응급실로 내원한 지역사회 획득 급성 신우신염 환자의 원인균 및 Ciprofloxacin 내성의 변화와 이에 영향을 미치는 인자

다국어 초록 (Multilingual Abstract)

Purpose: Over the 10 years, ciprofloxacin has been used as one of antibiotics of choice for the empirical treatment of community-acquired acute pyelonephritis (APN), of which Escherichia coli (E. coli) is the main causative bacterium. Recently, however, some studies show that ciprofloxacin-resistant E. coli is increasing in APN. This study aimed to re-evaluate ciprofloxacin as one of initial antibiotics for APN according to the survey of the patients' clinical and microbiologic characteristics, and consider adequate antibiotics therapy according to change in resistance of bacterium to ciprofloxacin and other antibiotics.
Patients & methods: The records of 356 patients who visited Gyeongsang National University Hospital emergency room from Jan 01, 2000 to Dec 31, 2009 and diagnosed as APN were reviewed retrospectively. This study investigated the clinical characteristics of patients, causative organisms and annual change of antibiotics susceptibility to each antibiotics, associated factors that influence the ciprofloxacin resistance, and appropriate choice of initial antibiotics afterward.
Results: The proportion of males to females was 1 : 6.3, and the average age was 54.9±18.1 years old. Complicated APNs were 150 out of 356 patients, and diabetes ranked highest as 26.7% (95/356). According to the urine or blood cultures, the patients with isolated microorganism reached up to 60.4% (215/356) and E. coli occupied 84.2% (181/215) out of the isolates. Among the antibiotics chosen initially, ciprofloxacin was most common (75.0%, 267/356) and the third generation cephalosporin was next (23.0%, 82/356). The analysis of antibiotics sensitivity among 181 E. coli isolates, demonstrated that ciprofloxacin susceptibility was 81.8%, 94.5% in the third generation cephalosporin, 39.2% in ampicillin and 69.4% in trimethoprim-sulfamethoxazole (TMP-SMX). And in the recent 3 years, from 2007 to 2009, ciprofloxacin susceptibility was 87.7% and this was higher than the years before 2007 (77.8%). When the ciprofloxacin-resistant bacterium was isolated, the patients tended to have a higher proportion of complicated APNs (especially, complicated by diabetes mellitus and urinary anatomical abnormalities)
Conclusion: For the community acquired APNs, among the E. coli isolates, there were no significant change in ciprofloxacin resistance by years. However, when APNs were complicated by diabetes mellitus, ciprofloxacin resistance was meaningfully higher than others. Therefore, ciprofloxacin should be carefully used as initial antibiotics especially in case of the patients having diabetes mellitus and urinary anatomical abnormalities.

목차 (Table of Contents)

• I. 서 론 1
• II. 연구 대상 및 방법 4
• 1. 연구 대상 4
• 2. 연구 방법 4
• 3. 통계적 분석 6
• III. 결 과 7
• 1. 전체 환자의 임상적 특징 7
• 2. 요 배양 검사 및 혈액 배양 검사 결과 8
• 3. 초기 경험적 항생제 선택과 치료 기간 8
• 4. 항생제 감수성의 차이와 변화 9
• IV. 고 찰 14
• V. 결 론 21
• VI. 참고 문헌 22