소아 요로 감염 원인균의 항생제 감수성 고찰(2003-2005)
Antibiotic Sensitivity Pattern of Pathogens from Children with UTI
0
조회
0
다운로드
5
인용
0
참고문헌
초록
목 적 : 소아 요로 감염은 치료가 되지 않을 경우 고혈압, 신부전, 말기 신질환 등을 초래할 수 있고, 특히 요로계의 해부학적 기형이 동반된 경우 재발하기 쉽다. 본 연구에서는 소아 요로 감염의 주요 원인균과 이에 따른 항생제의 감수성 변화와 ESBL 생성균의 빈도와 임상양상을 알아 봄으로서. 앞으로 소아 요로 감염에 대한 정확한 진단 및 치료 즉, 적절한 항생제 투여를 위하여 본 연구를 시행하였다. 방 법 : 2003. 1월부터 2005년 12월까지 최근 3년간 한동대학교 선린병원에서 요로 감염으로 치료 받은 250명의 환아 중, 소변 배양 검사상 요로 감염균이 의미있게 배양된 137명(54.8%)을 선별하였다. 선별된 137명의 환아들의 임상 증상, 혈액 검사, 소변 검사, 소변 배양검사, 항생제 감수성 결과, 그리고 방사선학적 검사 등을 후향적으로 의무 기록을 통해 조사하였다. 결 과 : 전체 137명의 요로 감염 원인균에서 그람 음성균이 122명(89.1%), 그람 양성균의 경우 15명(10.9%) 소견을 보였고, 이들 중 E. coli 89명(65.0%), K. pneumoniae 14명(10.2%) 등의 순으로 나타났으며, 분리된 E. coli와 K. pneumoniae 중 ESBL 생성균은 각각 4명(4.5%), 2명(14.3%)에서 동정되었다. E. coli에 대한 항생제 감수성은 amikacin, imipenem, ceftriaxone, tobramycin에서 각각 100%, 100%, 95.5% 91.4 %로 높은 감수성을 보인 반면, TMP/SMZ, ampicillin/sulbactam, ampicillin에서 각각 55.4%, 29.4%, 24.2%로 낮은 감수성을 보였다. 결 론 : 요로 감염 시 임상에서 많이 사용되고 있는 ampicillin, ampicillin/sulbactam과 TMP/ SMZ등의 항생제 감수성이 감소되고 있으므로 초기 선택 약제에서 배제하여야 할 것이다. 또한 높은 비율의 ESBL 생성균 발생과 이들 균의 높은 내성율이 문제되고 있어 요로 감염에 대한 적절한 항생제 사용이 더욱 요구된다고 하겠다.
Abstract
Purpose : We studied the degree of changes in antibiotic sensitivity toward causative organisms, prevalence and clinical manifestations of extended-spectrum β-lactamase(ESBL)- producers of urinary tract infection(UTI) for a period of three years. This serves to provide useful information in selecting adequate drugs for the treatment of UTI. Methods : We recruited 137 patients who grew more than 105 CFU/mL in their urine culture among 250 patients who visited and were admitted to Handong University's Sunlin Hospital for UTI treatment from January 2003 to December 2005. We retrospectively analyzed the data from the medical records. Results : The common pathogenic organisms were Escherichia coli(65.0%), Klepsiella pneumoniae(14.0%), Enterococcus faecalis(5.8%) and Proteus vulgaris(2.9%) in consecutive order. The prevalence of ESBL-producers among isolated E. coli and K. pneumoniae was 4.5%(4 cases) and 14.3%(2 cases), respectively. The antibiotic sensitivity rates of E. coli were relatively high to amikacin(100%), imipenem(100%), ceftriaxone(95.5%) and tobramycin (91.4%) while relatively low to TMP/SMZ(55.4%), ampicillin/sulbactam(29.4%) and ampicillin (24.2%). Conclusion : The use of ampicillin, ampicillin/sulbactam and TMP/SMZ, which have been the first choices in the treatment of UTI, should be reconsidered due to the low sensitivity rates towards these antibiotics. Due to the high incidence and antibiotic tolerance of ESBL that might have risen from the development of new antibiotics and increased antibiotic use, it is necessary to consider changing the standard antibiotics that have been used in the treatment of UTI.
참고문헌 (24)
- An HS, "Hongchanghee Pediatric science", pp.961~964 (2004), Daehan Printing & Publishing Co
- Kim NH, "Risk factors of urinary tract infectin due to extended-spectrum beta-lactamase producing Escherichia coli in children", 47, pp.164~169 (2004)
- Khurana S, "Extented-spectrum β-lactamase mediated resistance in urinary tract isolates of family Enterobacteriaceae", 116, pp.145~149 (2002)
- Chong YS, "New antimicrobial resistance and mechanisms of bacteria", pp.84~120 (2002), Suh Heung Co
- National Committee for Clinical Laboratory Standards, "Performance Standards for Antimicrobial Susceptibility Testing" (2002), NCCLS
- Kim SY, "Urinary tract infection in children", 40, pp.600~6 (1994)
- Hoberman A, "Prevalence of urinary tract infection in febrile in infants", 123, pp.12~23 (1993)
- Behrman RE, "Nelson textbook of pediatrics", pp.1785~1789 (2004), WB Saunders Co
- Kang YD, "Causative organisms of urinary tract infection in children,and their antibiotic susceptibility", 47, pp.1065~1071 (2004)
- Cha YH, "A clinical study on urinary tract infection in infants and children", 37, pp.1488~1499 (1994)
- Roh JI, "A clinical and bacteriologic study of Infants and children with urinary tract infection", 34, pp.57~65 (1991)
- Yang KS, "Clinical studies of urinary tract infection in infant and children", 32, pp.533~41 (1989)
- Hwang SJ, "Diagnosis value of dipstick urinalysis(Leukocyte Esterase and Nitrite)as a screening test for urinary tract infection in acute febrile children", 2, pp.1~8 (1998)
- Kang HG, "Treatment for urinary tract infection of children in Korea", 5, pp.15~21 (2001)
- American Academy of Pediatrics, "Practice parameter: The diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children", pp.843~852 (1999)
- Kim JS, "Incidence of vesicoureteral reflux in asymptomatic siblings of patients with reflux", 45, pp.1540~1545 (2002)
- Jodal U, "Management of children with unobstructed urinary tract infection", pp.647~56
- Cho TH, "Clinical and bacteriologic studies of urinary tract infection in children", 35, pp.69~78 (1999)
- Kang YD, "Causative organisms of urinary tract infection in children,and their Antibiotic Susceptability", 37, pp.1488~99 (1994)
- Sotto A, "Risk factors for antibiotics-resistant Escherichia coli isolated from hospitalized patients with urinary tract infection:a prospective study", 120, pp.265~267 (2003)
- McLoughlin TG Jr, "Antibiotic resistance patterns of uropathogens in pediatric emergency department patients", 10, pp.347~351 (2003)
- Kim NH, "Risk factors of urinary tract infectin due to extended-spectrum beta-lactamase producing Escherichia coli in children", 47, pp.164~169 (2004)
- Paterson DL, "Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended- spectrum beta-lactamases:Implications for the clinical microbiology", 39, pp.2206~2212 (2001)
- Chi HM, "Incidence of Escherichia coli and its susceptibility to antimicrobials in childhood urinary tract infection", 10, pp.18~26 (2006)