영아 요로 감염에서 농뇨의 지속기간에 따른 임상적 비교
A Comparison of Clinical Findings According to the Duration of Pyuria in Infants with Urinary Tract Infections
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목적:요로감염은 1세 미만의 영아에게 가장 많이 발생하는 질환이며, 신장의 장기 예후를 위해 조기 진단과 치료가 매우 중요한 질환이다. 농뇨는 요로 감염의 초기 진단에 있어 임상에서 많이 이용하고 있는 것으로, 본 연구에서는 항균제 치료 후 농뇨의 지속기간과 관련된 요인들을 찾아보고자 하였다. 방법:1995년 1월부터 2005년 12월까지 가톨릭대학교 성빈센트병원의 입원 환자 중 처음 요로 감염을 진단받은 1개월부터 12개월 미만의 영아 374명을 대상으로 하였다. 대상 환자들은 치료 후 농뇨가 3일 미만에 소실되는 군(1군)과, 3일 이상 지속되는 군(2군)으로 나누어 비교하였다. 결과:성별 및 평균 연령, 총 발열기간, 소변 배양으로부터 동정된 균에 있어 두 군 간 유의한 차이는 없었다. 반면 입원 당시 측정한 말초 혈액 백혈구 수(14,360.86±5,526.16 cells/mm3 vs 11,822.55± 5,687.26 cells/mm3, P<0.001)와 적혈구 침강속도(32.81±19.34 mm/hr vs 23.74±20.43 mm/hr, P< 0.001), C-반응단백의 상승 정도(6.84±5.68 mg/dL vs 3.78±3.99 mg/dL, P<0.001)는 2군에서 더 의미 있게 높았다. 또한 수신증과 중증 방광 요관 역류도 2군에서 더 자주 동반되었다. 결론:농뇨가 더 오래 지속되는 소아 요로 감염 환자는 중증의 요로 감염증을 시사하며, 중증의 방광 요관 역류를 자주 동반하므로 집중적인 치료와 배뇨 중 방광 요도 조영술을 포함한 적극적인 영상 검사가 필요하리라 여겨진다.
Abstract
Purpose:Urinary tract infection (UTI) in children is the most common disease during the infantile period, therefore early diagnosis and treatment are important. Pyuria is a useful clinical parameter for the initial diagnosis of a UTI. In this study we aimed to compare the clinical, laboratory, and imaging findings in relation to the duration of pyuria in infants with UTIs. Methods:Three hundred seventy-four infants <12 months of age who were admitted between January 1995 and December 2005 for the first episode of a febrile UTI were retrospectively reviewed. Patients were divided into two groups according to the duration of pyuria as follows: group 1, pyuria resolved <3 days after initial treatment; and group 2, pyuria lasted at least 3 days after initial treatment. Results:There were no significant differences between the two groups in relation to gender, age, total duration of fever, and organisms in the urine. Group 2 had a significantly higher peripheral blood leukocyte count (14,360.86±5,526.16 cells/ mm3 vs. 11,822.55±5,687.26 cells/mm3, P<0.001), erythrocyte sedimentation rate (32.81±19.34 mm/hr vs. 23.74±20.43 mm/ hr, P<0.001), and C-reactive protein (6.84±5.68 mg/dL vs. 3.78±3.99 mg/dL, P<0.001) than group 1. There was a significantly higher incidence of hydronephrosis and a higher grade of vesicoureteral reflux (VUR) in group 2 compared to group 1. Conclusion:In infants with UTI, pyuria of longer duration is related to severe UTI and higher grade VUR, therefore aggressive radiologic studies may be necessary.
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