• Pediatric Infection and Vaccine
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• v.22 no.1
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• pp.29-35
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• 2015

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.

• Childhood Kidney Diseases
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• v.16 no.2
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• pp.95-101
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• 2012

Purpose: Recently, many evidence-based guidelines for the management of urinary tract infection (UTI) have been developed because of the importance of proper management. However, there is a lack of data regarding how pediatricians manage UTIs in Korea. Therefore, we surveyed pediatricians to determine whether they manage UTIs in an appropriate manner. Methods: A postal questionnaire survey of 78 pediatricians practicing in Daegu city was performed. Subjects were asked about diagnosis, imaging studies, treatment, and prevention of UTIs. Results: Most of the respondents (94.8%) performed urinalysis to diagnose UTI in febrile children with an unknown fever focus. However, many preferred inaccurate collection methods, such as bagged urine collection, and did not obtain urine cultures. The most frequently performed imaging modality was renal-bladder ultrasonogram. Orally administered antibiotics were preferred unless admission was needed. After diagnosis of UTI, the pediatricians usually provided information to caregivers about the disease itself and supplementary treatment. Of the respondents, only 28.6% had their own guidelines for management of vesicoureteral reflux. Conclusion: Most pediatricians suspected UTI in febrile children with an unknown focus appropriately. Nevertheless, the fact that many pediatricians preferred inaccurate urine collection methods and did not perform sufficient imaging studies to detect associated abnormalities likely resulted in overtreatment due to false-positive diagnosis of UTI and a low probability of ruling out genitourinary anatomical problems. To improve the quality of management of UTI, pediatricians should follow scientific and evidence-based guidelines.

• Childhood Kidney Diseases
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• v.21 no.2
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• pp.121-127
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• 2017

Purpose: The aim of this study was to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli in urinary tract infections (UTIs) in children. Methods: We retrospectively reviewed the clinical records of 212 inpatients aged 18 years or younger with UTIs treated at the Pediatric Department of Dongguk University Gyeongju Hospital between January 2008 and December 2016. For comparison, patients were divided into three groups according to age as follows: group 1, ${\leq}1$ month; group 2, >1 month to ${\leq}12$ months; and group 3, ${\geq}13$ months. The antibiotic resistance rates from January 2008 to December 2012 (study period 1) and from January 2013 to December 2016 (study period 2) were analyzed statistically by group. Results: As the patient age increased, the antibiotic resistance rate to ampicillin (P=0.013), levofloxacin (P=0.050), piperacillin/tazobactam (TZP) (P<0.001), and trimethoprim/sulfamethoxazole (P=0.002) increased. The frequency of extended spectrum beta-lactamase producing E. coli showed a significant difference from 5 cases (4.6%) in study period 1 and 16 cases (15.8%) in study period 2 (P=0.007). The antibiotic resistance rate of E. coli was compared between the two time periods and we found that the antibiotic resistance rate to cefotaxime was significantly increased from 5.4% to 16.8% (P=0.008) and that to TZP was significantly decreased from 40.5% to 7.9% (P<0.001). Conclusion: Over the past 9 years, the resistance rate to cefotaxime has increased but the resistance rate to TZP has decreased. Thus, it is important to continue to investigate the antibiotic resistance rates of bacteria in the community.

• The Journal of The Korea Institute of Intelligent Transport Systems
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• v.11 no.6
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• pp.40-48
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• 2012

In this paper, we suggests methods for determining optimal representative value and the optimal size of historical data for reliable travel speed prediction. To evaluate the performance of the proposed method in real world environments, we did field tests at four roadway links in Seoul on Tuesday and Sunday. According to the results of applying the methods to historical data of Central Traffic Information Center, the optimal representative value were analyzed to be average and weighted average. Second, it was analyzed that 2 months data is the optimal size of historical data used for travel speed prediction.

• Microbiology and Biotechnology Letters
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• v.50 no.2
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• pp.283-292
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• 2022

Colibactins (clb) and Cytotoxic Necrotizing Factors (cnf) are virulence factors that impact cell cycle through cellular differentiation, proliferation, and apoptosis. Urinary tract infections (UTIs) are the most common among type of infection among outpatients, with a lifetime incidence of about 60-65% in adult females. Here, we sought to isolate uropathogenic Escherichia coli (UPCE) from urine specimens and investigates the prevalence of clb A, B and cnf 1, 2 genes among these isolates. A total of 110 E. coli isolates were collected from patients with UTIs. All the isolates were examined for their hemolytic activity and only 46 isolates showed a halo zone of hemolysis on blood agar. The collected UPEC isolates were screened for the existence of clb A, B and cnf genes. The results revealed that out of 110 isolates, 28 harbored the clbA gene, 40 harbored clb B, and 24 isolates harboured cnf1. 13 isolates harbored clbA, clbB, and cnf1 genes, while no cnf2 gene was detected among isolates. The molecular detection revealed that 8 out of 28 hemolytic isolates carrying the clbA, 11 out of 40 were carrying clbB, 1 out of 24 were carrying cnf 1, and 5 out of 9 carrying clbA+clbB. Furthermore, 7 out of 13 isolates were hemolytic and carrying clbA, clbB, and cnf1 genes. Finally, we investigated the cytotoxicity of E. coli harboring clb and cnf genes, eukaryotic REF cells were exposed to E. coli producing colibactin, which induces DNA damage and leads to cell cycle arrest, senescence and death.

• Childhood Kidney Diseases
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• v.26 no.1
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• pp.46-51
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• 2022

Purpose: Delta neutrophil index (DNI) indicates immature granulocytes in peripheral blood and has been confirmed to be effective as a prognostic factor for neonatal sepsis. Also, it has been reported to have diagnostic value in acute pyelonephritis and in predicting vesicoureteral reflux (VUR) in the infant. We conducted the study to verify whether DNI is also helpful in the entire pediatric age group with febrile urinary tract infection (UTI). Methods: Medical records of children hospitalized for febrile UTIs were analyzed retrospectively. All subjects underwent kidney ultrasound and voiding cystourethrography. In the group with and without VUR, we compared sex and age, and the following laboratory values: the white blood cell count, neutrophil, polymorphonuclear leucocyte, eosinophil, hemoglobin, platelet count, C-reactive protein, DNI value, and the finding of ultrasound. Results: A total of 315 patients (163 males and 152 females; range, 0-127 months) were eligible, and 41 patients (13%) had VUR. As a result of univariate analysis, the white blood cell count, neutrophil, DNI, and ultrasonic abnormalities were high in the reflux group, and the hemoglobin and lymphocyte fraction values were low. The value of DNI and the abnormal ultrasound were significantly higher in the reflux group on the multivariate analysis. The area under the curve value of the receiver operating curve was higher in DNI (0.640; 95% confidence interval, 0.536-0.744; P=0.004), and the DNI cutoff value for VUR prediction was 1.85%. Conclusions: We identified that ultrasound findings and DNI values were helpful predictors of VUR in pediatric febrile UTIs.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.65-72
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• 2013

Purpose: Urinary tract infection (UTI) caused by gram-positive uropathogens is usually hospital-acquired and associated with predisposing conditions. However, the incidence of gram-positive bacteria in community-acquired UTIs has recently increased worldwide. We aimed to investigate the clinical significance of UTI and associated genitourinary malformations in young children with febrile UTIs caused by gram-positive bacteria. Methods: We retrospectively reviewed the medical records of 566 patients (age, <1 year) who visited the Korea University Medical Center for febrile UTIs between January 2008 and May 2013. We classified the patients into the following two groups: gram-positive (P group) and gram-negative (N group), according to the results of urine culture. The fever duration; white blood cell (WBC) counts and C-reactive protein (CRP) levels in peripheral blood; and the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR), and renal scarring were compared between the two groups. Results: The number of patients with gram-positive bacteria was 23 (4.1%) and with gram-negative bacteria was 543 (95.9%). The most common pathogen was Escherichia coli, and Enterococcus faecalis showed the highest incidence among gram-positive uropathogens. Patients with gram-positive bacteria showed longer fever duration compared to that in patients with gram-negative bacteria (P vs. N, $3.4{\pm}1.2$ vs. $2.9{\pm}1.6$ days, P <0.05). The incidence of VUR was increased in the gram-positive group compared to that in the gram-negative group (P vs. N, 55.6 vs. 17.8%, P<0.05). However, there were no significant differences in other laboratory and radiologic findings. Conclusion: The findings of our study show that community-acquired UTIs in patients younger than 1 year of age, caused by gram-positive uropathogens, can be associated with prolonged fever duration and the presence of VUR.

• 대한상한금궤의학회지
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• v.12 no.1
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• pp.161-169
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• 2020

Objective: This case report describes the improvements of a patient with recurrent cystitis who was treated using an herbal medication according to the Shanghanlun disease pattern identification diagnostic system (DPIDS). Methods: 'DPIDS'and 'Interpretation based on Etymological chinese characters,'the patient was diagnosed with Shaoyin-bing, provision number 315, and administered Baektong-tang herb medication for 30 days. The changes in the symptoms of recurrent cystitis were estimated using the Interstitial Cystitis Symptom Index and Problem Index-Korean version (ICSI/ICPI-K) and Visual Analogue Scale (VAS). Results : The ICSI/ICPI-K score changed from 33 to 0 and VAS score changed from 7 to 0. Conclusions: The main causes of the disease were 微 and 利,and the symptoms of recurrent cystitis

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.265-270
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• 2003

Purpose : To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis Methods : Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of ${\geq}10^5$ colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study. Results : The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%. Conclusion : Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.142-149
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• 2009

Purpose : The aim of this study was to determine the diagnostic value of serum procalcitonin (PCT) compared with that of C-reactive protein (CRP) and the total white blood cell count (WBC) in predicting bacterial infections in febrile infants<6 months of age. Methods : A prospective study was performed with infants <6 months of age who were admitted to the Department of Pediatrics with a fever of uncertain source between July and September 2008. Spinal taps were performed according to clinical symptoms and physical examination. Serum PCT levels were measured using an enzyme-linked fluorescent assay. Results : Seventy-one infants (mean age, 2.62 months) were studied. Twenty-six infants (36.6%) had urinary tract infections (UTIs), and 22 infants (31.0%) had viral meningitis. The remaining infants had acute pharyngitis (n=1), herpangina (n=1), upper respiratory tract infections (n=7), acute bronchiolitis (n=8), acute gastroenteritis (n=4), and bacteremia (n=2). The median WBC and CRP levels were significantly higher in infants with UTIs than in infants with viral meningitis. However, there were no differences in the median PCT levels between the groups (0.14 ng/mL vs. 0.11 ng/mL, P=0.419). The area under the receiver operating characteristic curve was 0.792 (95% CI, 0.65-0.896) for WBC, 0.77 (95% CI, 0.626-0.879) for CRP, and 0.568 (95% CI, 0.417-0.710) for PCT. An elevated WBC count (>11,920/${\mu}L$) and an increased CRP level (>1.06mg/dL) were significant predictors of UTIs based on multiple logistic regression analysis. Conclusion : Serum PCT concentrations should be interpreted with caution in infants <6 months of age with a fever of uncertain source.