End-stage Renal Disease Caused by Paradoxical Response and Subsequent Bacterial Infection in Urinary Tract Tuberculosis: a Case Report

박경우,박준형,양인모,김영화,유수정,오동진 중앙대학교 의과대학 의과학연구소 2015 中央醫大誌 Vol.40 No.3

Tuberculosis of urinary tract seldom progress to End-stage renal disease (ESRD). It's because tuberculosis responds well to pharmacological treatment. Nevertheless, urinary tract tuberculosis can worsen paradoxically if treatment is started in far-advanced stage. Several case reports suggest that vitamin D deficiency or interferon-γ dysfunction may promote progression to ESRD in urinary tract tuberculosis. Urinary tract tuberculosis is frequently combined with bacterial infections. It is not a serious problem in usual case but, recurrent bacterial coinfection can cause progression to ESRD in far-advanced urinary tract tuberculosis. We describe a case of ESRD caused by urinary tract tuberculosis combined with recurrent bacterial infections. A 53-year-old woman to have been considered bacterial urinary tract infection was diagnosed finally with urinary tract tuberculosis. She had been maintaining percutaneous nephrostomy catheters in both kidneys. The patient progressed to ESRD although an appropriate anti-tuberculosis medication has been prescribed for 4 months. At the time of starting renal replacement therapy, the patient was suffering from sepsis caused by the bacterial urinary tract infection. New tuberculosis lesions were then developed in the lumbar spine and psoas muscle. We suggest that urinary tract tuberculosis could progress to ESRD if it is diagnosed in far-advanced stage and followed by subsequent recurrent bacterial urinary tract infection and paradoxical response against anti-tuberculosis treatment.

Clinical Significance of Extended-spectrum β-lactamaseproducing Bacteria in First Pediatric Febrile Urinary Tract Infections and Differences between Age Groups

박선영,김지홍 대한소아신장학회 2017 Childhood kidney diseases Vol.21 No.2

Purpose: Extended-spectrum β-lactamase-producing bacteria-induced urinary tract infections are increasing and require more potent antibiotics such as carbapenems. We evaluated the clinical significance of extended-spectrum β-lactamase urinary tract infection in children younger than 5 years to select proper antibiotics and determine prognostic factors. Differences were compared between age groups. Methods: We retrospectively studied 288 patients with their first febrile urinary tract infection when they were younger than 5 years. Patients were divided into extended-spectrum β-lactamase-positive and extended-spectrum β-lactamasenegative urinary tract infection groups. Clinical characteristics and outcomes were compared between the groups; an infant group was separately analyzed (onset age younger than 3 months). Results: Extended-spectrum β-lactamase urinary tract infection occurred in 11 % patients who had more frequent previous hospitalization (P =0.02) and higher recurrence rate (P =0.045). During the antimicrobial susceptibility test, the extendedspectrum β-lactamase-positive urinary tract infection group showed resistance to third-generation cephalosporins; however, 98% patients responded clinically. In the infant group, extended-spectrum β-lactamase-positive urinary tract infection occurred in 13% patients and was associated with a longer pre-onset hospitalization history (P =0.002), higher C-reactive protein level (P =0.04), and higher recurrence rate (P =0.02) than that in the older group. Conclusion: Extended-spectrum β-lactamase urinary tract infection requires more attention because of its higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins, but they can be used as first-line empirical antibiotics because of their high clinical response rate. Aminoglycosides can be second-line antibiotics before starting carbapenems when third-generation cephalosporins do not show bactericidal effects for extended- spectrum β-lactamase urinary tract infection.

Clinical Significance of Extended-spectrum β-lactamase-producing Bacteria in First Pediatric Febrile Urinary Tract Infections and Differences between Age Groups

Park, Sun Yeong,Kim, Ji Hong Korean Society of Pediatric Nephrology 2017 Childhood kidney diseases Vol.21 No.2

Purpose: Extended-spectrum ${\beta}$-lactamase-producing bacteria-induced urinary tract infections are increasing and require more potent antibiotics such as carbapenems. We evaluated the clinical significance of extended-spectrum ${\beta}$-lactamase -urinary tract infection in children younger than 5 years to select proper antibiotics and determine prognostic factors. Differences were compared between age groups. Methods: We retrospectively studied 288 patients with their first febrile urinary tract infection when they were younger than 5 years. Patients were divided into extended-spectrum ${\beta}$-lactamase-positive and extended-spectrum ${\beta}$-lactamasenegative urinary tract infection groups. Clinical characteristics and outcomes were compared between the groups; an infant group was separately analyzed (onset age younger than 3 months). Results: Extended-spectrum ${\beta}$-lactamase urinary tract infection occurred in 11 % patients who had more frequent previous hospitalization (P=0.02) and higher recurrence rate (P=0.045). During the antimicrobial susceptibility test, the extended-spectrum ${\beta}$-lactamase-positive urinary tract infection group showed resistance to third-generation cephalosporins; however, 98% patients responded clinically. In the infant group, extended-spectrum ${\beta}$-lactamase-positive urinary tract infection occurred in 13% patients and was associated with a longer pre-onset hospitalization history (P=0.002), higher C-reactive protein level (P=0.04), and higher recurrence rate (P=0.02) than that in the older group. Conclusion: Extended-spectrum ${\beta}$-lactamase urinary tract infection requires more attention because of its higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins, but they can be used as first-line empirical antibiotics because of their high clinical response rate. Aminoglycosides can be second-line antibiotics before starting carbapenems when third-generation cephalosporins do not show bactericidal effects for extended-spectrum ${\beta}$-lactamase urinary tract infection.

노인요양시설 요양보호사의 요로감염 예방행위에 대한 지식과 실천

오영주,송영신 사단법인 인문사회과학기술융합학회 2019 예술인문사회융합멀티미디어논문지 Vol.9 No.10

The purpose of this study was to survey the knowledge and practice about preventive behavior for urinary tract infection in caregivers, and ultimately to provide the basic information in terms of urinary tract infection prevention. Participants in this study were caregivers who working at the 7 long-term care facilities in J-city of South Korea. Total 198 were participated in this study. Descriptive statistics, t-test, one-way ANOVA, and scheffe test were performed using SPSS Windows for 21.0 program. The correct answer rate for the knowledge about preventive behavior of urinary tract infection was 79%. The practice of urinary tract infection preventive behavior were significantly differed by the number of nurses, the number of elderly, working time and the experience, perceived importancy, necessity with education for urinary tract infection. The preventive behavior for urinary tract infection in caregivers should be supervised by health care providers. Moreover, it should be needed to educate and apply the basic education program to improve the caregivers' knowledge and practice for preventive behavior in urinary tract infection by healthcare providers. Continuous infection monitor and education by healthcare providers can be contributed the quality of elderly caring services and development of monitoring system for urinary tract infection in long-term care facilities. 본 연구의 목적은 노인요양시설의 요양보호사를 대상으로 요로감염 예방행위와 관련된 지식과 실천 정도를 조사하여 간호사가 요양보호사에게 요로감염 예방행위의 중요성을 인지시키고 지도, 교육하는데 필요한 기초자료를 제공하고자 시도된 서술적 조사연구이다. 연구대상은 J도에 소재한 7개의 노인요양시설에서 근무하는 요양보호사 198명이였다. 자료분석을 위해 t-test, one-way ANOVA, Scheffes test로 분석을 실시하였다. 요로감염 예방행위에 대한 지식의 정답률은 79%였으며, 대상자의 일반적 및 직무관련 특성에 따른 요로감염 예방행위에 대한 실천은 근무하는 간호사의 수, 담당 노인의 수, 근무시간, 교육의 중요성과 필요성을 인지한 군, 교육을 받은 경험에서 통계적으로 유의한 차이가 나타났다. 본 연구결과를 바탕으로 요양보호사를 위한 체계적인 교육을 통한 지식함양 요구의 기초교육뿐 아니라 의료인에 의한 관리 감독 하에 지속적인 요로감염 예방행위의 실천은 노인요양시설의 기본 감염관리 체계를 완성하고 서비스의 질을 향상 시킬 수 있을 것이다.

Urinary Tract Infection Symptom Assessment 설문지의 한국어 번역본의 개발

민권식,김영호,김준모,신경림,홍재엽,김민의 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.4

Purpose: The aim of this study was to translate the Urinary Tract Infection Symptoms Assessment (UTISA) questionnaire, which assesses the severity and nuisance of symptoms and signs of uncomplicated urinary tract infection, into Korean with subsequent linguistic validation for clinical use and research. Materials and Methods: This self-administered questionnaire is composed of 14 items that cover the 7 most frequent symptoms and signs. After acquiring permission for use of the questionnaire in Korea from Bayer Health Care Pharmaceuticals Global Health Economics and Outcome Research, 2 bilingual linguists individually translated the original English version of the UTISA questionnaire into Korean, and the translations were then reconciled by the linguists and the authors. A preliminary Korean version was translated back into English and reconciled by another bilingual linguist to confirm proper forward translation of the UTISA questionnaire, and then a complete Korean version of the UTISA questionnaire was finished. Ten women with acute cystitis completed the Korean UTISA questionnaire and were then interviewed to confirm the final Korean version through cognitive debriefing. Results: Linguistic validation of the Korean version of the UTISA questionnaire was completed through forward translation and reconciliation, back-translation and reconciliation, cognitive debriefing, and finally, proofreading of the questionnaire as a instrument for assessing symptoms and signs of uncomplicated urinary tract infection. Conclusions: The UTISA questionnaire was translated into a Korean, and the translation was validated linguistically. Psychometric validation will be needed in a large set of patients with uncomplicated urinary tract infection. Purpose: The aim of this study was to translate the Urinary Tract Infection Symptoms Assessment (UTISA) questionnaire, which assesses the severity and nuisance of symptoms and signs of uncomplicated urinary tract infection, into Korean with subsequent linguistic validation for clinical use and research. Materials and Methods: This self-administered questionnaire is composed of 14 items that cover the 7 most frequent symptoms and signs. After acquiring permission for use of the questionnaire in Korea from Bayer Health Care Pharmaceuticals Global Health Economics and Outcome Research, 2 bilingual linguists individually translated the original English version of the UTISA questionnaire into Korean, and the translations were then reconciled by the linguists and the authors. A preliminary Korean version was translated back into English and reconciled by another bilingual linguist to confirm proper forward translation of the UTISA questionnaire, and then a complete Korean version of the UTISA questionnaire was finished. Ten women with acute cystitis completed the Korean UTISA questionnaire and were then interviewed to confirm the final Korean version through cognitive debriefing. Results: Linguistic validation of the Korean version of the UTISA questionnaire was completed through forward translation and reconciliation, back-translation and reconciliation, cognitive debriefing, and finally, proofreading of the questionnaire as a instrument for assessing symptoms and signs of uncomplicated urinary tract infection. Conclusions: The UTISA questionnaire was translated into a Korean, and the translation was validated linguistically. Psychometric validation will be needed in a large set of patients with uncomplicated urinary tract infection.

일개 병원에서의 응급실을 방문한 패혈성 폐쇄성 요로감염 환자에 대한 고찰

박재형,김성훈,최마이클승필,제동욱,노우영,박홍인,신수정,박용석,박창원,이미진,안재윤,이동언,문성배,김창호,이숙희 대한응급의학회 2020 대한응급의학회지 Vol.31 No.3

Objective: Unlike common acute urinary tract infections, obstructive urinary tract infections caused by urinary calculus can be fatal because they can progress to sepsis and cause shock or disseminated intravascular coagulation. The evidence of patients with obstructive urinary tract infections caused by urinary tract stones visiting the emergency center is still lacking. Methods: Seventy-seven patients who visited the emergency room with obstructive urinary tract infections caused by urinary calculus from January 2016 to December 2018 were enrolled in this study and divided into two groups: sepsis group and non-sepsis group. Results: The lymphocyte count, platelet count, neutrophil-lymphocyte ratio, serum creatinine, and C-reactive protein were significantly different in the sepsis-positive and negative groups. Percutaneous nephrostomy was also significantly higher in the sepsis-positive group. The area under the receiver operating characteristic curve was calculated to evaluate the ability of the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio to predict a septic urinary tract infection. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were 0.659 and 0.550, respectively. Multivariate logistic regression analysis showed that diabetic patients, percutaneous nephrostomy, and serum creatinine were associated with septic obstructive urinary tract infection. Conclusion: In patients with an obstructive urinary tract infection who were referred to the emergency center, diabetic patients and those with high blood urea nitrogen and creatinine levels are at high risk of sepsis. In such cases, rapid diagnosis and treatment, such as percutaneous nephrostomy, are necessary.

신장 이식 판자에서 Tribethoprim-Sulfamethoxazole이 감염에 미치는 영향 : Sulfamethoxazole for Prophylaxis of Infection in Renal Transplant Recipients

백인규,강경원,강종명,곽진영 대한신장학회 1996 대한신장학회잡지 Vol.15 No.4

위장관 증상으로 입원한 환아의 요로계 감염 실태

조수현,백종태,정종승 大韓家庭醫學會 1993 Korean Journal of Family Medicine Vol.14 No.4-5

소아의 요로감염증 환아에서 분리된 Escherichia coli의 ribotyping에 관한 연구

임애연,김순겸 고려대학교 의과대학 1996 고려대 의대 잡지 Vol.33 No.1

Urinary tract infections in childhood are very common and usually asymptomatic but can cause serious renal damage with relapses. It is important to recognize whether relapses are caused by bacterial persistence of the same strain in the urinary tract or not. Classical typing techniques using serotyping, antibiotic susceptibility patterns, and plasmid profiles have been used for strain differentiation in relapses, but the utility of these methods is notably limited because they may not be stably expressed under certain environmental or culture conditions. Recently, analysis of DNA polymorphism in the chromosomal regions containing the highly conserved rRNA genes, and referred to as ribotyping, has been widely used as a tool for epidemiological typing of various species of bacteria. To evaluate the utility of ribotyping analysis in strain differentiation of E. coli urinary isolates, the author analyzed ribotyping patterns, plasmid profiles, and antimicrobial susceptibility patterns of 34 E coli isolates from 32 children with urinary tract infections. The results are summarized as follows: 1. Twelve patterns were observed in antimicrobial susceptibility testing. 2. Plasmid were found in 7 of 34 subjects(21%). 3. EcoRI- and HindⅢ-digested ribotyping analysis demonstrated 21 and 14 ribotypes, respectively. 4. Three isolates collected at 7 and 34 day intervals from the same patient with vesicoureteral reflux showed identical EcoRI- and HindⅢ-digested ribotypes, respectively. The results indicate that ribotyping is a highly discriminatory and reproducible method for distinguishing E. coli strains isolated from children with urinary tract infections compared to plasmid profiles and antimicrobial susceptibility patterns. Thus, ribotyping analysis is clinically useful for the effective treatment of urinary tract infections in children.

요로 감염 임상진료지침 권고안: 무증상 세균뇨, 단순 요로감염, 복잡성 요로감염, 세균성 전립선염

대한감염학회,대한화학요법학회,대한요로생식기감염학회,대한임상미생물학회 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.1

The US guideline for urinary tract infections has been applied in our country. However, clinical characteristics, etiology and antimicrobial susceptibility could differ from country to country, therefore, we tried to make diagnosis and treatment guideline for urinary tract infections based on published articles of antimicrobial treatment efficacy of UTI and available antimicrobial susceptibility of major pathogens causing urinary tract infections in our country, which reflects clinical situation in Korea. This guideline was developed by the committee of the Korean Society for Chemotherapy, and covers asymptomatic bacteriuria, bacterial prostatitis, uncomplicated and complicated urinary tract infections