Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Febrile Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum β-Lactamase-Producing and-Nonproducing Bacteria: A Comparative Study

Extended-Spectrum β-Lactamase 생성 균주와 비생성 균주에 의한 지역사회 획득 요로 감염 비교

  • Ahn, Do Hee (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Kim, Kyu Won (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Cho, Hye-Kyung (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Tchah, Han (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Jeon, In Sang (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Ryoo, Eell (Department of Pediatrics, Graduate School of Medicine, Gachon University) ;
  • Sun, Yong Han (Department of Pediatrics, Graduate School of Medicine, Gachon University)
  • 안도희 (가천대학교 의학전문대학원 소아과학교실) ;
  • 김규원 (가천대학교 의학전문대학원 소아과학교실) ;
  • 조혜경 (가천대학교 의학전문대학원 소아과학교실) ;
  • 차한 (가천대학교 의학전문대학원 소아과학교실) ;
  • 전인상 (가천대학교 의학전문대학원 소아과학교실) ;
  • 류일 (가천대학교 의학전문대학원 소아과학교실) ;
  • 선용한 (가천대학교 의학전문대학원 소아과학교실)
  • Received : 2014.10.07
  • Accepted : 2014.10.29
  • Published : 2015.04.25
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Abstract

Purpose: The purpose of this study was to investigate the clinical characteristics and outcome of febrile urinary tract infections (UTIs) caused by community-acquired extended-spectrum ${\beta}$-lactamase (CA-ESBL)-producing and -nonproducing bacteria. Methods: We analyzed febrile UTIs in children hospitalized at Gachon University Gil Medical Center from January 2011 to December 2013 through retrospective data collection from their medical records. Results: Among pathogens causing 374 episodes of UTIs, the proportion of ESBL-producing bacteria was 13.1% (49/374). The proportion of ESBL-producing Escherichia coli and Klebsiella spp. was 13.6% (48/354) and 5.0% (1/20), respectively. There was no significant difference between the CA-ESBL and CA non-ESBL groups in duration of fever ($4.2{\pm}2.7$ vs. $3.7{\pm}2.1$ days, P=0.10) and bacterial eradication rate with empirical antibiotics (100% vs. 100%). The risk of cortical defects on renal scan significantly depended on existence of vesicoureteral reflux rather than ESBL production of pathogen. Conclusions: There was no significant difference between the CA-ESBL and CA non-ESBL groups in renal cortical defects and clinical outcome. Careful choice of antibiotics is important for treatment of community-acquired UTI in children.

목적: 지역 사회 획득 열성 요로 감염 환자에서 extended-spectrum ${\beta}$-lactamase (ESBL) 생성 균주의 임상적 의의에 대해 알아보고자 하였다. 방법: 2011년 1월 1일부터 2013년 12월 31일까지 가천대 길병원에서 지역 사회 획득 열성 요로 감염으로 치료받은 18세 이하 소아 청소년 환자들을 ESBL 양성군과 음성군으로 구분하여 각 군의 임상 양상을 의무기록을 토대로 후향적으로 분석하였다. 결과: 연구 대상 기준을 만족하는 374건 중 ESBL 생성 균주에 의한 요로 감염은 13.1% (49건)이었다. ESBL 생성 균주의 비율은 E. coli 와 Klebsiella spp.가 각각 13.6% (48/354)와 5.0% (1/20)이었다. ESBL양성군과 음성군에서 발열 소실 기간($4.2{\pm}2.7$일 대 $3.7{\pm}2.1$일, P=0.10)과 멸균율(100% 대100%)은 차이가 없었다. ESBL 생성 여부와 관계 없이 방광 요관 역류가 동반되었을 경우에 신 겉질결손이 발생한 경우(41.9%)는 ESBL 생성 균주에서 신 겉질 결손이 발생한 경우(3.2%) 보다 많았다(P <0.05). 결론: 소아 열성 요로 감염 환자에서 원인 균주의 ESBL 생성 여부는 신 겉질 결손과 임상 경과에 차이가 없었다. 지역사회 획득 요로감염의 치료에서 항생제를 신중하게 선택해야 하며 ESBL 생성 균주에 대한 지속적인 감시가 필요하다.

Keywords

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