소아 요로감염에서 Escherichia coli의 빈도와 항생제 감수성에 대한 연구
Incidence of Escherichia coli and Its Susceptibility to Antimicrobials in Childhood Urinary Tract Infection
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목 적 : 요로감염은 조기 진단 및 치료를 적절히 하지 않으면 비가역적 신손상, 패혈증 등을 유발하므로 원인 균주를 알기 전에 경험적 항생제 요법을 시행하는 것이 중요하다. 따라서 경험적 항생제의 적절한 선택을 위하여 원인 균주의 분포와 임상특징을 알아보고, 원인 균주의 대부분을 차지하는 E. coli의 항생제 감수성 정도에 대해 알아보고자 하였다.방 법 : 2004년 2월부터 2005년 2월까지 발열을 주소로 분당차병원 응급실과 소아과 외래를 방문하여 요로감염으로 진단된 환아 103명을 대상으로 요 배양검사 결과, 성별, 연령, DMSA 신스캔상 결손 유무, 방광 요관 역류 유무, 6개월 이내 재발 여부 등을 후향적으로 조사하고 원인 균주 중 가장 흔한 균인 E. coli에 대해 항생제 감수성 정도를 분석하였다.결 과 : 103명의 환아 중 92명(89.3%)이 E. coli에 의한 요로감염이었으며 ESBL 생성 E. coli는 3명(3.3%)에서 동정되었다. E. coli의 항생제 감수성 조사 결과 AMP, AMS, SXT는 각각 27.2%, 34.8%, 65.2%로 낮은 감수성을 보였으며 cephalosporin계 항생제는 1세대 cephalosporin인 cefazoline이 91.3%, 2세대인 cefoxitin이 100%, 3세대인 ceftriaxone 97.8%를 보여 대부분 매우 높은 감수성을 나타내었다. 또한 AMP와 SXT의 경우 연령이 1세 이상일 경우 1세 미만인 경우에 비해 내성의 위험이 증가하였다.
Abstract
Purpose : Empirical antimicrobial treatment is indicated before bacteriological results are available for young children with febrile UTI to minimize renal scarring. To ensure appropriate therapy, knowledge of the prevalence of causative organisms and their susceptibility patterns to antimicrobials is mandatory. We performed a retrospective analysis investigating the local prevalence and resistance patterns of uropathogens, primarily E. coli, isolated from community-acquired UTIs. Methods : A total of 103 positive urine cultures from children with febrile UTI collected at Bundang CHA General Hospital from February 2004 to February 2005 were analyzed. Inclusion criteria were fever higher than 37.5℃, significant bacteriuria with single strain growth of at least 105 colony forming units/mL urine, and leukocyturia >5/HPF. Results : E. coli(89.3%) was the leading uropathogen followed by Enterococcus spp.(3.9%) Klebsiella spp.(2.9%), Citrobacter spp.(1.9%) and Enterobacter spp.(1.9%). E. coli strains revealed a low proportion of antimicrobial susceptibility to ampicillin(AMP; 27.2%) ampicillin- sulbactam(AMS; 34.8%) and trimethoprim-sulfamethoxazole(SXT; 65.2%). Susceptibility patterns to cephalosporins were as follows; cefazolin(1st generation; 91.3%), cefoxitin(2nd; 100%), ceftriaxone(3rd; 97.8%) and cefepime(4th; 97.8%). Three E. coli isolates produced extended-spectrum beta-lactamase(ESBL). Conclusion : Empirical treatment with AMP, AMS and SXT, which are commonly used in pediatric clinics, is not recommended for childhood UTI due to high incidence of resistance. The high level of susceptibility to cephalosporins makes these drugs reasonable alternatives. However the emergence of ESBL-producers, even though they are quite few, may have an impact on cephalosporin treatment in the future.
참고문헌 (25)
- "Practice parameter:the diagnosis,treatment,and evaluation of the initial urinary tract infection in febrile infants and young children", 103, pp.843~852 (1999)
- "Febrile urinary tract infection:Escherichia coli susceptibility to oral antimicrobials", 17, pp.173~176 (2002)
- "Manual of clinical microbiology", pp.~73, ASM Press
- "Urinary tract infections:antimicrobial resistance", 10, pp.23~24 (2000)
- "Performance standards for antimicrobial susceptibility testing : Twelfth informational supplement", pp.19087~19098 (2002), NCCLS
- "Incidence and risk factors for Extended-Spectrum β-Lactamase-producing Escherichia coli in community-acquired childhood urinary tract infection", 8, pp.214~222 (2004)
- "Antibiotic sensitivity to the causative organism of acute simple urinary tract infection for recent 3 years", 32, pp.380~387 (2000)
- "Antibiotic susceptaibility of bacterial strains isolated from patients with community-acquired urinary tract infections", 18, pp.211~215 (2001)
- "Hospital-acquired urinary tract infections in Turkey:a nationwide multicenter point prevalence study", 53, pp.207~210 (2003)
- "Changes of causative organisms and antimicrobial sensitivity of urinary tract infection between 1979 and 2001", 44, pp.342~350 (2003)
- "Urinary tract infection in children", 319, pp.1173~1175 (1999)
- "Oral versus initial intravenous therapy for urinary tract infections in young febrile children", 104, pp.79~86 (1999)
- "Pyelonephritis at home-why not", 104, pp.110~111 (1999)
- "Antibiotic resistance in bacterial urinary tract infections,1991 to 1997", 169, pp.265~268 (1998)
- "Antibiotic resistance in community-acquired urinary tract infections", 84, pp.600~2 (1994)
- "Prevalencia de uropatogenos e sua resistencia aos antimicrobianos em uroculturas realizadas no Hospital Sao Lucas da PUCRS", 42, pp.137~142 (1998)
- "Risk factors of urinary tract infection due to extended-spectrum β-lactamase producing Escherichia coli in children", 47, pp.164~169 (2004)
- "Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy", 19, pp.982~986 (2004)
- "Increasing antibiotic resistance among urinary tract isolates", 88, pp.444~445 (2003)
- "Resistance rates to commonly used antimicrobials among pathogens of both bacteremic and non-bacteremic community- acquired urinary tract infection", 37, pp.185~191 (2004)
- "The characteristics of extended- spectrum β-lactamases in Korea isolates of Enterobacteriaceae", 39, pp.514~519 (1998)
- "Bloodstream infections by extended-spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae in children:Epidemiology and clinical outcome", 46, pp.1481~1491 (2002)
- "Antibiotic resistance patterns of uropathogens in pediatric emergency department patients", 10, pp.347~351 (2003)
- "Risk factors for antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections:a prospective study", 120, pp.265~267 (2003)
- "Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended- spectrum β-lactamases:Implications for the clinical microbiology laboratory", 39, pp.2206~2212 (2001)