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Journal of the Korean Society of Pediatric Nephrology 2013;17(2): 65-72. doi: https://doi.org/10.3339/jkspn.2013.17.2.65
1세 이하의 발열성 소아 요로감염에서 Gram-Positive Uropathogens의 발생 빈도 및 임상적 의의
양태환, 임형은, 유기환
고려대학교 의과대학 소아과학교실
Clinical Significance and Incidence of Grampositive Uropathogens in Pediatric Patients Younger than 1 Year of Age with Febrile Urinary Tract Infection
Tae Hwan Yang, Hyung Eun Yim, Kee Hwan Yoo
Department of Pediatrics, College of Medicine, Korea University
Corresponding Author: Hyung Eun Yim ,Tel: 031-412-5096, Fax: 031-405-8591, Email: he-yim@hanmail.net
Received: August 8, 2013;  Accepted: August 27, 2013.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons. org/licenses/bync/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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ABSTRACT
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: grampositive (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±1.2 vs. 2.9± 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.
Key words: Fever duration | Gram-positive uropathogens | Urinary tract infection | Vesicoureteral reflux
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