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응급실을 방문한 광범위베타락탐분해효소 양성 대장균 요로감염 환자의 임상적 특징 및 위험인자

Clinical characteristics of children who visited the emergency department with extended-spectrum beta-lactamase-producing Escherichia coli urinary tract infection and its risk factors

대한소아응급의학회지 2020년 7권 2호 p.101 ~ 107
홍상화, 김효빈, 최희원,
소속 상세정보
홍상화 ( Hong Sang-Ha ) - Dong-A University College of Medicine Department of Pediatrics
김효빈 ( Kim Hyo-Bin ) - Dong-A University College of Medicine Department of Pediatrics
최희원 ( Chueh Hee-Won ) - Dong-A University College of Medicine Department of Pediatrics

Abstract


Purpose: To identify the differences in features between children with urinary tract infection (UTI) caused by extended-spectrum beta-lactamases (ESBL)-positive and -negative Escherichia coli, and analyze risk factors for the former infection.

Methods: We reviewed medical records of children younger than 36 months with E. coli UTI who visited the emergency department from January 2012 through January 2019. Differences in variables regarding clinical, laboratory, and microbiologic (i.e., ESBL-positive E. coli on urine culture) features, and outcomes between the ESBL-positive and -negative groups were identified. Factors associated with ESBL-positive E. coli infection were analyzed by logistic regression.

Results: The children were classified into the ESBL-positive (n = 151) and -negative (n = 40) groups. The former group showed higher frequency of prior UTI (P = 0.038) without other differences between the groups. The median counts of white blood cells, absolute neutrophils, and absolute lymphocytes were higher in the ESBL-positive group than in the other group (P = 0.009, 0.022, and 0.027, respectively). The former group showed longer median hospital length of stay (11.0 days [interquartile range, 8.9-12.0] vs. 6.0 [5.0-7.0]; P < 0.001), and more frequent recurrence per child (3.0 [2.5-3.0] vs. 1.0 [1.0-1.75]; P = 0.047) and presence of vesicoureteral reflux (27.5% vs. 13.2%; P = 0.001). Logistic regression showed leukocytosis (odds ratio, 12.85; 95% confidence interval, 1.04-157.69) and vesicoureteral reflux (4.00; 1.19-13.43) as the factors for ESBL-positive E. coli infection.

Conclusion: The ESBL-positive group showed significantly higher leukocyte count and rate of vesicoureteral reflux than the ESBL-negative group. For children with these features, empirical antibiotics should be chosen in consideration of the resistant bacteria.

키워드

Bacteria; Child; Drug Resistance; Emergency Medicine; Escherichia coli; Fever; Urinary Tract Infections

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