소아 요로감염의 원인균주별 임상양상과 항생제 내성률 : 대장균과 비대장균의 비교
Clinical Characteristics and Antibiotic Resistance of Urinary Tract Infections in Children: Escherichia. coli Versus Non-E. coli
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목 적:소아 UTI에서 non-E. coli UTI 의 빈도를 확인하고 원인균주별(E. coli vs. non-E. coli) 임상양상과 항생제 내성률을 비교하고자 하였다. 방 법: 2008년 9월부터 2009년 8월까지 UTI 입원환아 중에서 원인균주가 배양 증명된 환아들을 대상으로하였다. 인구학적 특징, 임상양상, 검사소견, 원인균주와항생제 내성률을 전향적으로 조사하였다. 결 과:전체 84명 중 E. coli UTI 은 63명(75.0%)이었고 non-E. coli UTI은 21명(25.0%)이었다. 성별ㆍ연령군에 따라서 non-E. coli의 분포는 차이를 보였다 :6개월 미만 남아군, 10.5%; 6개월 이상 남아군, 50.0%;6개월 미만 여아군, 43.7%; 6개월 이상 여아군, 25.0%(P =0.014). E. coli UTI군에 비해, non-E. coli UTI 군에는 입원 전 항생제를 치료받은 환아의 비율이 높았고(P =0.017), 혈뇨가 동반된 환아의 비율은 낮았다(P =0.014). E. coli 보다 non-E. coli는 cefazolin과cefotaxime, imipenem, TMP/SMX, tetracycline에 대해 높은 내성률을 보였다(P <0.05). 결 론:소아 UTI 치료과정에서, 증가 추세의 non-E. coli UTI 빈도와 성별ㆍ연령군별 원인균주의 차이, E. coli 보다 높은 non-E. coli의 항생제 내성률은 고려되어야 할 사항이다.
Abstract
Purpose : We aimed to compare the clinical features and antibiotic resistance of urinary tract infection (UTI) caused by pathogens other than E. coli (non-E. coli) with UTI caused by E. coli in children. Methods : We enrolled patients with culture-proven UTI, who were admitted to the study hospital from September 2008to August 2009. We investigated clinical data of patients with UTI and antibiotic resistance of isolated strains. For comparison,patients were divided according by results of the urine culture into E. coli and non-E. coli UTI groups. Results : A total of 84 patients participated in this study. Twenty one cases (25.0%) were caused by non-E. coli pathogens. Frequency of non-E. coli UTI differed according to age and sex: ‘male <6 months’, 10.5%; ‘male ≥6 months’, 50.0%; ‘female <6 months’, 43.7%; and ‘female ≥6 months’, 25.0% (P =0.014). More patients who received previous antibiotic treatment (P =0.017), but fewer patients who showed hematuria (P =0.014) were included in the non-E. coli UTI group than in the E. coli UTI group. Comparison of antibiotic resistance showed that the non-E. coli UTI group possessed more strains that were resistant to cefazolin, cefotaxime, imipenem, trimethoprim/sulfamethoxazole (TMP/SMZ) and tetracycline than the E. coli UTI group (P <0.05). Conclusion : Increased incidence, different distribution by age and sex, and high antibiotic resistance of non-E. coli UTI should be considered in selection of empirical antibiotics for treatment of UTI in children.
참고문헌 (21)
- Elder JS, "Urologic disorders in infants and children. In: Nelson Textbook of Pediatrics. 18th ed", pp.2223~2228 (2007), WB Saunders Co
- Shaikh N, "Prevalence of urinary tract infection in childhood: a meta-analysis", Pediatr Infect Dis J, 27, pp.302~308 (2008)
- Hoberman A, "Imaging studies after a first febrile urinary tract infection in young children", N Engl J Med, 348, pp.195~202 (2003)
- Hoberman A, "Treatment of urinary tract infections", Pediatr Infect Dis J, 18, pp.1020~1021 (1999)
- Ashkenazi S, "Uropathogens of various childhood populations and their antibiotic susceptibility", Pediatr Infect Dis J, 10, pp.742~746 (1991)
- Hellerstein S, "Urinary tract infections: old and new concepts", Pediatr Clin North Am, 42, pp.1433~1457 (1996)
- Hoberman A, "Oral versus initial intravenous therapy for urinary tract infections in young febrile children", Pediatrics, 104, pp.79~86 (1999)
- Committee on Quality Improvement, "Subcommittee on Urinary Tract Infections. Practice parameter: the diagnosis, treatment, and evaluation of the initial UTI in febrile infants and young children", Pediatrics, 103, pp.843~852 (1999)
- Bagga A, "Consensus statement on management of urinary tract infections", Indian Pediatr, 38, pp.1106~1115 (2001)
- Gupta K, "Emerging antibiotic resistance in urinary tract pathogens", Infect Dis Clin North Am, 17, pp.243~259 (2003)
- Marcus N, "Non-Escherichia coli versus Escherichia coli communityacquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome", Pediatr Infect Dis J, 24, pp.581~585 (2005)
- Cheng CH, "Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia", Pediatrics, 117, pp.84~89 (2006)
- Fernbach SK, "Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology", Pediatr Radiol, 23, pp.478~480 (1993)
- Belman AB, "Vesicoureteral reflux", Pediatr Clin North Am, 44, pp.1171~1190 (1997)
- "Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Fifth informational supplement, M100-S15", CLSI, ~ (2005)
- 정희진, "Escherichea coli 요로 감염과 non-Escherichea coli 요로 감염 사이의 차이점", Korean Journal of Pediatrics, 50(5), pp.457~461 (2007), 대한소아과학회
- 이수영, "발열과 농뇨가 있는 영아에서 요로감염에 관한 연구", 소아감염, 11(1), pp.90~100 (2004), 한국소아감염병학회
- 이수영, "소아 원외 요로감염 환아에서 분리된 E. coli에 대한cefixime을 포함한 경구 항생제의 감수성 연구", Korean Journal of Pediatrics, 49(7), pp.777~783 (2006), 대한소아과학회
- 한승범, "생애 첫 발열성 요로 감염 환아에 대한 평가에서 배뇨성 방광요도 조영술을 대체하기 위한 검사로서 99mtechnetiumdimercaptosuccinic acid(DMSA) scan의 의의", 대한소아신장학회지, 11(2), pp.220~228 (2007), 대소아신장학회
- Friedman S, "Clinical and laboratory characteristics of non-E. coli urinary tract infections", Arch Dis Child, 91, pp.845~846 (2006)
- 정진교, "대장균과 비대장균에 의한 영아 요로 감염의 비교", 소아감염, 16(2), pp.162~166 (2009), 한국소아감염병학회