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일차성 방광요관역류 소아에서 항생제 예방요법 중에발생한 재발성 요로감염의 빈도와 위험인자

Incidence and Risk Factors of Recurrent Urinary Tract Infections during Antibiotic Prophylaxis in Children with Primary Vesicoureteral Reflux

이정원|김현진|이승주|조수진
대한소아신장학회 (The Korean Society Of Pediatric Nephrology)|2005.04|Childhood Kidney Diseases (Childhood Kidney diseases)|제9권 제1호|pp. 46-55

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참고문헌

주제분류소아과학

초록

목 적:일차성 방광요관역류 소아에서 재발성 요로감염은 신반흔의 원인으로 장기간 저용량 항생제 예방요법이 권장되어 왔다. 그러나 최근 항생제 예방요법의 효과에 대한 의문이 제기되었고 항생제 내성에 대한 우려도 있었다. 이에 일차성 방광요관역류 소아에서 항생제 예방요법의 효과에 대한 기초자료를 얻기 위하여 항생제 예방요법 중에 발생한 재발성 요로감염의 빈도와 위험요인을 조사하고자 하였다. 방 법:1995년 3월부터 2001년 12월까지 이대 목동병원 소아과에서 첫 발열성 요로감염 후에 일차성 방광요관역류가 발견되어 1년간 저용량의 trimethoprim-sulfimethoxazole을 투여받은 91명을 후향적으로 조사하여 재발성 요로감염의 빈도와 요로감염의 위험요인들을 분석하였다. 결 과:재발성 요로감염은 31.9%(29/91)에서 발생하였고 이는 0.32회/환자년 이였다. 발열성 요로감염은 0.26회/환자년이였고 비발열성 요로감염은 0.07회/환자년이였다. 포경 남아에서 요로감염의 재발율은 37.2%(19/54)로 포경이 없는 남아의 0%(0/5)에 비하여 유의하게 높았다(P= 0.025). 위험 예측치는 신반흔에서만 유의하게 높았다[RR=3.8(95% CI 1.0-14.1), P=0.04]. 여아, 연령, 급성신우신염, 배뇨장애 및 원인균 등은 위험인자로 작용하지 않았고 방광요관역류의 정도에 따른 유의한 차이도 없었다.. 결 론:일차성 방광요관역류가 있는 소아에서 항생제 예방요법은 요로감염의 재발을 억제하지 못하였다. 포경과 신반흔이 재발성 요로감염의 위험요인이였고 방광요관역류의 정도에 따른 차이는 없었다. 일차성 방광요관역류 소아에서 우선적으로 포경과 신반흔이 없는 소아에서부터 항생제 예방요법을 시행하지 않는 무작위 대조연구가 필요할 것으로 생각된다.

Abstract

Purpose:Recurrent urinary tract infection(UTI) in primary vesicoureteral reflux(VUR) may lead to serious renal scarring, a major cause of childhood hypertension and end-stage renal disease. To prevent recurrent UTI, low-dose long-term antibiotic prophylaxis has been recommended. However, recurrent UTI still develops during antibiotic prophylaxis, the efficacy of which is now being disputed. The emergence of resistant bacteria has also raised concerns. To evaluate the effect of antibiotic prophylaxis, we investigated recurrent UTI during prophylactic antibiotic use in children with primary VUR. Materials:The incidence and risk factors of recurrent UTI were retrospectively evaluated in ninety-one children with primary VUR on trimethoprim-sulfamethoxazole(TMP/SMX) prophylaxis during the year following their index febrile UTI. Results:Recurrent UTI occurred in 31.9%(29/91) children and comprised 0.32 episodes/ patient year. Febrile UTI was 0.26 episodes/patient year and afebrile UTI was 0.07 episodes/ patient year. The recurrent rate of UTI in male patients with phimosis was 37.2%(19/51), which was significantly higher than in males without phimosis 0%(0/5)(P=0.025). In the logistic regression analysis for recurrent UTI, renal scar was the significant risk factor for recurrent UTI [RR 3.8(95% CI 1.0-14.1) P=0.04]. For other well-known risk factors such as sex, age, degree of VUR, APN, and voiding dysfunction, the differences were not significant. Conclusion:TMP/SMX prophylaxis did not prevent recurrent UTI in children with primary VUR. Phimosis and renal scars were the risk factors for recurrent UTI but the grade of primary VUR was not. In VUR without phimosis and renal scar, a randomized controlled study without antibiotic prophylaxis is required

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