• Clinical and Experimental Pediatrics
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• 제58권9호
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• pp.341-346
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• 2015

Purpose: To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. Methods: We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. Results: A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. Conclusion: UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR.

• 대한한방내과학회지
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• 제25권4호
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• pp.373-382
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• 2004

Cystitis and acute pyelonephritis(APN) are usually caused by ascending infection. Two cases of urinary tract infection(UTI) were encountered. Because antibiotics might cause some adverse reactions such as diarrhea, eruption, anorexia, nausea and vomiting, so Korean Traditional Medicine has been applied to UTI, and several reports can be found in the literature. This study was performed on two patients with UTI who were treated with herbal medicine, acupuncture and moxibustion. Noteworthy results were obtained in hematology and urinalysis. UTI symptoms, signs and laboratory findings are indicative of successful treatment. Results suggests that Korean Traditional Medicine applied to UTI is effective. These findings are reported with a brief review of related literature.

• Childhood Kidney Diseases
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• 제22권2호
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• pp.42-46
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• 2018

Purpose: We investigated whether the white blood cell (WBC) count to hemoglobin (Hgb) level ratio is correlated with the presence of cortical defects on dimercaptosuccinic acid (DMSA) renal scan in children with febrile urinary tract infection (UTI). Methods: We examined 95 children who were consecutively admitted to our hospital with their first episode of febrile UTI. Blood tests (C-reactive protein [CRP], WBC, Hgb] were performed. All enrolled children underwent DMSA scanning during admission. Data were compared between children with positive and negative DMSA results. The correlations between WBC to Hgb ratio and the presence of cortical defects on DMSA scan, and between WBC to Hgb ratio and CRP level were analyzed using the Pearson chi-squared test. Multiple logistic regression analysis was used to evaluate whether WBC to Hgb ratio could predict the cortical defects on DMSA scan in children with febrile UTI. Results: The WBC to Hgb ratio was significantly higher in children with positive DMSA results than in those with negative DMSA results; positively correlated with the presence of cortical defects on DMSA scan and CRP; and was a significant factor for predicting the presence of cortical defects on DMSA scan. Conclusion: The WBC to Hgb ratio may predict the presence of cortical defects on acute DMSA scans in children with febrile UTI.

• 생약학회지
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• 제36권1호통권140호
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• pp.56-59
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• 2005

Urease plays an important role in the urea metabolism and the effect of urease activity on human and environment is enormous. For instance, urease acts as a virulence factor of the urinary and gastrointestinal tracts infections in human and animal, being involved in kidney stone formation, catheter encrusatation, pyelonephritis, ammonia encephalopathy, hepatic coma, and urinary tract infections. Widespread urease activity in soil induces a plant damage due to ammonia toxicity and pH increase. Therefore, urease activity regulation through urease inhibitors would lead to an enhanced efficiency of urea nitrogen uptake in plants and to the improved therapeutic strategies for ureolytic bacterial infections. To search for new inhibitory compounds on urease activity from herbs, MeOH extracts of herbs were screened. Among of them, the MeOH extracts of Areca catechu exhibited an excellent inhibitory effect on urease activity. Two compounds were isolated from the ethyl acetate fraction by the activity guided fractionation. Their chemical structures were identified as (+)-catechin(compound I) and allantoin(compound II) by spectroscopic evidence, respectively. Compound I showed a stronger inhibitory effect on urease activity than compound II.

• 한국임상수의학회지
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• 제29권2호
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• pp.165-168
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• 2012

14년 령의 중성화 하지 않은 수컷 Siberian Husky는 1개월 전부터 혈뇨, 기면, 식욕부진을 보였다. 신체검사상 복부 팽만과 통증을 확인할 수 있었다. 혈액 및 혈청 화학 검사상 빈혈과 질소혈증을 확인할 수 있었다. 방사선 검사 상 신장의 비대를 확인할 수 있었으며 초음파 검사 상 피수질의 경계가 불분명하며 피질의 에코가 증가한 신장을 확인할 수 있었다. 뇨검사 상에서는 혈뇨와 단백뇨를 확인할 수 있었으며 초기의 감별 진단으로는 신부전, 방광염, 신우신염과 종양을 생각했다. 환자의 상태는 내원 후 계속적으로 악화되었으며 폐사했다. 부검 상에서 복강 내 출혈과 양측 신장의 종양을 확인할 수 있었다. 조직검사 상에서 혈관육종을 진단하였다. 본 증례에서는 개에서 비특이적으로 발생하는 양측성의 신장원성 혈관육종에 대해서 다룬다.

• 한국미생물·생명공학회지
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• 제20권3호
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• pp.301-310
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• 1992

요로계 감염에 대처함에 있어 hemolysin과 Gal-Gal pili의 multicomponent 백신 개발 가능성을 조사하기 위하여 본 연구를 수행하였다. 요로계 감염환자로부터 분리되어 그의 hemolysin gene 의 염기배열과 아미노산 배열이 밝혀진 대장균 J96 균중의 hemolysin에 대하여 10곳에 해당하는 20 mer-oligonucleotide를 합성하였다. 이들 probe를 사용하여 요로계감염 환자들로부터 분리한 wild type 대장균들의 DNA에 대하여 hemolysin gene 의 상동성을 조사하였는 바 8개의 probe는 거의 모든 hemolysin signal을 보여주었고 HA484는 28.3, HA661은 71.7의 positive signal을 나타내었다.이는 요로계 감염 대장균들의 Hemolysin gene의 상동성이 매우 높은 것을 의미한다. 또한 J96 hemolysin에 대한 12개의 MAB은 모두 wild type 대장균들이 분비하는 90% 이상의 균주에 대하여 양성 immunoblotting을 나타내었다. 특히 J96 hemolysin의 functional site를 가장 강력하게 block할 수 있는 monoclonal antibody MAＢ132가 모든 wild type으로부터 분리된 hemolysin의 function을 중화시킬수 있는 결과는 J96의 cloned hemolysin product를 vaccine으로 사용할 수 있는 가능성을 증대시키는 결과라고 할 수 있다.

• Journal of Chest Surgery
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• 제19권1호
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• pp.174-179
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• 1986

Augmentin is a formulation of amoxycillin trihydrate and potassium clavulanate, a fused beta-lactam molecule produced by the fermentation of Streptomyces clavuligerus. Most clinically important resistance is due to the production by bacteria of antibiotic destroying enzymes. In the case of penicillins and cephalosporins these enzymes are termed beta-lactamase as they destroy the beta-lectern ring of these antibiotics, completely inactivating them. The presence of clavulanic acid extends the spectrum of amoxycillin to include bet On clinical study of the intravenous Augmentin in the field of thoracic and cardiovascular surgical cases, we selected randomly 30 patients, 21 male and 9 female, age from 13 to 72, in the period from April to December 1985. Among the total 30 patients, 22 were preoperatively infected [11 thoracic empyema, 5 lobar pneumonia, 2 lung abscess, 2 bronchiectasis, one acute pyelonephritis with ureter stone and one rheumatic carditis], and 8 were not infected preoperatively [Table 1, 2]. Of the preoperatively infected group, 11 cases [50%] were culture positive [4 staphylococcus, 3 pseudomonas, 2 Serratia group, and one E. coli], and preoperatively non-infected group [8 cases] revealed expectedly negative findings on bacterial culture. All of the culture positive bacteria were sensitive to Augmentin on disc culture sensitivity test except one case of E. coli. Daily doses of intravenous Augmentin were 2.-1-6.0gm divided in 2-5 injections. Every injection administered [1.2gm at Augmentin dissolved in 20ml distilled water] slowly for more than 20 minutes. Duration of injection was variable according to the clinical conditions from minimum 5 to maximum 31 days. The results of antibiotic treatment with Augmentin and some other antibiotic combinations pre- and postoperatively were subgrouped as EXCELLENT, EFFECTIVE, and FAILURE. Clinical criteria of the therapeutic result were symptomatic, objective and laboratory improvement. 8 cases were excellent, 13 effective, and one failure among the preoperatively infected group, and all 8 cases of the preoperatively non-infected group were effective as pro;hylactive antibiotic therapy. Overall effective ratio was 97% in both subgroup. There was no side effect clinically and laboratory study including liver and kidney function test during and after the I.V. administration of Augmentin. Oral swallow tablets which were administered after discharge from hospital also revealed good effects with some degree of gastrointestinal trouble.

• Clinical and Experimental Pediatrics
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• 제64권6호
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• pp.293-300
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• 2021

Background: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. Purpose: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. Methods: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated. Results: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). Conclusion: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.

• Childhood Kidney Diseases
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• 제26권1호
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• pp.46-51
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• 2022

Purpose: Delta neutrophil index (DNI) indicates immature granulocytes in peripheral blood and has been confirmed to be effective as a prognostic factor for neonatal sepsis. Also, it has been reported to have diagnostic value in acute pyelonephritis and in predicting vesicoureteral reflux (VUR) in the infant. We conducted the study to verify whether DNI is also helpful in the entire pediatric age group with febrile urinary tract infection (UTI). Methods: Medical records of children hospitalized for febrile UTIs were analyzed retrospectively. All subjects underwent kidney ultrasound and voiding cystourethrography. In the group with and without VUR, we compared sex and age, and the following laboratory values: the white blood cell count, neutrophil, polymorphonuclear leucocyte, eosinophil, hemoglobin, platelet count, C-reactive protein, DNI value, and the finding of ultrasound. Results: A total of 315 patients (163 males and 152 females; range, 0-127 months) were eligible, and 41 patients (13%) had VUR. As a result of univariate analysis, the white blood cell count, neutrophil, DNI, and ultrasonic abnormalities were high in the reflux group, and the hemoglobin and lymphocyte fraction values were low. The value of DNI and the abnormal ultrasound were significantly higher in the reflux group on the multivariate analysis. The area under the curve value of the receiver operating curve was higher in DNI (0.640; 95% confidence interval, 0.536-0.744; P=0.004), and the DNI cutoff value for VUR prediction was 1.85%. Conclusions: We identified that ultrasound findings and DNI values were helpful predictors of VUR in pediatric febrile UTIs.

• Childhood Kidney Diseases
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• 제28권1호
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• pp.35-43
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• 2024

Purpose: Recurrent urinary tract infections (UTIs) in children is a major challenge for pediatricians. This study was designed to investigate the risk factors for recurrent UTIs and determine the association between recurrent UTIs and clinical findings, including growth patterns in infants and children younger than 24 months of age. Methods: We retrospectively reviewed the medical records of 147 patients <24 months of age with UTIs who were hospitalized between August 2018 and October 2021. The patients were divided into recurrent and single UTI episode groups. Clinical findings and anthropometric and laboratory data were compared between the two groups. Results: In the recurrent UTI group, the weight-for-length (WFL) percentile at the first UTI diagnosis was lower compared to the single UTI episode group, and the weight-for-age percentile at 3-month and 6-month follow-ups after the first UTI decreased (all P<0.05). In univariable logistic regression analysis, higher birth weight, lower WFL percentile, the presence of hydronephrosis, acute pyelonephritis or vesicoureteral reflux, the use of prophylactic antibiotics, and non-Escherichia coli infections were associated with the development of recurrent UTIs (all P<0.05). However, in the multivariable analysis, only the presence of hydronephrosis and prophylactic antibiotic use were independently related to UTI recurrence (P<0.05). Conclusions: The presence of hydronephrosis at the first UTI can be helpful for predicting UTI recurrence in young children aged <24 months. Antibiotic prophylaxis may be associated with UTI recurrence. Potential growth delay should be carefully monitored in infants with recurrent UTI.