• Journal of Yeungnam Medical Science
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• 제38권3호
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• pp.225-230
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• 2021

Background: We aimed to analyze the effectiveness of albumin to globulin ratio (AGR) in predicting postoperative febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URS) and retrograde intrarenal surgery (RIRS). Methods: From January 2013 to May 2018, 332 patients underwent URS and RIRS. The rate of postoperative fUTI and risk factors for postoperative fUTI were analyzed using logistic regression. Patients were divided into postoperative fUTI and non-postoperative fUTI (non-fUTI) groups. AGR with other demographic and perioperative data were compared between the two groups to predict the development of fUTI after URS. Results: Of the 332 patients, postoperative fUTI occurred in 41 (12.3%). Preoperative pyuria, microscopic hematuria, diabetes mellitus, hypoalbuminemia, and hyperglobulinemia were more prevalent in the fUTI group. Patients in the fUTI group had larger stone size, lower preoperative AGR, longer operation time, and longer preoperative antibiotic coverage period. In a multivariable logistic analysis, preoperative pyuria, AGR, and stone size were independently correlated with postoperative fUTI (p<0.001, p=0.008, and p=0.041, respectively). Receiver operating curve analysis showed that the cutoff value of AGR that could predict a high risk of fUTI after URS was 1.437 (sensitivity, 77.3%; specificity, 76.9%), while the cutoff value of stone size was 8.5 mm (sensitivity, 55.3%; specificity, 44.7%). Conclusion: This study demonstrated that preoperative pyuria, AGR, and stone size can serve as prognostic factors for predicting fUTI after URS.

• Childhood Kidney Diseases
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• 제25권1호
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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.

• 가정간호학회지
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• 제28권2호
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• pp.178-185
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• 2021

Purpose: In this study, we aimed to explore the risk factors for catheter-associated urinary tract infections (CAUTI) in patients receiving home care nursing. Methods: A total of 117 participants registered for home care nursing provided by the University of C hospital in Seoul were included in the study. Data were based on a survey and urine examination results from June to July 2018. Results: Asymptomatic bacteriuria was identified in 96 (82%) patients. Age, sex, activity, diabetes mellitus, mental status, presence of other diseases, catheter material type, catheter size and fixation, hand washing (care giver), gloving (care giver), perineal care, and bladder irrigation were not recognized as risk factors for CAUTI. Age and catheterization duration were associated with CAUTI. Conclusions: Old age was found to be a risk factor for CAUTI (p=0.048). CAUTI incidence decreased as catheter use exceeded 70 months (p=0.028).

• Childhood Kidney Diseases
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• 제26권1호
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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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• 제26권1호
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• pp.52-57
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• 2022

Purpose: To determine predictive factors for detecting renal parenchymal damages (RPDs) in infants with recurrent febrile urinary tract infection (fUTI). Methods: From January 2015 to December 2021, 102 infants with recurrent fUTI and who underwent ^99mTc-dimercaptosuccinic acid (DMSA) renal scan in our hospital were included in this study. Controls included infants with normal DMSA results performed 3 months apart from the 2nd episode of fUTI. DMSA-positive group included infants with positive DMSA results performed 3 months apart from the 2nd episode of fUTI or at the 3rd episode of fUTI. The recurrence rate, causative bacteria, renal size discrepancy of both kidneys, and laboratory findings including C-reactive protein (CRP) and spot urine sodium-to-potassium ratio (uNa/K) were compared between both groups. Results: Only 3.8% of 79 infants with a 2nd episode of fUTI showed positive DMSA results. fUTI recurred more frequently within 12 months of follow-up in the DMSA-positive group than in the control group (69% vs. 13%, P<0.001). CRP values were significantly higher in the DMSA-positive group than in the control group (7.3 mg/dL vs. 3.7 mg/dL, P<0.001). Spot uNa/K were significantly lower in the DMSA-positive group than in the control group (0.6 vs. 1.1, P<0.001). Conclusions: Congenital renal scar and RPDs on the DMSA scan were more frequently found in infants with recurrent fUTI than those in the control group. High CRP values and low spot uNa/K in acute infections were helpful in predicting the presence of RPD in infants with recurrent fUTI.

• Childhood Kidney Diseases
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• 제28권1호
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• pp.35-43
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• 2024

Purpose: Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods: We retrospectively reviewed the medical records of 147 patients <24 months of age with UTIs who were hospitalized between August 2018 and October 2021. The patients were divided into recurrent and single UTI episode groups. Clinical findings and anthropometric and laboratory data were compared between the two groups. Results: In the recurrent UTI group, the weight-for-length (WFL) percentile at the first UTI diagnosis was lower compared to the single UTI episode group, and the weight-for-age percentile at 3-month and 6-month follow-ups after the first UTI decreased (all P<0.05). In univariable logistic regression analysis, higher birth weight, lower WFL percentile, the presence of hydronephrosis, acute pyelonephritis or vesicoureteral reflux, the use of prophylactic antibiotics, and non-Escherichia coli infections were associated with the development of recurrent UTIs (all P<0.05). However, in the multivariable analysis, only the presence of hydronephrosis and prophylactic antibiotic use were independently related to UTI recurrence (P<0.05). Conclusions: The presence of hydronephrosis at the first UTI can be helpful for predicting UTI recurrence in young children aged <24 months. Antibiotic prophylaxis may be associated with UTI recurrence. Potential growth delay should be carefully monitored in infants with recurrent UTI.

• Clinical and Experimental Pediatrics
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• 제48권6호
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• pp.575-579
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• 2005

Urinary incontinence is the most common urinary symptom in children and causes considerable anxiety in children and parents. In most cases, there is no underlying organic pathology and the longterm prognosis is excellent. Despite these reassuring facts, children with wetting problems can be a challenge for primary pediatrician. This is probably because the problem is poorly understood, there is no readily identifiable medical pathology, and because treatment is usually time consuming and arduous. There is a great demand for treatment because wetting is an unpleasant symptom that can cause a stress and anxiety in the family. There may also be other coexisting problems such as urinary tract infection, constipation, soiling, and behavioral or emotional difficulties. Despite the frequency and vexing nature of voiding dysfunction, physicians may not always obtain a careful history to identify and to treat children properly with this condition. This article addresses the comprehensive diagnostic and therapeutic approach to such children.

• Pediatric Infection and Vaccine
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• 제5권2호
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• pp.221-229
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• 1998

목 적 : 소아의 요로감염은 성인과 달리 비특이적이고 전신적인 증상이 많아 진단이 늦어질 수 있고 요로계 이상과 발견당시 이미 신 반흔이 증명되는 경우가 많아 적절한 치료를 하지 않으면 청소년기의 신부전, 고혈압, 성장부진 등의 심각한 후유증을 남길 수 있다. 특히 신장을 침범하는 상부요로감염에서 치명적인 후유증을 남기기 때문에 요 배양검사 결과가 나오기 전 임상에서 쉽게 할 수 있는 급성기 반응 지표들과 방사선학적 검사를 통해 상부요로감염을 예측하고 신속하게 치료를 시작함으로씨 합병증을 감소시키고 환자 보호자에게 치료기간과 치료 방침 등을 설명해 줌으로써 향후 치료 및 추적 검사시 도움을 얻고자 하였다. 대상 및 방법 : 1995년 l월부터 1998년 5월까지 단국대학교 병원 소아과에 입원한 환아 56명을 대상으로 입원 당시 급성기 반응지표(CRP, ESR, WBC), 농뇨와 발열정도를 정량적으로 분석하여 방광 요관 역류 정도와 함께 신초음파 및 $^{99m}TC$-DMSA 신주사와 비교 분석하였다. 통계처리는 chi-square (x2) test를 이용하였고 P<0.05를 유의한 기준으로 삼았다. 결 과 : 1) 요로감염은 l세 미만에서 남아의 발생 빈도수가 더 높았으나 l세 이후에는 여아에서 더 높았다. 2) 급성기 반응지표인 CRP, 백혈구의 수지가 높을수록 상부요로감염을 시사하였다{P<0.05). 3) 발열이 심할수록 상부요로감염을 시사하였다(P<0.05). 4) 농뇨가 심할수록 상부요로감염을 일으킬 확률이 높았다(P<0.05). 5) 방광 요관 역류정도가 심할수록 상부요로감염을 일으킬 확률이 높았다(P<0.05). 6) $^{99m}TC$-DMSA 신주사가 상부요로감염을 예측하는데 신초음파보다 더 유용하였다. 결 론 : 급성기 반응지표들과 발열의 정도, 농뇨, $^{99m}TC$-DMSA 신주사 소견 등으로 상부요로감염을 예측할 수 있고 신속한 치료로 합병증을 감소시킬 수 있으며 보호자에게 향후 치료기간과 치료방침을 설명함으로써 좋은 유대 관계 속에서 지속적인 치료 및 추적관찰을 하는데 도움이 되리라 사료된다.

• 대한의생명과학회지
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• 제18권2호
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• pp.146-151
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• 2012

Urinary tract infection (UTI) is one of the most common bacterial infections and is predominantly caused by uropathogenic Escherichia coli (UPEC). UPEC strains generally possess several genes encoding virulent factors, which are mostly adhesins, toxins, bacteriocin and siderophores. E. coli is composed of four main phylogenetic group (A, B1, B2, D) and virulent extra-intestinal strains mainly belong to groups B2 and D. Prescription of ciprofloxacin, a kind of fluoroquinolone group antibiotics, is increasing now a days, but resistance to this drug is also increasing. A total of 188 strains of E. coli were collected. Thirteen strains were collected from healthy students in 2011 and 175 strains from patients with urinary tract infection in 2010. Virulence factor genes (papC, fimG/H, sfaD/E, hlyA, cnf1, and usp) were amplified by polymerase chain reaction (PCR) methods for phylogenetic group (A, B1, B2, D) detection. Ciprofloxacin susceptibility test was performed by disk diffusion method. The identified virulence factors (VFs), phylogenetic groups and ciprofloxacin resistance in 13 E. coli strains isolated from healthy students were papC (15.4%), fimG/H (76.9%), sfaD/E (30.8%), hlyA (23.1%), cnf1 (23.1%), usp (7.7%), phylogenetic group A (23%), B1 (8%), B2 (46%), D (23%) and ciprofloxacin resistance (7.7%), while those of in 175 E. coli strains isolated from patients with UTI were papC (41.1%), fimG/H (92.5%), sfaD/E (30.3%), hlyA (10.3%), cnf1 (30.3%), usp (27.4%), phylogenetic group A (9.1%), B1 (5.1%), B2 (60.6%), D (25.1%) and ciprofloxacin resistance (29.7%). In this study, 10 out of 13 E. coli strains (76.9%) from healthy students were found to possess more than one virulence factor associated with adhesion. In addition, one E. coli strain isolated from healthy students who had never been infected with UPEC showed ciprofloxacin resistance. According to these results between the virulence factors and phylogenetic groups it was closely associated, and UPEC strains isolated from patients showed high level of ciprofloxacin resistance.

• Childhood Kidney Diseases
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• 제5권2호
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• pp.176-181
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• 2001

목 적 : 요의 감염증 환아에서 방광 요관 역류는 흔히 발견되는 이상으로 대부분의 연구에서 요로 감염 3-6주 후 VCUG를 시행하는 것을 권유하고 있다. 하지만 검사를 하기 위해 기다리는 동안 만성 신질환으로 진행할 가능성이 있으며 추적 관찰에 실패하여 검사자체를 하지 못 하는 환아가 발생 할 수 있다. 따라서, 본 연구에서는 요로 감염 후 VCUG를 시행하는 시기가 요관 방광 역류의 빈도와 정도에 영향을 미치는지를 조사하였다. 대상 및 방법 : 1997년 3월부터 2000년 12월까지 요로 감염으로 메리놀병원 소아과에 내원한 환아 213명을 대상으로 후향적으로 조사하였다. 이들 환아를 요로 감염 진단 후 1주일 이내에 VCUG를 시행한 군(A군, 142명)과 1주일 이후에 VCUG를 시행한 군(B군, 71명)으로 나누어 각각을 비교하였다. 결 과 : A군의 $19\%$(27/142명), B군의 $18\%$(6/71명)에서 역류가 발견되었으며 통계학적으로 의미 있는 차이가 없었다(P=0.854). 하지만, 실제로 계획된 VCUG를 받은 환아는 A군 $100\%$, B군 $48\%$로 의미있은 차이가 있었으며(P<0.001), B군 환아에서 감염 후 VCUG를 받은 기간과 역류 정도에는 의미 있는 차이가 없었다(P=0.001). 결 론 : 본 연구의 결과에 따르면 요로 감염후 VCUG를 하는 기간과 역류의 빈도와 정도에는 차이가 없으므로 환아가 입원하고 있는 동안 VCUG를 시행하는 건이 더욱 바람직하며 이에 대한 보다 많은 연구가 필요하다고 생각한다.