발열성 소아 요로감염에서 Extended-Spectrum β- Lactamase 생성 Escherichia coli의 임상적 의의
Clinical Significance of Extended-Spectrum β-Lactamase Producing Escherichia coli in Pediatric Patients with Febrile Urinary Tract Infection
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목적: 광범위 베타락탐 분해 효소(extended-spectrum β-lactamase, ESBL) 생성 E.coli에 의한 지역 사회 요로감염의 빈도가 전세계적으로 증가하고 있다. ESBL은 광범위 cephalosporin 계 항생제와 monobactam 계 항생제를 포함한 다양한 새로운 β-lactam 계 항생제에 대하여 내성을 일으킨다. 본 연구에서는 발열성 소아 요로감염에서 ESBL(+) E.coli의 감염 여부가 요로감염의 중증도, 동반 비뇨기계 기형과 연관이 있는지 알아보고자 하였다. 방법: 2008년 1월부터 2010년 10월까지 고려대학교 병원에서 입원 치료한 소아 중 E.coli에 의한 발열성 요로감염 소아 290명을 대상으로 하였다. 요 배양검사에서 항생제 감수성 검사 및 ESBL 생성 여부에 따라서 ESBL(+) E.coli 군과 ESBL(-) E.coli 군으로 나누어 입원 전후 발열 기간, 입원 기간, 말초 혈액 내 백혈구 수와 혈청 C-반응성 단백, 농뇨의 동반 여부, 수신증의 유무, 신 스캔에서 초기 신 결손의 유무, 신 반흔의 유무, 방광 요관 역류의 유무 등의 항목들에 대하여 두 군간에 후향적 비교 분석을 시행하였다. 결과: 대상 소아 총 290명 중 ESBL(+) E.coli 군은 32명, ESBL(-) E.coli 군은 258명이었다. 무균 채뇨백으로 검사를 진행한 소아는 56명이었으며, 이를 제외한 소아는 총 234명으로 ESBL(+) E.coli 군은 22명, ESBL(-) E.coli 군은 212명이었다. 무균 채뇨백으로 검사를 진행한 소아를 포함했을 때와 제외했을 때 모두 두 군간에 통계학적으로 유의한 차이를 보이는 항목은 없었다. 결론: 저자들은 발열성 소아 요로감염에서 ESBL 생성 E.coli 의 감염 여부가 요로감염의 중증도 및 동반 비뇨기계 기형과의 관련이 없음을 제시하는 바이다.
Abstract
Purpose: The incidence of community-acquired urinary tract infection (UTI) due to extended-spectrum β-lactamase producing Escherichia coli (ESBL(+) E. coli) has increased worldwide. ESBL causes resistance to various types of the newer β-lactam antibiotics, including the expanded spectrum cephalosporins and monobactams. We aimed to investigate the severity of UTI and associated genitourinary malformations in children with febrile UTI caused by ESBL(+) E. coli. Methods: We retrospectively reviewed the medical records of 290 patients diagnosed as febrile UTI caused by E. coli between January 2008 and October 2010 at Korea University Medical center. We classified the patients into two groups with ESBL(+) and ESBL(-) E. coli group according to the sensitivity of urine culture. Fever duration, admission period, white blood cell (WBC) counts and C-reactive protein (CRP) in peripheral blood, the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR) and renal scar were compared between the two groups. Results: Patients with ESBL(+) E. coli were 32, and those with ESBL(-) E. coli were 258. If we excluded those tested with a sterile urine bag, patients with ESBL(+) E. coli were 22, and those with ESBL(-) E. coli were 212. Whether the results of sterile urine bag tests were included or not, there was no significant difference in all parameters between the two groups statistically. Conclusion: Our data shows that ESBL(+) E. coli may not be related to the severity of UTI and associated genitourinary malformations.
참고문헌 (38)
- Hellstrom A, "Association between urinary symptoms at 7 years old and previous urinary tract infection", Arch Dis Child, 66, pp.232~234 (1991)
- Marild S, "Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age", Acta Paediatr, 87, pp.549~552 (1998)
- Hoberman A, "Imaging studies after a first febrile urinary tract infection in young children", N Engl J Med, 348, pp.195~202 (2003)
- American academy of pediatrics, committee on quality improvement, subcommittee on urinary tract infection., "Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children", Pediatrics, 103, pp.843~851 (1999)
- Jacobson SH, "Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up", BMJ, 299, pp.703~706 (1989)
- Prajapati BS, "Advances in management of urinary tract infections", Indian J Pediatr, 75, pp.809~814 (2008)
- 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
- Oteo J, "Extended-spectrum b-lactamase-producing Escherichia coli : changing epidemiology and clinical impact", Curr Opin Infect Dis, 23, pp.320~326 (2010)
- Yiee J, "Management of fetal hydronephrosis", Pediatr Nephrol, 23, pp.347~353 (2008)
- Jaksic E, "Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis", Ann Nucl Med, 25, pp.37~43 (2011)
- Piepsz A, "Paediatric nuclear medicine", Eur J Nucl Med, 18, pp.41~66 (1991)
- Lavocat MP, "The importance of 99mTc-DMSA renal scintigraphy in the follow-up of acute pyelonephritis in children: comparison with urographic data", Nucl Med Commun, 19, pp.703~710 (1998)
- Ferraro MJ, "Performance standards for antimicrobial susceptibility testing", An NCCLS, 22, pp.37~46 (2002)
- Williams G, "Prevention of recurrent urinary tract infection in children", Curr Opin Infect Dis, 22, pp.72~76 (2009)
- Shaikh N, "Prevalence of urinary tract infection in childhood", Pediatr Infect Dis J, 27, pp.302~308 (2008)
- Noemia PG, "Febrile urinary tract infection: Escherichia coli susceptibility to oral antimicrobials", Pediatr Nephrol, 17, pp.173~176 (2002)
- Hirakata Y, "Regional variation in the prevalence of extended-spectrum β-lactamase producing clinical isolates in the Asia-Pacific region (SENTRY 1998-2002)", Diagn Microbiol Infect Dis, 52, pp.323~329 (2005)
- Du Bois SK, "TEM- and SHV-derived extended-spectrum α-lactamase: Relationship between selection, structure and function", J Antimicrob Chemother, 35, pp.1697~1704 (1995)
- Knothe H, "Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens", Infection, 11, pp.315~317 (1983)
- Jacoby GA, "Extended-spectrum beta-lactamases and other enzymes providing resistance to oxymino-beta-lactams", Infect Dis Clin North Am, 11, pp.875~887 (1997)
- Paterson DL, "Extended-spectrum betalactamases: a clinical update", Clin Microbiol Rev, 18, pp.657~686 (2005)
- Jarlier N, "Extended broad-spectrum β-lactamase conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility pattern", Rev Infect Dis, 10, pp.867~878 (1988)
- Bush K, "A functional classification scheme for beta-lactamase and its correlation with molecular structure", Antimicrob Agents Chemother, 39, pp.211~233 (1995)
- Cantón R, "Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe", Clin Microbiol Infect, 1, pp.144~153 (2008)
- Brigante G, "Evolution of CTX-M-type beta-lactamases in isolates of Escherichia coli infecting hospital and community patients", Int J Antimicrob Agents, 25, pp.157~162 (2005)
- Pai H, "The characteristics of extended-spectrum beta-lactamases in Korean isolates of Enterobacteriaceae", Yonsei Med J, 39, pp.514~519 (1998)
- 이정원, "지역사회 획득 소아 요로검염에서 Extended-Spectrum b-Lactamase 생성 Escherichia coli의 발생과 위험인자", 대한소아신장학회지, 8(2), pp.214~222 (2004), 대한소아신장학회
- Topaloglu R, "Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children", Pediatr Nephrol, 25, pp.919~925 (2010)
- 김남희, "Extended-Spectrum β - Lactamase 생성 Escherichia coli에 의한 소아 요로감염의 위험인자", Korean Journal of Pediatrics, 47(2), pp.164~169 (2004), 대한소아과학회
- 모은하, "소아 발열 환아에서 감염의 감별 지표로서의 C 단백의 의의", Korean Journal of Pediatrics, 47(8), pp.839~843 (2004), 대한소아과학회
- 정지인, "소아 요로감염에서 발열과 신반흔의 관계", 대한소아신장학회지, 12(1), pp.70~77 (2008), 대한소아신장학회
- Lohr JA, "Making a presumptive diagnosis of urinary tract infection by using a urinalysis performed in an on-site", Laboratory J Pediatr, 122, pp.22~25 (1993)
- American academy of pediatrics, steering committee on quality improvement and management, subcommittee on urinary tract infection, "Urinary tract infection : Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months", Pediatrics, 128, pp.595~610 (2011)
- Smith T, "Radiation dosimetry of technetium-99m-DMSA in children", J Nucl Med, 37, pp.1336~1342 (1996)
- Paquin AJ, "Ureterovesical anastamosis: the description and evaluation of a technique", J Urol, 82, pp.573~583 (1959)
- Chand DH, "Incidence and severity of vesicoureteral reflux in children related to age, gender, race and diagnosis", J Urol, 170, pp.1548~1550 (2003)
- Rushton HG, "The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions", Pediatr Nephrol, 11, pp.108~120 (1997)
- Brun-Buisson C, "Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae", Lancet, 2, pp.302~306 (1987)