• Childhood Kidney Diseases
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• v.23 no.1
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• pp.22-28
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• 2019

Purpose: We studied the pathogens and trends in antibiotic sensitivity pattern in children with urinary tract infection (UTI) over 8 years in order to evaluate adequate treatment. Methods: We performed a retrospective review of medical records of children with UTI from January 2009 to December 2016 in Daegu Fatima Hospital. Uropathogens and antibiotic sensitivity patterns were selected. Only 1 bacterial species with a colony count of ${\geq}105CFU/mL$ was considered a positive result. We compared 2 periods group (A: 2009~2012, B: 2013~2016) to investigate trends of antibiotic sensitivity pattern. Results: During the 8 year period, 589 cases are identified (E. coli was cultured in 509 cases, 86.4%). Among all patients, this study investigated the antibiotic sensitivity of E. coli. Antimicrobial susceptibility to ampicillin was steadily low for both periods (A: 32.6%, B: 40.1%, P=0.125), and to amikacin was consistently high for both periods (A: 99.4%, B: 99.3%, P=1.000). Antibiotic sensitivity to third-generation cephalosporin decreased from period A to B (A: 91.7%, B: 75.5%, P=0.000). Antibiotic sensitivity to quinolone significantly decreased from A to B (A: 88.4%, B: 78.2%, P=0.003). The prevalence of extended-spectrum ${\beta}$-lactamase-producing E. coli increased from period A to B (A: 6.1%, B: 17.1%, P=0.000). Conclusion: This study showed that conventional antibiotic therapy for the treatment of pediatric UTI needs to be reevaluated. A careful choice of antibiotic is required due to the change in antibiotic sensitivity and the emergence of antibiotic-resistant bacteria.

• The Journal of the Society of Stroke on Korean Medicine
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• v.20 no.1
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• pp.17-24
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• 2019

■ Objectives The purpose of this case report is to show the effect of Bojungiki-tang on a patient complaining dysuria and urinary pain caused by repeated urinary tract infection(UTI) occurred after onset of cerebral infarction. ■ Methods A cerebral infarction patient with repeated UTI was treated with herbal medication, Bojungiki-tang. Then we evaluated the improvement with amount of total urine output, nelaton catheterization urine output and self voiding urine output. ■ Results Increase in amount of total and self voiding urine output and decrease in amount of nelaton urine output were observed after taking Bojungiki-tang. ■ Conclusion This case showed the effect of Bojungiki-tang on dysuria and urinary pain caused by repeated UTI.

• Childhood Kidney Diseases
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• v.21 no.1
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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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• v.10 no.2
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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.

• Clinical and Experimental Pediatrics
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• v.64 no.6
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• pp.293-300
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• 2021

Background: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. Purpose: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. Methods: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated. Results: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). Conclusion: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.

• 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.

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.156-171
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• 1996

Background: Nosocomial infection control is one of important means to assure the quality of medical care in the hospital, however, it has been neglected by most of the hospital personnels. Of nosocomial infections, urinary tract infection is the highest incidence, which is related to the indwelling catheter. It is, therefore, necessary to pay primary attention to the patients with the indwelling catheter in intensive care unit in order to control nosocomial Infection and to improve the quality of medical care in the hospital. Methods : The subjects of this study were patients with indwelling catheter who were admitted to the ICU of Pusan Paik Hospital from March 1994 to May 1995. The author calculated UTI rate among the subjects through the cultivation of the urine, identified the related factors of the UTI through brain storming of study team and head nurses working at ICU, and analized the effectiveness of the proposed approaches through comparing the infection rates of before and after activities. Results : The major activities carried out by the study team were to conduct in-service education programs for the staffs working at ICU about the importance of the nosocomial infection control in QA, and nursing intervention to reduce the UTI rate among the patients with indwelling catether. 1. The major nursing interventions that the study team had implemented were as follows ; 1) Drainage system was changed from partial open system to completely closed system. 2) Bladder irrigation which was routinely practised in all patients stopped among the noninfected patients. 3) Bladder irrigation set was changed to the disposable one. 4) Catheter was inserted under the anesthesia for patients to be operated. 5) Male patient receiving wrapped with gauze after perineal care was not wrapped. 6) Clamp which had not been before was newly attached to drainage tube. 7) Urine bag which had been packed into a lot of pieces was done into each piece. 8) The interval of change of indwelling catheter had regularly been four weeks, however it was used continously until it worked well. 9) Catheter was attached well at the defined site. 10) Paper towel was used instead of cotton towel. 11) Mats at the entrance were removed and cleansing of wards was enhanced. 2. The UTI rate by month was 34.4% in maximum and 9.8% in minimum during the period of this study, however it had gradually decreased. After 6 months from initiating infection control activities, the trend of rates was relatively stable. It was identified that UTI rate was different by season 12.5% in winter and 27.2% in summer. 3. Utilization rate of indwelling catheter was maintained at under 50%, but it was increased above 57% from April 1995. 4. The number of bladder irrigation sets used per day was 33.3 sets in maximum and 2.8 sets in minimum. The number used per day were also remarkably deceased. Conclusion : It was found that a program to control UTI could contribute to nosocomial infection control, and it was, in turn, a mean to assure the quality of medical care in the hospital. The nursing interventions which this study team had implemented were effective in the reduce of UTI rates.

• Childhood Kidney Diseases
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• v.20 no.2
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• pp.63-68
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• 2016

Purpose: Disruption of normal renal development can lead to congenital anomalies of the kidney and urinary tract, including renal hypodysplasia. We aimed to clarify whether small kidney size affects clinical manifestations in children with urinary tract infection (UTI). Methods: One hundred fifty-four patients who had their first symptomatic UTI between January 2014 and June 2015 were enrolled in this study. Differences in kidney size were estimated based on percent uptake of $^{99m}Tc-$ dimercaptosuccinic acid (DMSA) in scintigraphy. The patients who showed more than 10% difference in kidney size on DMSA scintigraphy with none or minimal cortical defects were included in group A. (group A, n=17). Laboratory, clinical, and imaging results were compared with those of the other patients (group B, n=137). Results: Group A had a relatively higher incidence of vesicoureteral reflux than group B (44% vs 20%, P<0.05). The levels of plasma neutrophil gelatinase-associated lipocalin (NGAL) and serum C-reactive protein were significantly higher in group A (193 [64-337] vs 91 [59-211] ng/mL and 4.1 [0.5-11.9] vs 2.1 [0.7-5.3] ng/mL, respectively; all P <0.05). Linear regression analysis revealed that plasma NGAL level strongly correlated with the difference in renal uptake in DMSA scintigraphy in group A ($R^2=0.505$). Conclusion: The difference in kidney size could influence the clinical course and severity of pediatric UTI.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.3
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• pp.85-93
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• 2017

The urinary tract infection (UTI) is one of the most important infections in hospital. The overuse and misuse of antimicrobial agents and the resulting emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult. This study examined the changes in the antibiotic susceptibility to the causative organisms of urinary tract infections to provide useful information on the choice of adequate drugs in the treatment of urinary tract infections. The medical records of 2,707 patients with more than $10^5/ml$ microorganism in urine culture between January 2010 and December 2015 were reviewed retrospectively. The most common pathogenic organism was E. coli (28.1%). In the case of E.coli, there were no differences in frequency from 2010 to 2015 in men, but since 2014, the frequency decreased gradually since 2014 in women. For E. coli, the resistance rates to antibiotics were 72.2% in ampicillin, 44.9% in trimethoprim/sulfamethoxazole (TMP/SMX), and 41.3% in ciprofloxacin, but the 2nd, 3rd, and 4th cephalosporin (5%) had low antibiotic resistance rates. The pathogens of urinary tract infection are becoming diverse and their frequencies are also changing over time. These results suggest that the recommended drugs for UTI should be selected more carefully for in-patients and out-patients.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.215-221
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• 2009

Purpose : Thymus is a lymphoproliferative organ that changes size in various physiological states in addition to some pathological conditions. Thymus is susceptible to involution, and shows a dramatic response to severe stress. Thymic measurements may be helpful in various diseases. UTI (urinary tract infection) is most common bacterial infection in infants and VUR (vesicoureteral reflux) is a common abnormality associated with UTI. In our study, the size of thymus was compared on the premise that a greater stress is exerted on the body when UTI is accompanied by VUR, than when occurs on its own. Methods : Thymic size was measured on standard chest anteroposterior radiographs and expressed as the ratio between the transverse diameter of the cardiothymic image at the level of the carina and that of the thorax (CT/T). The medical records of 99 febrile urinary tract infection infants without other genitourinary anomalies except VUR were reviewed retrospectively. Results : Among 99 patients with febrile UTIs, 25 were febrile UTI without VUR and 74 with VUR. For the UTI with VUR group, there was a significant decrease in the thymic size compared to the those without VUR group ($0.382{\pm}0.048$ vs $0.439{\pm}0.079$, P<0.05). However, there were no differences in the duration of fever and WBC, CRP between the UTI with VUR and UTI without VUR. In addition, there were no differences in the cardiothymic/thoracic ratios between renal defects and renal scars in febrile UTI patients. Conclusion : The results of this study show that the shirinkage of thymus was more frequently found in the UTI patients with VUR. Therefore, awareness of the risks associated with thymic size is important for the appropriate work up and management of UTI patients.