• Pediatric Infection and Vaccine
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• v.17 no.2
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• pp.67-73
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• 2010

Purpose : We aimed to compare the clinical features and antibiotic resistance of urinary tract infection (UTI) caused by pathogens other than E. coli (non-E. coli) with UTI caused by E. coli in children. Methods : We enrolled patients with culture-proven UTI, who were admitted to the study hospital from September 2008 to August 2009. We investigated clinical data of patients with UTI and antibiotic resistance of isolated strains. For comparison, patients were divided according by results of the urine culture into E. coli and non-E. coli UTI groups. Results : A total of 84 patients participated in this study. Twenty one cases (25.0%) were caused by non-E. coli pathogens. Frequency of non-E. coli UTI differed according to age and sex: 'male <6 months', 10.5%; 'male ${\geq}$6 months', 50.0%; 'female <6 months', 43.7%; and 'female ${\geq}$6 months', 25.0% (P=0.014). More patients who received previous antibiotic treatment (P=0.017), but fewer patients who showed hematuria (P=0.014) were included in the non-E. coli UTI group than in the E. coli UTI group. Comparison of antibiotic resistance showed that the non-E. coli UTI group possessed more strains that were resistant to cefazolin, cefotaxime, imipenem, trimethoprim/sulfamethoxazole (TMP/SMZ) and tetracycline than the E. coli UTI group (P<0.05). Conclusion : Increased incidence, different distribution by age and sex, and high antibiotic resistance of non-E. coli UTI should be considered in selection of empirical antibiotics for treatment of UTI in children.

• Pediatric Infection and Vaccine
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• v.22 no.1
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• pp.29-35
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• 2015

Purpose: The purpose of this study was to investigate the clinical characteristics and outcome of febrile urinary tract infections (UTIs) caused by community-acquired extended-spectrum ${\beta}$-lactamase (CA-ESBL)-producing and -nonproducing bacteria. Methods: We analyzed febrile UTIs in children hospitalized at Gachon University Gil Medical Center from January 2011 to December 2013 through retrospective data collection from their medical records. Results: Among pathogens causing 374 episodes of UTIs, the proportion of ESBL-producing bacteria was 13.1% (49/374). The proportion of ESBL-producing Escherichia coli and Klebsiella spp. was 13.6% (48/354) and 5.0% (1/20), respectively. There was no significant difference between the CA-ESBL and CA non-ESBL groups in duration of fever ($4.2{\pm}2.7$ vs. $3.7{\pm}2.1$ days, P=0.10) and bacterial eradication rate with empirical antibiotics (100% vs. 100%). The risk of cortical defects on renal scan significantly depended on existence of vesicoureteral reflux rather than ESBL production of pathogen. Conclusions: There was no significant difference between the CA-ESBL and CA non-ESBL groups in renal cortical defects and clinical outcome. Careful choice of antibiotics is important for treatment of community-acquired UTI in children.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3223-3227
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• 2015

Objective: We evaluated the association of body mass index (BMI) with perioperative outcomes in patients who underwent laparoscopic or open radical nephroureterectomy. Materials and Methods: This retrospective single-center study included 113 patients who had been diagnosed with upper urinary tract cancer from January 1998 to June 2013 and were treated with laparoscopic nephroureterectomy (Lap group, n=60) or open nephroureterectomy (Open group, n=53). Laparoscopic nephroureterectomy was performed via a retroperitoneal approach following an open partial cystectomy. The two surgical groups were stratified into a normal-BMI group (<25) and a high-BMI group ($BMI{\geq}25$). The high-BMI group included 27 patients: 13 in the Lap group and 14 in the Open group. Results: Estimated blood loss (EBL) in the Lap group was much lower than that in the Open group irrespective of BMI (p<0.01). Operative time was significantly prolonged in normal-BMI patients in the Lap group compared to those in the Open group (p=0.03), but there was no difference in operative time between the Open and Lap groups among the high-BMI patients. Multivariate logistic regression analysis of the data for all the cohorts revealed that the open procedure was a significant risk factor for high EBL (p<0.0001, hazard ratio 8.02). Normal BMI was an independent predictor for low EBL (p=0.01, hazard ratio 0.25). There was no significant risk factor for operative time in multivariate analysis. There were no differences in blood transfusion rates or adverse event rates between the two surgical groups. Conclusions: Laparoscopic radical nephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced EBL even in obese patients with upper urinary tract cancer.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.222-227
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• 2010

Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR) in childhood urinary tract infection (UTI). Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP), positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography (VCUG) results. Results : VCUG was performed in 148 patients; of them, 37 (25.0%) had VUR: 18 (12.2%) had low-grade (I-II) VUR, and 19 (10.5%) had high-grade (III-V) VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5%) had cortical defects, of which 21 (63.6%) had VUR: 10 (30.3%), low-grade (I-II) VUR; and 11 (33.3%), high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0%) had low-grade VUR and 6 (10.5%) had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever ($36{\geq}$ hours) after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

• Pediatric Infection and Vaccine
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• v.24 no.1
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• pp.54-59
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• 2017

Purpose: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. Methods: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. Results: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. Conclusions: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.

• Childhood Kidney Diseases
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• v.18 no.2
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• pp.85-91
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• 2014

Purpose: We aimed to investigate the correlation between serum cystatin C and clinical manifestations in pediatric patients with urinary tract infections (UTIs). Methods: We studied 137 patients admitted with UTIs from June 2012 to May 2014. Depending on the presence of renal cortical defects on 99m Tc-dimercaptosuccinic acid scintigraphy, we classified patients into non-renal and renal defect groups. Laboratory and clinical parameters were analyzed, including the levels of serum cystatin C. The correlation between cystatin C and other variables was assessed. Results: Serum cystatin C levels did not differ between the non-renal and renal defect groups. In both groups, serum cystatin C levels increased after 4-5 days of treatment, compared with the level at admission (P<0.001). However, mean levels were within normal ranges. The concentration of serum cystatin C positively correlated with serum creatinine and negatively correlated with age (P <0.05). In contrast, there was no correlation between serum cystatin C and other variables. Conclusion: Serum cystatin C does not appear to be a useful biomarker for renal defects in pediatric patients with UTIs. Further studies are necessary to conclude whether serum cystatin C is helpful in predicting deterioration in renal function in pediatric patients with UTIs.

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.70-77
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• 2008

Purpose: Urinary tract infections(UTIs) are not uncommon findings in febrile pediatric patients and approximately one third of patients with UTI may have renal scars. This research was intended to establish the relationship between duration of fever and renal scars. Methods: The medical records of 143 patients were reviewed retrospectively. Inclusion criteria were as follows: 1) fever as defined by an axillary temperature $\geq37.5^{\circ}C$, 2) accurate history of fever duration and the use of antibiotics 3) no previous history of UTI and 4) positive urine culture. We observed whether the longer fever duration could be associated with the development of initial renal defects and subsequent renal scars, increased C-reactive protein(CRP), leukocytosis and the presence of vesicoureteral reflux(VUR). Results: 1) Patients with longer fever duration after antibiotics showed more frequent initial renal defects(P=0.014). However, fever duration before antibiotic use was not associated with the development of initial renal defects(P=0.244). 2) Incidence of renal scar increased with fever duration before antibiotic use(P=0.006) and fever duration after antibiotic use(P=0.015). 3) CRP correlated with the fever duration after antibiotic use(r=0.287, P=0.003). 4) There was no relationships between fever duration and VUR(P>0.05). Conclusion: Our data suggest that fever duration before/after antibiotic use is significantly associated with the increased development of renal scars in pediatric UTI.

• Childhood Kidney Diseases
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• v.16 no.2
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• pp.95-101
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• 2012

Purpose: Recently, many evidence-based guidelines for the management of urinary tract infection (UTI) have been developed because of the importance of proper management. However, there is a lack of data regarding how pediatricians manage UTIs in Korea. Therefore, we surveyed pediatricians to determine whether they manage UTIs in an appropriate manner. Methods: A postal questionnaire survey of 78 pediatricians practicing in Daegu city was performed. Subjects were asked about diagnosis, imaging studies, treatment, and prevention of UTIs. Results: Most of the respondents (94.8%) performed urinalysis to diagnose UTI in febrile children with an unknown fever focus. However, many preferred inaccurate collection methods, such as bagged urine collection, and did not obtain urine cultures. The most frequently performed imaging modality was renal-bladder ultrasonogram. Orally administered antibiotics were preferred unless admission was needed. After diagnosis of UTI, the pediatricians usually provided information to caregivers about the disease itself and supplementary treatment. Of the respondents, only 28.6% had their own guidelines for management of vesicoureteral reflux. Conclusion: Most pediatricians suspected UTI in febrile children with an unknown focus appropriately. Nevertheless, the fact that many pediatricians preferred inaccurate urine collection methods and did not perform sufficient imaging studies to detect associated abnormalities likely resulted in overtreatment due to false-positive diagnosis of UTI and a low probability of ruling out genitourinary anatomical problems. To improve the quality of management of UTI, pediatricians should follow scientific and evidence-based guidelines.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.186-193
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• 2008

Purpose : Intrarenal reflux(IRR) is backflow of urine from the renal pelvis into the collecting ducts. IRR is the main cause of renal injury in children with vesicoureteral reflux (VUR) which leads to renal scars, hypertension, proteinuria, and chronic renal failure. The purpose of our study was to investigate the characteristics of intrarenal reflux. Method : We retrospectively reviewed the medical records of 80 patients who were diagnosed as having grades of III-V VUR from Jan. 2004 to Dec. 2006 in the department of pediatrics in Ajou University Hospital. The patients were divided into two groups according to the presence of IRR on voiding cystoureterogram and compared to each other for the possible factors associated with intrarenal reflux. Results : Among 80 VUR patients, IRR(＋) group comprised 17(21.3%) patients and 27 renal units(23.2%) and revealed younger age, higher grade of VUR, and more proteinuria compared to IRR(-) group. There were no significant difference in gender, laboratory findings and the rate of resolution in VUR or defects on renal scan between two groups. Also, intrarenal reflux mostly corresponded to the same site of photon defects on DMSA scan. Conclusion : We suggest that intrarenal reflux tends to be associated with younger age, higher grade of reflux, more proteinuria with no difference in resolution rate of VUR when compared to the VUR patients without IRR. From this study, we were able to understand the characteristics of intrarenal reflux in children with urinary tract infection.

• Childhood Kidney Diseases
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• v.20 no.1
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• pp.29-32
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• 2016

Purpose: Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common anomalies identified in newborns. This study aims to demonstrate the prevalence of CAKUT including hydronephrosis diagnosed by antenatal and postnatal ultrasound over a five-year period. Methods: The records of births between May $1^{st}$, 2009 and April $30^{th}$, 2014 at our hospital were collected. The number of infants who underwent renal ultrasound after birth for the detection of CAKUT was counted. The incidence of each type of CAKUT such as hydronephrosis, size abnormality, horseshoe kidney, and Multicystic dysplastic kidney (MCDK) was retrospectively evaluated for antenatal screening and postnatal follow-up examination. Results: During the study period, 33,276 infants were born and 521 neonates underwent postnatal renal ultrasound. 183 cases of CAKUT were detected prenatally and 140 postnatally using ultrasonographic examinations at the following time: (i) 3-7 days postnatally in 123 newborns (87.9%), (ii) during 1-3 months in 11 newborns (7.9%), and (iii) later than 3 months in 6 newborns (4.3%). Among diagnosed CAKUT, hydronephrosis was the most common anomaly with 113 newborns diagnosed prenatally and 46 postnatally. Duplex kidney was the second most common anomaly followed by horseshoe kidney, simple cysts in the kidney and so on. Conclusion: The detection of CAKUT is an important part of the prenatal ultrasound. This study analyzed the prevalence of CAKUT detected on prenatal screening and compared the results to those detected postnatally. Prenatal ultrasound screening fulfills the needs of postnatal examinations and therefore, both antenatal and postnatal sonographic investigations are of vital importance for diagnosis of renal and urinary tract anomalies.