• The Monthly Diabetes
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• s.240
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• pp.17-19
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• 2009

요로 감염증은 당뇨병환자에게 흔히 발생하는 대표적인 감염질환 중 하나이다. 당뇨병환자에서 감염이 흔한 이유는 여러 가설들이 있으나, 다양한 기전에 의한 면역체계의 이상과 면역 저하 등 때문으로 생각하고 있다. 당뇨병환자에서 일반적인 감염이 좀 더 빈번하게 일어나지만 거의 당뇨병에서만 관찰되는 희귀 감염질환도 흔한데 그 중 요로의 기종성(공기주머니 형성) 염증은 특징적이다. 또한 일반 요로 감염에서는 흔하지 않은 칸디다와 같은 진균(곰팡이균)에 의한 요로 감염도 드물지 않게 관찰할 수 있다. 따라서 여기에서는 당뇨병에서 보이는 요로 감염의 특징과 대처방법에 대해서 살펴보기로 한다.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1994.04a
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• pp.331-331
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• 1994

최근 개발된 Teicoplanin은 glycopeptide계의 항생제로서 vancomycin과 그 작용 기전이 비슷하지만, 근육 주사가 가능하고, 반감기가 길어서 하루 한번 주사하여도 되며, 빨리 주입하더라도 red man syndrome이생기지 않는 장점이 있다. 이 연구의 목적은 그람 양성균에 의한 감염증을 치료하는데 teicoplanin이 효과적이고 안전한지를 vancomycin과 비교하는 것이다. 대상 환자 및 방법: 서울대학교병원에 입원하여 그람 양성균 감염증이 확인되거나 강력히 의심되는 환자를 대상으로 하였다. 감염증의 종류는 패혈증, 골수염, 하기도 감염증, 감염성 관절염, 피부 및 연조직 감염증, 요로 감염증으로 하였다. 대상 환자를 무작위로 teicoplanin또는 vancomycin군에 무작위 배정하였다. Teinoplanin은 처음에 loading을 위하여 400mg씩 12시간마다 3회 주사하고 이후에는 증증 감염이면 하루에 400mg, 중등중이면 200mg씩을 주사하였다. Vancomycin은 500mg을 6시간마다 또는 1. 0g을 12시간마다 정맥주사하였다. 치료 기간은 요로 감염증 5-10일, 하기도 감염증 5-10일, 패혈증 14-21일, 골수염 21-42일, 세균성 관절염 21-42일, 피부 및 연조직 감염증 5-10일로 하였다.

• The Monthly Diabetes
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• s.216
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• pp.39-41
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• 2007

당뇨병환자에서의 감염증은 인슐린과 항균제의 사용으로 그 이환율과 사망률이 현저히 감소하였으나, 현재까지 당뇨병환자의 진료에 있어서 해결해야 할 중요한 문제로 남아있다. 당뇨병환자에서 감염증의 발생빈도는 대부분 일반인과 차이가 없다고 보고되고 있으나 일부 특정 감염증의 빈도는 현저하게 증가하고 감염증의 정도가 훨씬 심하며, 임상양상도 정상인과 다른 것으로 알려져 있다. 특히 인플루엔자, 세균뇨, 악성 외이도염, 비뇌모균증, 기종성 담낭염, 기종성 신우신염 또는 방광염, 급성 신유두괴사, 신주위 농양, 진균성 요로 감염증, 그람 음성균에 의한 폐렴, 괴사성 연조직 감염과 족부 궤양 관련 감염증 등은 당뇨병과의 관련성이 이미 입증된 감염질환들이다. 당뇨병 환자에서 감염증의 발생빈도는 약 14.4%에서 39.5%까지 보고되고 있으며, 국내에서는 폐결핵 20%, 요로 감염 20%, 폐렴 16%, 진균감염 7.6%, 균혈증 6.2%, 족부 궤양 관련 감염증 5.5%의 순으로 보고되고 있다. 당뇨병환자가 감염증에 대한 원인에 대해서는 확실히 밝혀지지는 않았지만 탈수, 영양실조, 다형 백혈구의 기능 장애, 혈액 순환장애 및 신경병증 등으로 설명되고 있다. 특히 당뇨병환자에서는 미세 혈관병증과 죽상경화증이 흔히 발생하기 때문에 각 조직으로의 혈액 공급이 감소되어 각 장기 조직에서는 정상적인 영양 및 산소 공급과 적절한 면역 반응을 유지하는 것이 어려워 결과적으로 감염증에 걸리기 쉽다. 이 글에서는 여러 가지 감염증 중 족부 궤양 감염증, 기종성 신우신염, 비대뇌모균증, 간농양에 대해 사례를 중심으로 알아보겠다.

• The Monthly Diabetes
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• s.199
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• pp.11-13
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• 2006

당뇨병환자들은 일반인보다 요로감염의 위험이 크다. 이러한 감염증으로 인한 스트레스로 고혈당이 유발되기도 한다. 따라서 혈당이 높아지면 감염증 치료에 악영향을 끼치므로 엄격한 혈당 조절이 필요할 것이다.

• The Monthly Diabetes
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• s.220
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• pp.36-38
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• 2008

요로감염은 우리에게 조금은 생소하지만 당뇨병으로 인한 감염으로 무시할 수 없는 부분을 차지한다. 당뇨로 인한 방광염의 빈도가 증가하면서 요로감염이 동반될 수도 있기 때문에, 그 심각성과 대처방안 등을 울산대학교병원 감염내과 전재범 교수에게 들어 보았다.

• Childhood Kidney Diseases
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• v.14 no.1
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• pp.71-78
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• 2010

Purpose : Hydronephrosis is found about 30% of children with urinary tract infection (UTI). It can be caused by various conditions, although most childhood hydronephrosis is congenital. This study was performed to investigate the relationship between febrile UTI and hydronephrosis. Methods : We retrospectively reviewed the medical charts of 183 patients diagnosed as UTI between January 2007 and May 2009 at Korea University Guro Hospital. Inclusion criteria were as followings; 1) fever more than $37.5^{\circ}C$ measured in the axilla, 2) positive urine culture, 3) no history of urinary tract anomaly on antenatal sonography and urinary tract infection. We classified the enrolled children into two groups of patients with hydronephrosis (HN) and those without hydronephrosis (NHN). Results : The 80 patients were HN and 103 patients NHN. Hydronephrosis was found in 58 patients with left kidney, 8 right and 14 both kidneys. Most of hydronephrosis were of low grade. Compared with NHN group, initial renal cortical defects on DMSA scan significantly increased in HN group (HN 37.5%, NHN 16.5%, P<0.05). The incidence of VUR was not different between the two groups (HN 22%, NHN 12.1%). White blood cell counts and C-reactive protein were not different between the two groups. Follow-up DMSA scan (about 6 months later after UTI) showed no difference of renal scarring in both two groups. Conclusion : Our data suggests that hydronephrosis in febrile UTI patients is clinically useful for detecting renal cortical defects, but is not associated with follow-up renal scar.

• Pediatric Infection and Vaccine
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• v.24 no.1
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• pp.54-59
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• 2017

Purpose: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. Methods: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. Results: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. Conclusions: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.

• Childhood Kidney Diseases
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• v.14 no.2
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• pp.184-194
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• 2010

Purpose : The aim of this study was to evaluate the incidence of febrile urinary tract infection (UTI) according to clinical characteristics in patients with congenital hydronephrosis (CH) and hydronephrotic patients first diagnosed with hydronephrosis during treatment of febrile UTII. Methods : In this study, 200 patients with congenital hydronephrosis were enrolled in group 1 and 252 patients first diagnosed with hydronephrosis during treatment of febrile UTI were enrolled in group 2. We counted the episodes of UTI in the two groups according to clinical characteristics, the presence of VUR, type of feeding, and clinical outcomes since 2000. And we compared those results between the two groups. and compared two groups as well. Results : The incidence of recurrent UTI was 10%, 0.028 per person-year in group 1 and 16.7%, 0.051 per person-year in group 2, respectively (P <0.05). Group 2 had more VUR (3% vs. 27%, P <0.05) and higher incidence of UTI than group 1. The incidence of UTI in patients with CH of Society of Fetal Urology (SFU) grade 4 or grade 4-5 VUR was 80% and 44.4%, respectively. No significant differences were found in incidence of UTI between BMF (breast milk feeding) and artificial milk feeding group in both groups (P 1=0.274, P 2=0.4). The time of resolution of CH had no correlation with either number of UTI episodes or the presence of VUR. Conclusion : The overall incidence of UTI is low in patients with CH as well as patients patients first diagnosed with hydronephrosis during treatment of febrile UTI except patients with SFU grade 4 or grade 4-5 VUR. BMF has no protective effect against UTI.

• Journal of Veterinary Clinics
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• v.27 no.1
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• pp.6-10
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• 2010

Bacterial pathogens were isolated from dogs with urinary tract infection (UTI) in local animal hospitals between August 2003 and December 2009. Bacteria were isolated from urine of 47 dogs. The isolated pathogens were Escherichia coli (n = 27), Streptococcus spp. (n = 7), Staphylococcus spp. (n = 5), Enterobacter spp. (n = 3), Proteus spp. (n = 2), other species were 3 strains, respectively. E. coli were susceptible to imimpenem, polymyxin B, amikacin, cephalosporins, aztreonam, amoxicillin clavulate, cephalosporins, tricarcillin, and amoxicillin clavulate, while were resistant bacitracin, erythromycin, lincomycin, oxacillin, penicillin, and novobiocin. Streptococcus spp. were susceptible to bacitracin, imimpenem, and trimethoprime-sulfa, while were highly resistant amikacin, cefotaxim, cefoxitin, cloxacillin, gentamicin, lincomycin, oxacillin, penicillin, streptomycin, and tobramycin. Staphylococcus spp. were susceptible to cefoxitin, doxycycline, enrofloxacin, imimpenem, and tobramycin, but were resistant aztreonam and tetracycline.

• Childhood Kidney Diseases
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• v.13 no.1
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• pp.49-55
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• 2009

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.