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The Clinical Usefulness of a Repeat Urine Culture 48 Hours after Antimicrobial treatment in Anatomically Normal and Abnormal Urinary Tract Infection

소아 요로 감염증 환아의 항생제 치료 48시간 후 반복적 요 배양 검사의 임상적 유용성

  • Park, Kyung-Hee (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Yeom, Jung-Suk (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Park, Ji-Suk (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Park, Eun-Sil (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Seo, Ji-Hyun (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Lim, Jae-Young (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Park, Chan-Hoo (Department of Pediatrics, Gyeongsang National University School of Medicine) ;
  • Youn, Hee-Shang (Department of Pediatrics, Gyeongsang National University School of Medicine)
  • 박경희 (경상대학교 의학전문대학원 소아과학교실) ;
  • 염정숙 (경상대학교 의학전문대학원 소아과학교실) ;
  • 박지숙 (경상대학교 의학전문대학원 소아과학교실) ;
  • 박은실 (경상대학교 의학전문대학원 소아과학교실) ;
  • 서지현 (경상대학교 의학전문대학원 소아과학교실) ;
  • 임재영 (경상대학교 의학전문대학원 소아과학교실) ;
  • 박찬후 (경상대학교 의학전문대학원 소아과학교실) ;
  • 윤희상 (경상대학교 의학전문대학원 소아과학교실)
  • Published : 2009.04.30

Abstract

Purpose : We aimed to compare the frequency of positive repeat urine cultures 48 hours after antimicrobial treatment between anatomically normal and abnormal urinary tract Infection (UTI) groups to determine the potential clinical usefulness of the tests. Methods : We reviewed medical records of 930 patients under age 14, who had been admitted for UTI at Gyeongsang National University Hospital from January 1, 1998 to August 1, 2008. The eligible patients were divided into two groups the anatomically normal UTI group and the anatomically abnormal UTI group. Statistical analyses were performed with variables consisting of the sex ratio, age distribution and the frequency of positive repeat urine cultures of each group. Results : The sex ratio of the anatomically normal UTI group was M:F=1.9:1, whereas that of the anatomically abnormal UTI group was M:F=3.5:1 (P=0.019). For age distribution, it was found that the mean age of the anatomically normal UTI group was $0.82{\pm}1.83$ years, whereas that of the anatomically abnormal UTI group was $1.18{\pm}2.57$ years (P=0.113). The frequency of positive repeat urine cultures in the anatomically normal UTI group was 3/279 (1.1%), whereas that of the anatomically abnormal UTI group was 1/90 (1.1%) (P=0.675). Conclusion : We conclude that performing a repeat urine culture is not justified in terms of clinical usefulness, and it is unreasonable to use the results as an index of therapeutic success. A follow-up urine culture is unnecessary in patients with both the anatomically normal and abnormal UTI group.

목 적 : 요로 감염증 환아를 요로계 기형이 있는 요로 감염군과 이러한 기형이 없는 요로 감염군으로 나누어 반복 요 배양검사에서 균의 재배양 양성율을 비교하여 반복 요 배양 검사의 임상적 유용성에 대해 알아보고자 하였다. 방 법 : 1998년 1월 1일부터 2008년 8월 1일까지 경상대학교병원에 내원하여 발열 또는 요로감염의 전형적인 임상양상을 보이고 농뇨가 있으면서 소변배양 검사에서 균이 $10^5$ colony-forming units (CFU)/mL개 이상 자란 요로 감염 환아 369명을 대상으로 2일 후에 다시 요 배양검사를 시행하였다. 요로기형이 없는 요로 감염군과 요로기형(방광요관역류, 수신증)을 동반하는 요로 감염군으로 나누어 각각의 군의 성비, 나이, 재배양 양성율을 통계적으로 분석하였다. 통계량 분석은 Students t-test와 Fishers exact test를 사용하였고 SPSS 14.0 버전을 사용하여 P값이 0.05미만인 경우에 통계적으로 유의한 것으로 평가하였다. 결 과 : 요로 기형이 없는 요로 감염군의 성비는 M:F=1.9:1 (183/96)이었고 요로 기형을 동반하는 요로 감염군의 성비는 M:F=3.5:1 (70/20)으로 요로 기형이 있는 요로 감염군에서 통계적으로 유의하게 남자가 많았다(P=0.019). 나이는 요로 기형이 없는 요로 감염군이 $0.82{\pm}1.83$세이고 요로 기형이 있는 요로 감염군이 $1.18{\pm}2.57$세로 통계적으로 차이가 없었다. 재배양 양성율은 정상요로를 가진 요로 감염군이 3/279 (1.1%)이고 요로 기형이 있는 요로 감염군이 1/90 (1.1%)으로 통계적으로 차이가 없었다. 결 론 : 정상 요로를 가진 요로 감염군과 요로 기형이 있는 요로 감염군에서의 균의 재배양 양성율은 통계적으로 차이가 없을 뿐만 아니라 재배양 양성율 자체의 빈도도 매우 드물었다. 따라서 반복 요 배양 검사 결과를 치료의 성공 지표로 삼는 것은 임상적 유용성이 부족하며, 정상 요로를 가진 요로 감염군과 요로 기형이 있는 요로 감염군 모두에서 반복 요 배양 검사는 불필요한 검사라고 생각된다.

Keywords

References

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