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Journal of the Korean Society of Pediatric Nephrology 2005;9(1): 46-55.
일차성 방광요관역류 소아에서 항생제 예방요법 중에 발생한 재발성 요로감염의 빈도와 위험인자
조수진, 김현진, 이정원, 이승주
1이화여자대학교 의과대학 소아과학교실
2이화여자대학교 의과대학 소아과학교실
3이화여자대학교 의과대학 소아과학교실
4이화여자대학교 의과대학 소아과학교실
Incidence and Risk Factors of Recurrent Urinary Tract Infections during Antibiotic Prophylaxis in Children with Primary Vesicoureteral Reflux
Su-Jin Cho, Hyun-Jin Kim, Jeong-Won Lee, Seung-Joo Lee
1Department of Pediatrics, Euha Woman University College of Medicine
2Department of Pediatrics, Euha Woman University College of Medicine
3Department of Pediatrics, Euha Woman University College of Medicine
4Department of Pediatrics, Euha Woman University College of Medicine
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ABSTRACT
Purpose : Recurrent urinary tract Infection(UTI) in primary vesicoureteral reflux(VUR) may lead to serious renal scarring, a major cause of childhood hypertension and end-stage renal disease. To prevent recurrent UTI, low-dose long--term antibiotic prophylaxis has been recommended. However, recurrent UTI still develops during antibiotic prophylaxis, the efficacy of which is now being disputed. The emergence of resistant bacteria has also raised concerns. To evaluate the effect of antibiotic prophylaxis, we investigated recurrent UTI during prophylactic antibiotic use in children with primary VUR Materials : The incidence and risk factors of recurrent UTI were retrospectively evaluated in ninety-one children with primary VUR on trimethoprim- sulfamethoxazole(TMP/SMX) prophylafis during the year following their index febri]e UTI.
Results : Recurrent UTI occurred in 31.9%(29/91) children and comprised 0.32 episodes/patient year. Febrile UTI was 0.26 episode/patient year and afebrile UTI was 0.07 episodes/patient year. The recurrent rate of UTI in male patients with phimosis was 37.2%(19/51), which was significantly higher than in males without phimosis 0%(0/5)(P=0.025). In the logistic regression analysis for recurrent UTI, renal scar was the significant risk factor for recurrent UTI [RR 3.8(95% CI 1.0-14.1) P=0.04]. For other well-known risk factors such as sex, age, degree of VUR, APN, and voiding dysfunction, the differences were not significant.
Conclusion : TMP/SMX prophylaxis did not prevent recurrent UTI in children with primary VUR. Phimosis and renal scars were the risk factors for recurrent UTI but the grade of primary VUR was not. In VUR without phlmosis and renal scar, a randomized controlled study without antibiotic prophylaxis is required.
Key words: Primary Vesicoureteral Reflux | Antibiotic prophylaxis | Recurrent UTI | Risk factors | Phimosis | Renal scar
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