• Clinical and Experimental Pediatrics
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• 제53권9호
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• pp.840-844
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• 2010

Purpose: Microalbuminuria is defined as increased urinary albumin excretion (30-300 mg/day) or microalbumin/creatinine ratio (30-300 mg/g) in a spot urine sample. Although microalbuminuria is a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated microalbuminuria in children with urinary tract infection (UTI). Therefore, we compared the spot urine microalbumin/creatinine ratio in pediatric UTI patients with that of control subjects. Methods: We investigated the correlation between the ratio in children with UTI and age, height, weight, blood pressure, glomerular filtration rate (GFR), hematuria, vesicoureteral reflux, renal parenchymal defect, and renal scar, and its predictability for UTI complications. Results: We studied 66 patients (42 boys, 24 girls) and 52 healthy children (24 boys, 28 girls). The mean microalbumin/creatinine ratio in UTI patients was statistically significantly increased compared to the control group ($340.04{\pm}321.36mg/g$ vs. $225.68{\pm}154.61mg/g$, $P$=0.0141). The mean value of spot urine microalbumin/creatinine ratio ($384.70{\pm}342.22mg/g$ vs. $264.92{\pm}158.13mg/g$, $P$=0.0341) in 1-23 months age patient group showed statistically significant increase compared to control group. Microalbumin/creatinine ratio showed negative correlation to age (r=-0.29, $P$=0.0167), body surface area (BSA) (r=-0.29, $P$=0.0173) and GFR (r=-0.26, $P$=0.0343). The presence of hematuria ($P$=0.0169) was found to be correlated. Conclusion: The spot urine microalbumin/creatinine ratio in children with UTI was significantly greater than that in normal children, and it was positively correlated with GFR. This ratio is a potential prescreening and prognostic marker in UTI patients. Further studies are required to validate the predictability of microalbuminuria in pediatric UTI patients.

• 대한한의학방제학회지
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• 제23권1호
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• pp.141-150
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• 2015

Objectives : This study is to report the effects of Bangkibokryeong-tang(Fanjifuling-tang(BBT)) on stroke patient with Urinary tract infection.(UTI) Methods : A stroke patient diagnosed as UTI was treated with BBT (防己茯笭湯) at one-month intervals. We observed body temperature, amount of urine and recorded photographs of any changes during the treatment period. Treatment efficacy was assessed using urinary analysis. Results : After the treatment, there was improvement in urine analysis. And the symptoms of UTI and her conditions got better. Conclusion : The report suggests that BBT is effective in controlling various symptoms related to UTI with antibiotic resistance on stroke patient.

• Clinical and Experimental Pediatrics
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• 제55권10호
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• pp.367-370
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• 2012

Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.

• Childhood Kidney Diseases
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• 제9권1호
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• pp.46-55
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• 2005

목 적 : 일차성 방광요관역류 소아에서 재발성 요로감염은 신반흔의 원인으로 장기간 저용량 항생제 예방요법이 권장되어 왔다. 그러나 최근 항생제 예방요법의 효과에 대한 의문이 제기되었고 항생제 내성에 대한 우려도 있었다. 이에 일차성 발광요관역류 소아에서 항생제 예방요법의 효과에 대한 기초자료를 얻기 위하여 항생제 예방요법에 발생한 재발성 요로감염의 빈도와 위험요인을 조사하고자 하였다 방 법 : 1995년 3월부터 2001년 12월까지 이대목동병원 소아과에서 첫 발열성 요로감염 후에 일차성 방광요관역류가 발견되어 1년간 저용량의 trimethoprim-sulfimethoxazole을 투여 받은 91명을 후향적으로 조사하여 재발성 요로감염의 빈도와 요로감염의 위험요인들을 분석하였다. 결 과 : 재발성 요로감염은 31.9%(29/91)에서 발생하였고 이는 0.32회/환자년 이였다. 발열성 요로감염은 0.26회/환자년이였고 비발열성 요로 감염은 0.07회/환자년이였다. 포경 남아에서 요로 감염의 재발율은 37.2%(19/54)로 포경이 없는 남아의 0%(0/5)에 비하여 유의하게 높았다(P=0.025). 위험 예측치는 신반흔에서만 유의하게 높았다[RR=3.8(95% CI 1.0-14.1), P=0.04]. 여아, 연령, 급성신우신염, 배뇨장애 및 원인균 등은 위험인자로 작용하지 않았고 방광요관역류의 정도에 짜른 유의한 차이도 없었다. .결 론 : 일차성 방광요관역류가 있는 소아에서 항생제 예방요법은 요로감염의 재발을 억제하지 못히였다. 포경과 신반흔이 재발성 요로감염의 위험요인이였고 방광요관역류의 정도에 따른 차이는 없었다. 일차성 방광요관역류 소아에서 우선적으로 포경과 신반흔이 없는 소아에서부터 항생제 예방요법을 시행하지 않는 무작위 대조연구가 필요할 것으로 생각된다.

• Childhood Kidney Diseases
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• 제21권1호
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• pp.15-20
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• 2017

Purpose: Febrile urinary tract infection (UTI) is one of the commonest bacterial infections in children. The purpose of this study is to investigate the clinical characteristics of the first episode of febrile UTI occurring in children over 5 years compared to those in infants younger than a year. Methods: We retrospectively reviewed the medical records of 10 patients over 5 years, having febrile UTI, and 25 controls under 1 year. Clinical characteristics including symptoms at admission, the time interval between symptom onset and hospital visit and/or diagnosis, duration of fever, urinalysis, and other laboratory and imaging test results were compared between the two groups. Results: Most patients in the control group showed only high fever at the time of presentation to the hospital. However, 60% of the case group had fever along with gastrointestinal (GI) symptoms such as abdominal and flank pain, vomiting, as well as relatively mild pyuria. The case group showed a longer duration between symptom onset and hospital visit and/or diagnosis. Conclusions: Delay in diagnosis and initiation of treatment of UTI increases the risk of permanent renal scarring and associated complications. Therefore, early diagnosis and treatment of febrile UTI is vital for very young infants, as well as children considering that febrile UTI could be an important cause of febrile illness in children over 5 years.

• Childhood Kidney Diseases
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• 제19권2호
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• pp.143-147
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• 2015

Purpose: Burkholderia cepacia is an aerobic, glucose-non-fermenting, gram-negative bacillus that mainly affects immunocompromised and hospitalized patients. Burkholderia cepacia has high levels of resistance to many antimicrobial agents, and therapeutic options are limited. The authors sought to analyze the incidence, clinical manifestation, risk factors, antimicrobial sensitivity and outcomes of B. cepacia urinary tract infection (UTI) in pediatric patients. Methods: Pediatric patients with urine culture-proven B. cepacia UTI between January 2000 and December 2014 at Samsung Medical Center, a tertiary referral hospital in Seoul, Republic of Korea, were included in a retrospective analysis of medical records. Results: Over 14 years, 14 patients (male-to-female ratio of 1:1) were diagnosed with B. cepacia UTI. Of 14 patients with UTI, 11 patients were admitted to the intensive care unit, and a bladder catheter was present in 9 patients when urine culture was positive for B. cepacia. Patients had multiple predisposing factors for UTI, including double-J catheter insertion (14.2%), vesico-ureteral reflux (28.6%), congenital heart disease (28.6%), or malignancy (21.4%). Burkholderia cepacia isolates were sensitive to piperacillin-tazobactam and sulfamethoxazole-trimethoprim, and resistant to amikacin and colistin. Treatment with parenteral or oral antimicrobial agents including piperacillin-tazobactam, ceftazidime, meropenem, and sulfamethoxazole-trimethoprim resulted in complete recovery from UTI. Conclusion: Burkholderia cepacia may be a causative pathogen for nosocomial UTI in pediatric patients with predisposing factors, and appropriate selection of antimicrobial therapy is necessary because of high levels of resistance to empirical therapy, including aminoglycosides.

• Childhood Kidney Diseases
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• 제10권2호
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• pp.182-191
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• 2006

Purpose : We studied the degree of changes in antibiotic sensitivity toward causative organisms, prevalence and clinical manifestations of extended-spectrum $\beta$-lactamase(ESBL)-producers of urinary tract infection(UTI) for a period of three years. This serves to provide useful information in selecting adequate drugs for the treatment of UTI. Methods : We recruited 137 patients who grew more than $10^5$ CFU/mL in their urine culture among 250 patients who visited and were admitted to Handong University's Sunlin Hospital for UTI treatment from January 2003 to December 2005. We retrospectively analyzed the data from the medical records. Results : The common pathogenic organisms were Escherichia coli(65.0%), Klepsiella pneumoniae(14.0%), Enterococcus faecalis(5.8%) and Proteus vulgaris(2.9%) in consecutive order. The prevalence of ESBL-producers among isolated E. coli and K. pneumoniae was 4.5%(4 cases) and 14.3%(2 cases), respectively. The antibiotic sensitivity rates of E. coli were relatively high to amikacin(100%), imipenem(100%), ceftriaxone(95.5%) and tobramycin(91.4%) while relatively low to TMP/SMZ(55.4%), ampicillin/sulbactam(29.4%) and ampicillin(24.2%). Conclusion : The use of ampicillin, ampicillin/sulbactam and TMP/SMZ, which have been the first choices in the treatment of UTI, should be reconsidered due to the low sensitivity rates towards these antibiotics. Due to the high incidence and antibiotic tolerance of ESBL that might have risen from the development of new antibiotics and increased antibiotic use, it is necessary to consider changing the standard antibiotics that have been used in the treatment of UTI.

• Journal of Biosystems Engineering
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• 제33권5호
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• pp.340-347
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• 2008

Dipstick urinalysis is used as a routine test for a screening test of UTI (urinary tract infection) in primary practice because urine dipstick test is simple. The result of dipstick urinalysis brings medical professionals to make a microscopic examination and urine culture for exact UTI diagnosis, therefore it is emphasized on a role of screening test. The objective of this study was to the classification between UTI patients and normal subjects using hybrid neural network classifier with enhanced clustering performance in urine dipstick screening test. In order to propose a classifier, we made a hybrid neural network which combines with RBF layer, summation & normalization layer and L VQ artificial neural network layer. For the demonstration of proposed hybrid neural network, we compared proposed classifier with various artificial neural networks such as back-propagation, RBFNN and PNN method. As a result, classification performance of proposed classifier was able to classify 95.81% of the normal subjects and 83.87% of the UTI patients, total average 90.72% according to validation dataset. The proposed classifier confirms better performance than other classifiers. Therefore the application of such a proposed classifier expect to utilize telemedicine to classify between UTI patients and normal subjects in the future.

• 대한의생명과학회지
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• 제7권3호
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• pp.117-125
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• 2001

This study was performed in order to evaluate the risk factors for nosocomial urinary tract infection and the frequencies of organisms isolated, and to provide the epidemiologic and basic data of hospital acquired urinary tract infection in intensive care unit. A prospective analysis was performed with 1,235 urine samples following urinary bladder catheterization in 569 patients, who had no evidence of UTI at the time of catheter insertion, admitted to intensive care unit in Pusan P hospital between June 1997 and May 1998. To identify risk factors for UTI, clinical characteristics of infected patients were analyzed. We analyzed these data by percentage, chi-square and odd ratio. Obtained results were as follows: A total of 569 patients (male 341 and female 228) were an average age of 50.8 years and catheterization of 8.04 days. Incidence of UTI was 16.1% (199/1,235) and The risk factors of UTI were duration of catheterization over 7 days, no use of systemic antibiotics, summer and female, and During the first 7 days these risk factors were no use of systemic antibiotics, summer, place of first catheter insertion (ICU) and type of intensive care unit (NSICU). A total of 220 the isolated strains were Gram negative rod 83 (37.7%), yeast like fungi 74 (33.6%) and Gram positive cocci 63 (28.6%). The common organisms isolated were Enterococcus faecalis 23 (10.5%), Serratia marcescens 19 (8.6%), Pseudomonu spp.17 (7.7%), E. ooh 16 (7.3%), Staphylococcus epidemidis 11 (5.0%) mdklebsiellapneumoniae 8 (3.6%). Therefore, in these results 199 of 569 (35%) patients in ICU with indwelling urinary catheter developed UTI. The risk factors for UTI are prolonged duration of catheterization, no use of systemic antibiotics, summer, and female.

• Childhood Kidney Diseases
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• 제24권2호
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• pp.83-90
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• 2020

Purpose: To investigate the association between urinary neutrophil gelatinase-associated lipocalin (uNGAL) and leukocyte differential count in children with urinary tract infections (UTIs). Methods: A retrospective chart review was performed in children undergoing uNGAL measurements between June 2018 and September 2019. Patients with suspected or diagnosed UTIs were included. The relationship between uNGAL and blood leukocyte differential count was investigated in children. Results: A total of 197 children were included in this study, 119 of whom (60%) had UTIs. The non-UTI patients (n=78) were diagnosed with pneumonia, acute gastroenteritis, viral upper respiratory infection, and others. After adjusting for age, gender, and fever duration, the leukocyte count, monocyte count, and uNGAL levels were higher in the UTI group than in the non-UTI group (P<0.05). uNGAL showed positive correlations with neutrophil counts, monocyte counts, the neutrophil-to-lymphocyte ratio, and the monocyte-to-lymphocyte ratio in the UTI group (P<0.05). uNGAL levels were only associated with the neutrophil-to-lymphocyte ratio in the non-UTI group (P<0.05). In a multivariable logistic regression analysis, only uNGAL was associated with the presence of UTI (P<0.05). The area under the receiver operating characteristic curves for uNGAL and monocyte counts to identify UTI were 0.89 (95% confidence interval (CI): 0.824-0.939; P=0.025) and 0.7 (95% CI: 0.627-0.774; P=0.038), respectively. Conclusions: In children with UTIs, uNGAL levels may be associated with blood leukocyte differential counts. uNGAL measurements and monocyte counts can be helpful in children with suspected UTIs.