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Journal of the Korean Society of Pediatric Nephrology 2004;8(2): 214-222.
지역사회 획득 소아 요로 감염에서 Extended-Spectrum ${beta}-Lactamase$ 생성
이정원, 신지선, 서정완, 이미애, 이승주
1이화여자대학교 의과대학 소아과학교실
2이화여자대학교 의과대학 소아과학교실
3이화여자대학교 의과대학 소아과학교실
4이화여자대학교 의과대학 진단검사의학교실
5이화여자대학교 의과대학 소아과학교실
Incidence and Risk Factors for Extended-Spectrum ${beta}-Lactamase-Producing$ Escherichia coli in Community-acquired Childhood Urinary Tract Infection
Jung-Won Lee, Jee-Sun Shin, Jeong-Wan Seo, Mi-Ae Lee, Seung-Joo Lee
1Department of Pediatrics, Ewha Womans University, College of Medicine
2Department of Pediatrics, Ewha Womans University, College of Medicine
3Department of Pediatrics, Ewha Womans University, College of Medicine
4Department of Laboratory Medicine, Ewha Womans University, College of Medicine
5Department of Pediatrics, Ewha Womans University, College of Medicine
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ABSTRACT
Purpose: Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended-Spectrum ${beta}-Lactamase(ESBL)$ is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL (+) E. coli in community-acquired childhood UTI.
Methods: In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI.
Results : Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(+) E. coli compared with control patients (P<0.05). Although ceftriaxone showed 100% resistance in ESBL(+) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%).
Conclusion : Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(+) E. coli UTI and changes in selection of empirical antibiotics should be considered.
Key words: Extended-spectrum ${\beta}-lactamase$ | Escherichia coli | Community-aquired | Urinary tract infection
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