연관 설사
Antibiotic-Associated Diarrhea in 3 to 6 Month Old Infants with Febrile Urinary Tract Infections
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목 적 : 본 연구는 발열성 요로감염으로 입원한 영아에서 항생제 연관 설사(Antibiotic-associated Diarrhea,이하 AAD)의 양상 및 연관인자를 조사하였다. 이 연구는 영아 AAD의 예방과 치료에 사용되는 생균제에 대한기초 연구이다. 방 법:가천의대길병원에서 2008년 1월부터 2010년9월 사이에 급성 발열성 요로감염으로 입원한 생후 3-6개월의 영아들의 의무기록을 후향적으로 조사하여 AAD 를 보인 환자(AAD군)와 보이지 않은 환자(non-AAD 군)를 비교하였다. AAD군 내에서 사용한 항생제 요법과용량, 설사의 양상을 비교하였다. 결 과:총 147명 중 AAD군은 54명(36.7%)이었고,이 중 3세대 세팔로스포린(3rd CS) 단일요법군, 3rd CS 과 비세팔로스포린 혼합요법군, 비세팔로스포린 혼합요법군 간의 설사의 발현 시점, 지속기간 및 횟수의 유의한차이가 없었다(P>0.05). AAD군과 non-AAD군과의cefotaxime 사용량의 유의한 차이는 없었다. 결 론:생후 3-6개월 영아의 발열성 요로감염 환자에서 AAD는 항생제의 요법과 평상적 투여량 범위내에서용량에 관계없이 흔하게 발생하였다. 영아 AAD의 예방과 치료에 사용되는 생균제의 효과에 대한 추가적인 연구가 필요하다.
Abstract
Purpose : This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. Methods : Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. Result : Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin (3rd CS) single therapy was used for 102 patients (69.4%), the 3rd CS and non-3rd CS combination therapy for 24 (16.3%), and non-3rd CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P =0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P =0.717, P =0.830). Although the frequency of diarrhea was higher for the 3rd CS and non-3rd CS combination therapy subgroup with 9.25±5.30 times/day than the other two subgroups (7.58±2.97 times/day in 3rd CS single therapy subgroup, 6.75±4.40 times/day in non-3rd CS combination therapy subgroup),there was no statistical significance (P =0.078). Conclusion : AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.
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