지역사회 획득 소아 요로검염에서 Extended-Spectrum b-Lactamase 생성 Escherichia coli의 발생과 위험인자
Incidence and Risk Factors for Extended-Spectrum β-Lactamase-Producing Escherichia coli in Community-acquired Childhood Urinary Tract Infection
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목 적 : 소아 요로감염은 적절한 항생제 치료가 중요하며 항생제의 선택에는 E. coli에 대한 항생제 감수성이 기준이 된다. Extended-spectrum β-lactamase(ESBL)은 E. coli 등 그람 음성균에서 분비되어 광범위 항생제 내성을 초래하는 효소로서 주로 병원 감염에서 발생하여 치료를 어렵게 하는 요인으로 알려져 있다. 저자들은 지역사회 획득 소아 요로감염에서도 ESBL(＋) E. coli가 분리되었기에 ESBL(＋) E. coli요로감염의 특성을 후향적으로 조사하고자 하였다. 방 법 : 2001년 3월부터 2003년 2월까지 이대목동병원 소아과에 입원한 지역사회 획득 E. coli 요로감염 소아(288명)를 대상으로 ESBL을 검사하였다. 검사 방법은 미량 액체배지 희석법을 이용한 자동화 기계(Vitek GNS 433 card)에서 ESBL이 의심되는 균주에 한해 National Committee for Clinical Laboratory Standard (NCCLS)의 기준에 따라 ESBL을 확인하였다. ESBL의 결과에 따라 ESBL(＋) E. coli 요로감염의 발생률을 조사하였고 임상적 특징, 위험요인, 항생제 내성률 및 치료효과 등을 ESBL(-) E. coli 요로감염과 비교 분석하였다. 결 과 : 지역사회 획득 소아 요로감염에서 ESBL(＋) E. coli의 발생률은 10.8%(31명)이였고 93.5%(29/31)가 6개월 미만의 영아에서 발생하였다(P<0.01). 임상소견은 ESBL 양성군과 음성군 사이에 유의한 차이가 없었다. ESBL 발생의 위험인자로 잘 알려진 항생제 사용력, 입원 병력 및 요로계 기형과도 무관하였다. ESBL(＋) E. coli의 항생제 내성률은 ESBL(-) E. coli 에 비하여 유의하게 높았다(P<0.05). Ceftriaxone 투여 48시간 후의 멸균률은 ceftriaxone에 대한 높은 내성률에도 불구하고 96.8%(30/31)로 높았다. 그러나 6개월 이내의 재발률이 25.8%(9/31)나 되었고 이는 ESBL 음성군의 재발률 6.6% (17/227)에 비하여 유의하게 높았다(P<0.05). 결 론:지역사회 획득 소아 요로감염에서 6개월 미만의 어린 영아는 ESBL(＋) E. coli 발생의 새로운 위험요인이므로 이에 대한 역학적 연구가 요구된다. 소아 요로감염에서 경험적으로 사용하는 항생제의 선택에 대한 변화가 필요할 것으로 생각된다.
Abstract
Purpose:Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended- Spectrum β-Lactamase(ESBL) is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL(＋) E. coli in community-acquired childhood UTI. Methods:In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI. Results:Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(＋) E. coli compared with control patients (P< 0.05). Although ceftriaxone showed 100% resistance in ESBL(＋) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%). Conclusion:Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(＋) E. coli UTI and changes in selection of empirical antibiotics should be considered.
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