• Childhood Kidney Diseases
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• v.25 no.1
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• pp.22-28
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• 2021

Purpose: The purpose of this study was to investigate the clinical outcomes of non-carbapenem treatment for urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) in young children. Methods: We retrospectively reviewed the medical records of children under 2 years of age who were diagnosed and treated for UTIs caused by ESBL-producing E. coli from September 2014 to March 2020. Results: Forty-three children under 2 years of age were treated with non-carbapenem antimicrobials for UTIs caused by ESBL-producing E. coli without bloodstream infections. The overall clinical and microbiological success rates for empirical antimicrobial treatment were 90.7% and 97.7%. Three of the patients (7.0%) experienced a relapse of UTI within a month. An in vitro susceptibility test showed that two patients were sensitive and one was resistant to the antimicrobial treatments. Furthermore, there were no significant differences in the time to defervescence, clinical success, microbiological success, and relapse rate between the susceptible (n=13) and non-susceptible groups (n=30). Conclusion: In this study, the overall relapse rate of patients treated with non-carbapenem antimicrobials was 7.0%. The patients showed high success rates in the clinical and microbiological responses to the non-carbapenems regardless of the results of the in vitro antimicrobial susceptibility test. These results provide evidence that non-carbapenems may be viable alternative treatments for UTIs caused by ESBL-producing E. coli.

• Microbiology and Biotechnology Letters
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• v.50 no.1
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• pp.147-156
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• 2022

Urinary tract infections (UTIs) are one of the most common infections in different age groups, including children. Bacteria are the main etiological agents of UTIs. The aim of the present study was to isolate, identify, and determine the antibiotic susceptibility of bacteria isolated from children with UTIs from Baghdad, Iraq. Three hundred and two urine samples were collected from children aged 6 months to 12 years. The samples were cultured on blood agar and MacConkey agar. The selected colonies were subjected to biochemical tests and antibiotic susceptibility analysis using the Vitek^® 2 Compact automated microbial identification system. In this sample, 299 bacteria were identified, of which, 267 were gram-negative bacteria, and 32 were gram-positive bacteria. Escherichia coli (56%) was the most commonly isolated gram-negative bacteria, followed by Pseudomonas aeruginosa (14%), Enterobacter spp. (10.48%), Klebsiella pneumoniae (9.36%), Proteus spp. (7.8%), Acinetobacter baumannii (1.5%), and Morganella morganii (0.37%). Enterococcus faecalis (62.5%) was the most commonly detected gram-positive bacteria, followed by Staphylococcus aureus (37.5%). E. coli and P. aeruginosa were the most antibiotic-resistant bacteria. Among the tested antibiotics, meropenem showed 100% sensitivity, followed by imipenem (97.4%), amikacin (91.8%), and tobramycin (83.5%). In contrast, the high frequencies of resistance were observed with cefixime (93.2%), cefotaxime (78.7%), and ceftriaxone/cefotaxime (71.2%). In conclusion, carbapenems and aminoglycosides are highly recommended for the empirical treatment of UTIs, while, Quinolones, penicillins, and cephalosporins are not suggested. Frequent antibiotics susceptibility testing are warranted to determine the resistance pattern of UTI bacteria.

• Childhood Kidney Diseases
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• v.17 no.1
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• pp.19-24
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• 2013

Purpose: Recently, enterococcus spp. have become one of the most common nosocomial pathogens with increasing rates of multi-drug resistance. However, study on enterococcal urinary tract infections (UTIs) in children is very limited, especially community acquired UTIs. We studied the clinical characteristics of enterococcus spp. in community acquired UTIs and antibiotic resistance within our urban area. Methods: All children with first episode of community acquired UTIs due to enterococcus spp. and Echerichia coli who were admitted in Pusan National University Children's Hospital between January 2010 and January 2013 were included in our study. We retrospectively reviewed their medical records. Results: During the study period, 201 patients were identified to have first episode of community acquired UTIs. 154 cases were E.coli UTIs (76.6%) and 11 cases were enterococcal UTIs (5.5%) and all enterococcus spp. were Enterococcus feacalis. In enterococcal UTI group, voiding cystourethrogram(VCUG) was performed in 7/11 patients and demonstrated 4 vesicoureteral refluxes (VURs) with renal scar and 3 patients underwent corrective surgery. In E.coli UTI group, VCUG was performed in 121/154 patients and demonstrated 23 VURs and 11 patients underwent corrective surgery. Enterococcal group had significant high rate of underlying urinary abnormalities and surgical corrections compared with E. coli group. All enterococcus spp. were susceptible to ampicillin, vancomycin and linezolid, but all were resistant to tetracycline. They also showed 71.4% resistance to trimethoprim-sulfamethoxazole and 20% resistance to ciprofloxacin. Conclusion: Community acquired enterococcal UTIs in children were rare within our urban area. However, they could be indicative of severe underlying urinary tract abnormalities.

• Childhood Kidney Diseases
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• v.24 no.1
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• pp.27-35
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• 2020

Purpose: Urinary tract infections (UTIs) are the most common and serious bacterial infections in children. Therefore, early diagnosis of vesicoureteral reflux (VUR) for treatment planning and the identification of noninvasive markers that can predict renal injury are important in patients with UTIs. We analyzed the clinical features of pediatric UTIs commonly encountered by general practitioners and reinterpreted the blood tests and imaging findings to identify the important clinical predictive markers of VUR in order to selectively perform VCUG. Methods: This retrospective study was performed among 183 children diagnosed with a UTI or acute pyelonephritis. Results: The most significant predictor of high grade and bilateral VUR identified using area under the curve analyses was hydronephrosis on kidney ultrasound images with renal cortical defects on dimercaptosuccinic acid (DMSA) kidney scan simultaneously, followed by hydronephrosis only on kidney ultrasound. Conclusion: The presence of hydronephrosis on kidney ultrasound images or cortical defects or asymmetric kidneys on the DMSA kidney scans can be predictive markers of VUR, reducing the need for VCUG. Our study can thus help minimize the exposure to radiation among patients through selective VCUG.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.162-166
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• 2009

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.

• Proceedings of the Korean Information Science Society Conference
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• 2006.06d
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• pp.316-318
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• 2006

본 논문에서는 차세대 지능형 교통시스템인 UTIS(Urban Traffic Information System)의 빠른 접속 요구 조건을 만족하기 위한 DLC(Dynamic Limited Contention) 알고리즘을 제안한다. UTIS 네트워크는 고속으로 이동하는 차량에 설치된 모바일 노드와 도로 변에 설치된 노변 기지국으로 구성되며, 이 네트워크를 통해서 IP 데이터 그램의 전송 서비스, 방송 데이터를 실시간으로 전송하는 실시간 전송 서비스 그리고 차량의 위치를 계속적으로 알려 주는 위치 탐색 서비스를 지원한다. 이러한 전송 서비스를 지원하기 위해서 UTIS는 물리 계층과 MAC 계층으로 구성된다. 그러나 UTIS에서는 차량의 고속 이동으로 인해서 셀(cell)간의 핸드오프가 빈번히 발생하고 또한 위치 추적과 방송 서비스와 같은 실시간 전송 서비스를 지원해야 하기 때문에 기존의 802.11 MAC을 사용할 수 없다. 즉 UTIS에서의 빠른 등록 요구 조건을 충족시키기 위해 기존의 802.11에서 사용하는 경쟁(contention) 방식은 비효율적이다. 본 논문에서는 셀 내에 도착하는 노드 수에 따라 경쟁을 하는 그룹의 크기를 동적으로 조절하는 DLC 알고리즘을 제안한다. 기존의 UTIS에서는 그룹 크기를 정적으로 결정하고 모바일 노드는 자신의 주소에 이 정적 그룹 크기로 modulo하여 자신의 속한 그룹을 초기에 계산한다. 기지국이 접속해야하는 그룹을 폴링 메시지로 지정할 때 그 그룹에 속한 모바일 노드들만이 제한적으로 경쟁하게 된다. 이러한 정적인 그룹 크기는 셀 내에의 노드의 숫자와 그룹 크기의 분포를 고려하지 않는 방식으로 비효율적이다. 본 DLC 알고리즘에서는 전 폴링 주기 동안에 경쟁하는 노드의 빈도수를 계속적으로 추적하여 등록 시점에 경쟁하는 그룹의 개수를 동적으로 조절하게 된다. 이러한 방식은 UTIS와 같이 접속 시간이 제한적이고 접속하려는 노드 수가 빠르게 변화하는 환경 하에서 기존의 802.11 MAC 프로토콜과 정적인 그룹 크기 방식에 비해 효율적이다.

• Childhood Kidney Diseases
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• v.19 no.2
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• pp.56-64
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• 2015

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. $^{99m}Tc$-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

• Childhood Kidney Diseases
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• v.20 no.2
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• pp.57-62
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• 2016

Purpose: We used technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy to identify factors predictive of renal cortical defects in infants <3 months of age with urinary tract infections (UTIs). Methods: We retrospectively reviewed data on infants <3 months of age with culture-proven UTIs treated at a single center from March 2010 to February 2016. Blood samples were obtained for laboratory evaluation prior to commencement of antibiotic therapy. The therapeutic delay time (TDT) and therapeutic response time (TRT) were recorded. All patients were divided into two groups depending on features of their DMSA scans. We compared the demographic, clinical, and laboratory characteristics of the two groups. Results: A total of 119 infants (94 males and 25 females; mean age, $56.9{\pm}21.3days$) were included. Cortical defects were evident in the DMSA scans of 47 cases (39.5%). In infants with such defects, the peak temperatures ($38.9{\pm}0.57^{\circ}C$ vs. $38.4{\pm}0.81^{\circ}C$, P=0.001), the absolute neutrophil counts ($8,920{\pm}4,460/mm$ vs. $7,290{\pm}4,090/mm$, P=0.043), and the C-reactive protein (CRP) levels ($6.49{\pm}4.33mg/dL$ vs. $3.21{\pm}2.81mg/dL$, P=0.001) were significantly higher than those in infants without cortical defects. The TDT was also longer in those with cortical defects (P=0.037). Conclusion: We found that a TDT ${\geq}8.5hr$ (odds ratio [OR] 5.81), a peak temperature ${\geq}38.3^{\circ}C$ (OR 6.19), and a CRP level ${\geq}4.96mg/dL$ (OR 7.26) predicted abnormal DMSA scan results in infants <3 months of age with UTIs.

• Journal of Korean Society of Transportation
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• v.29 no.6
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• pp.107-116
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• 2011

In this paper, we implement an algorithm of transit signal priority control that not only maximizes service quality and efficiency of bus, but also minimizes the control delay of passenger cars using UTIS currently being deployed and operated in Seoul national capital area. For this purpose, we propose an algorithm that coordinates the strength of TSP by estimating bus demand. Typically, the higher the strength of TSP is on main street, the bigger the control delay is on the cross street. Motivated by this practical difficulty, we proposes an algorithm that coordinates TSP's strength by checking the degree of saturation of cross street. Also, we verify the possibility of field implementation via simulation analysis using CORSIM RTE based HILS (Hardware In the Loop Simulation). The result shows that travel time of bus improves about 10 percent without increasing control delay of passenger cars by TSP. We expect the result of this research to contribute to increasing the overall transit ridership in this country.

• The Journal of the Korea Contents Association
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• v.18 no.3
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• pp.52-61
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• 2018

This research suggested the traffic signal timing calculation model for signal intersections based on sectional travel time. A detection system that collects sectional travel time data such as Urban Transport Information System(UTIS) is applied. This research developed the model to calculate saturation flow rate and demand volume from travel time information using a deterministic delay model. Moreover, this model could determine the traffic signal timings to minimize a delay based on Webster model using traffic demand volume. In micro simulation analysis using VISSIM and its API ComInterface, it checked the saturation conditions and determined the traffic signal timings to minimize the intersection delay. Recently, sectional vehicle detection systems are being installed in various projects, such as Urban Transportation Information System(UTIS) and Advanced Transportation Management System(ATMS) in Korea. This research has important contribution to apply the traffic information system to traffic signal operation sector.