Antibiotic-Associated Diarrhea in 3 to 6 Month Old Infants with Febrile Urinary Tract Infections

영아 발열성 요로감염 환자의 항생제 연관 설사

  • Won, Chong Bock (Department of Pediatrics, Gachon University Gil Hospital) ;
  • Kim, Min Chae (Graduate School of Medicine, Gachon University) ;
  • Eun, Byung Wook (Department of Pediatrics, Gachon University Gil Hospital) ;
  • Sun, Yong Han (Department of Pediatrics, Gachon University Gil Hospital) ;
  • Cho, Kang Ho (Department of Pediatrics, Gachon University Gil Hospital) ;
  • Tcha, Hann (Department of Pediatrics, Gachon University Gil Hospital) ;
  • Jeon, In Sang (Department of Pediatrics, Gachon University Gil Hospital)
  • 원종복 (가천의대길병원 소아청소년과) ;
  • 김민채 (가천대학교 의학전문대학원) ;
  • 은병욱 (가천의대길병원 소아청소년과) ;
  • 선용한 (가천의대길병원 소아청소년과) ;
  • 조강호 (가천의대길병원 소아청소년과) ;
  • 차한 (가천의대길병원 소아청소년과) ;
  • 전인상 (가천의대길병원 소아청소년과)
  • Received : 2011.09.16
  • Accepted : 2011.10.20
  • Published : 2012.04.25

Abstract

Purpose : This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. Methods : Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008 to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. Result : Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin ($3^{rd}$ CS) single therapy was used for 102 patients (69.4%), the $3^{rd}$ CS and non-$3^{rd}$ CS combination therapy for 24 (16.3%), and non-$3^{rd}$ CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P=0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P=0.717, P=0.830). Although the frequency of diarrhea was higher for the $3^{rd}$ CS and non-$3^{rd}$ CS combination therapy subgroup with $9.25{\pm}5.30$ times/day than the other two subgroups ($7.58{\pm}2.97$ times/day in $3^{rd}$ CS single therapy subgroup, $6.75{\pm}4.40$ times/day in non-$3^{rd}$ CS combination therapy subgroup), there was no statistical significance (P=0.078). Conclusion : AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.

목 적 : 본 연구는 발열성 요로감염으로 입원한 영아에서 항생제 연관 설사(Antibiotic-associated Diarrhea, 이하 AAD)의 양상 및 연관인자를 조사하였다. 이 연구는 영아 AAD의 예방과 치료에 사용되는 생균제에 대한 기초 연구이다. 방 법 : 가천의대길병원에서 2008년 1월부터 2010년 9월 사이에 급성 발열성 요로감염으로 입원한 생후 3-6개월의 영아들의 의무기록을 후향적으로 조사하여 AAD를 보인 환자(AAD군)와 보이지 않은 환자(non-AAD군)를 비교하였다. AAD군 내에서 사용한 항생제 요법과 용량, 설사의 양상을 비교하였다. 결 과 : 총 147명 중 AAD군은 54명(36.7%)이었고, 이 중 3세대 세팔로스포린($3^{rd}$ CS) 단일요법군, $3^{rd}$ CS과 비세팔로스포린 혼합요법군, 비세팔로스포린 혼합요법군 간의 설사의 발현 시점, 지속기간 및 횟수의 유의한 차이가 없었다(P>0.05). AAD군과 non-AAD군과의 cefotaxime 사용량의 유의한 차이는 없었다. 결 론 : 생후 3-6개월 영아의 발열성 요로감염 환자에서 AAD는 항생제의 요법과 평상적 투여량 범위내에서 용량에 관계없이 흔하게 발생하였다. 영아 AAD의 예방과 치료에 사용되는 생균제의 효과에 대한 추가적인 연구가 필요하다.

Keywords

References

  1. Berg RD. The indigenous gastrointestinal microflora. Trends Microbiol 1996;4:430-5. https://doi.org/10.1016/0966-842X(96)10057-3
  2. Park HS, Han DS. Management of antibiotics-associated diarrhea. Korean J Gastroenterol 2009;54:5-12. https://doi.org/10.4166/kjg.2009.54.1.5
  3. Alam S, Mushtaq M. Antibiotic associated diarrhea in children. Indian Pediatr 2009;46:491-6.
  4. Simakachorn N, Pichaipat V, Rithipornpaisarn P,Kongkaew C, Tongpradit P, Varavithya W. Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr 2000;30:68-72. https://doi.org/10.1097/00005176-200001000-00020
  5. Kotowska M, Albrecht P, Szajewska H. Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebocontrolled trial. Aliment Pharmacol Ther 2005;21:583-90. https://doi.org/10.1111/j.1365-2036.2005.02356.x
  6. Jo YJ, Lee EJ, Choi KM, Eun YM, Yoo HJ, Kim CH, et al. Causative organisms of community acquired urinary tract infection and their antibiotic susceptibility at a secondary hospital in Korea. Korean J Pediatr Infect Dis 2010;17:30-5.
  7. Bae EY, Lee SY, Jeong DC, Kang JH. Clinical characteristics and antibiotic resistance of urinary tract infections in children: Escherichia coli Versus Non-E. coli. Korean J Pediatr Infect Dis 2010;17:67-73.
  8. Hoogenauer C, Hammer HF, Krejs GJ, Reisinger EC. Mechanisms and management of antibiotic-associated diarrhea. Clin Infect Dis 1998;27:702-10. https://doi.org/10.1086/514958
  9. Kligler B, Hanaway P, Cohrssen A. Probiotics in children. Pediatr Clin North Am 2007;54:949-67. https://doi.org/10.1016/j.pcl.2007.10.002
  10. Villarruel G, Rubio DM, Lopez F, Cintioni J, Gurevech R, Romero G, et al. Saccharomyces boulardii in acute childhood diarrhoea: a randomized, placebo-controlled study. Acta Paediatr 2007;96:538-41. https://doi.org/10.1111/j.1651-2227.2007.00191.x
  11. Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2007:CD004827.
  12. Floch MH, Walker WA, Guandalini S, Hibberd P, Gorbach S, Surawicz C, et al. Recommendations for probiotic use--2008. J Clin Gastroenterol 2008;42 (Suppl 2):S104-8. https://doi.org/10.1097/MCG.0b013e31816b903f
  13. Turck D, Bernet JP, Marx J, Kempf H, Giard P, Walbaum O, et al. Incidence and risk factors of oral antibiotic associated diarrhea in an outpatient pediatric population.J Pediatr Gastroenterol Nutr 2003;37:22-6. https://doi.org/10.1097/00005176-200307000-00004
  14. Song HJ, Kim JY, Jung SA, Kim SE, Park HS, Jeong Y, et al. Effect of probiotic Lactobacillus (Lacidofil(R) cap) for the prevention of antibiotic-associated diarrhea: a prospective, randomized, double-blind, multicenter study. J Korean Med Sci 2010;25:1784-91. https://doi.org/10.3346/jkms.2010.25.12.1784
  15. Jirapinyo P, Densupsoontorn N, Thamonsiri N, Wongarn R. Prevention of antibiotic-associated diarrhea in infants by probiotics. J Med Assoc Thai 2002;85 (Suppl 2): S739-42.
  16. Sullivan A, Nord CE. Probiotics and gastrointestinal diseases. J Intern Med 2005;257:78-92. https://doi.org/10.1111/j.1365-2796.2004.01410.x