Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Comparison of Urinary Tract Infections Caused by Escherichia coli and Non-E.coli in Infants

대장균과 비대장균에 의한 영아 요로 감염의 비교

  • Joung, Jin-Kyo (Department of Pediatrics, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Choi, Cheol-Soon (Department of Pediatrics, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Seong-Joon (Department of Pediatrics, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Park, So-Hyun (Department of Pediatrics, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Jong-Hyun (Department of Pediatrics, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Koh, Dae-Kyun (Department of Pediatrics, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea)
  • 정진교 (가톨릭대학교 의과대학 성빈센트병원 소아청소년과) ;
  • 최철순 (가톨릭대학교 의과대학 성빈센트병원 소아청소년과) ;
  • 김성준 (가톨릭대학교 의과대학 성빈센트병원 소아청소년과) ;
  • 박소현 (가톨릭대학교 의과대학 성빈센트병원 소아청소년과) ;
  • 김종현 (가톨릭대학교 의과대학 성빈센트병원 소아청소년과) ;
  • 고대균 (가톨릭대학교 의과대학 성빈센트병원 소아청소년과)
  • Received : 2009.09.17
  • Accepted : 2009.10.19
  • Published : 2009.12.25
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Abstract

Purpose : Urinary tract infection (UTI) is one of the most common bacterial infectious disease in childhood. Renal scarring is an important complication of UTIs. Known risk factors for renal scarring are younger age, anatomic defects, delayed treatment, and causative pathogens other than Escherichia coli. The aim of this study was to compare the characteristics of clinical and laboratory features of UTI with E. coli to those with non-E. coli in infants. Methods : We reviewed the medical records of 1,120 infants under 12 months of age who had been admitted for UTIs between January 1998 and December 2007. All patients who were diagnosed with UTIs were divided into two groups (E. coli and non-E. coli UTIs). Results : Three hundred twenty-four of 1,120 cases met the inclusion criteria. The number of E. coli and non-E. coli UTIs was 273 (84.3%) and 51 (15.7%), respectively. As compared to the non-E. coli UTI group, the E. coli UTI group was younger (3.59 vs. 4.47 months, P =0.008), a longer duration of pyuria (3.96 vs. 3.06 days, P =0.01), higher peripheral white blood cell counts (13.89 vs. $12.13{\times}10^3/mm^3$, P =0.043), and lower rates of high degree (III-V) vesico-ureteral reflux (P =0.005). Conclusion : UTIs with E. coli might have more severe clinical features and a lower prevalence of high grade vesicoureteral reflux than UTIs with non-E. coli. However, no difference was noted in the clinical response to antibiotic therapy between the two groups.

목 적: 소아에서 요로 감염은 가장 흔한 세균 질환 중 하나로 합병증으로 신손상이 초래될 수 있다. 신손상의 위험 인자로는 더 어린 나이에 발병하거나, 요로계의 선천 기형이 동반되는 경우, 치료의 시작이 늦어진 경우, 비 E. coli에 의한 경우 등이다. 따라서 본 연구에서는 영아에서 E. coli UTI의 특징적인 임상 및 검사실 소견을 non-E. coli UTI과 비교해보았다. 방 법: 1998년 1월부터 2007년 12월까지 가톨릭대학교 성빈센트병원 소아청소년과에 요로 감염으로 진단된 12개월 미만의 환자를 대상으로 하였다. 모든 환자들을 E. coli UTI군과 non-E. coli UTI 군으로 나누어 의무기록 및 검사 소견을 후향적으로 조사하였다. 결 과: 연구군의 포함 기준에 합당한 환자는 총 324명이었으며, 이중 273명(84.3%)은 E. coli에 의한 요로 감염, 나머지 51명(15.7%)은 다른 균에 의한 감염이었다. E. coli UTI 군은 non-E. coli UTI 군에 비해 발병 연령이 더 어리고(3.59 vs 4.47개월, P =0.008), 입원 후 농뇨의 소실 기간이 더 길었고 (3.96 vs 3.06일, P =0.010), 진단 당시 말초 혈액 검사에서 백혈구 수가 더 많았으나(13.89 vs $12.13{\times}10^3/mm^3, P =0.043), III 등급 이상의 고등급 방광 요관 역류의 동반 빈도는 낮았다(P =0.005). 그러나 입원 후 해열 기간 및 항균제 치료의 반응에는 차이가 없었다. 결 론: 요로감염에서 균주에 따른 재발률 및 신 손상 등 장기 예후에 대한 추가적인 연구를 시행하여 영상 검사 및 치료 방침을 차별화 하여야 할 것으로 사료된다.

Keywords

References

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