Kidney Research and Clinical Practice

  • 제25권4호
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  • Pages.571-578
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  • 2006
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  • 2211-9132(pISSN)
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  • 2211-9140(eISSN)
대한신장학회 (Korean Society of Nephrology)
권호 표지

지역사회획득 급성신우신염에서 Quinolone 항생제 내성

Quinolone Resistance in Community-Acquired Acute Pyelonephritis

김지현;이충식;최낙원;박수경;이창화;김근호;강종명
Kim, Ji-Hyeon;Lee, Chung-Sik;Choe, Nak-Won;Park, Su-Gyeong;Lee, Chang-Hwa;Kim, Geun-Ho;Gang, Jong-Myeong

  • 발행 : 20060000
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 급성신우신염에서는 quinolone 제제가 경험적 항생제요법으로서 흔히 사용되지만 초치료에 실패하는 경우가 간혹 있다. 1999년 미국감염학회 지침에서 trimethoprim-sulfamethoxazole의 내성률이 20% 이상인 지역에서는 요로감염증 초치료로 quinolone 사용을 권하여, quinolone을 사용하고 있으나 사용빈도 증가에 따른 내성 증가가 우려된다. 이에 연구자들은 지역사회획득 급성신우신염에서 현재 차지하는 quinolone 내성의 분포와 quinolone 내성균에 의한 임상적 특징을 조사하고자 하였다.방 법 : 2002년 1월부터 2004년 12월까지 한양대학교병원 신장내과에 입원하여 급성신우신염으로 진단된 367명의 자료를 후향적으로 분석하였다. 입원 중 발생한 병원감염은 제외하였고, quinolone에 대한 감수성 환자군과 내성 환자군을 비교하였다.결 과 : 총 367명 환자 중 241명 (65.7%)에서 요배양에서 균이 동정되었고 이 중 217명 (90 %)에서 E. coli가 동정되었으며 24명 (10%)에서는 다른 그람음성간균 혹은 그람양성구균이 동정되었다. Quinolone 내성률은 요배양 양성인 전체 환자군에서는 19.5%였고, E. coli가 동정된 환자군에서는 19.8%였다. 기저질환이 있는 경우에 요배양 양성 및 요패혈증 빈도가 유의하게 높았다 (p<0.005). 연령과 입원시 질소혈증의 빈도는 quinolone 내성군과 감수성군 사이에 차이가 없었으나, 당뇨병과 요패혈증 빈도가 quinolone 내성군에서 감수성군에 비해 유의하게 낮았다 (p<0.05). 전체 환자 중 76.3%에서 quinolone을 초기 항생제로 사용하였고 quinolone에 내성을 나타낸 47명 중 70.2%에서도 quinolone 사용으로 임상 경과가 호전되었다.

Background : Quinolone antibiotics are now frequently used for the empirical therapy of acute pyelonephritis (APN). However, failure of this empirical therapy is often encountered in clinical practice, and the emergence of quinolone resistance should be concerned. This study was undertaken to investigate the prevalence of quinolone resistance in community- acquired APN and to analyze the clinical characteristics of quinolone-resistant APN. Methods : Clinical data were retrospectively analyzed from 367 patients who were admitted to Hanyang University Hospital for APN from January 2002 through December 2004. According to the result of urine culture, the patients were divided into quinolone-susceptible and quinolone-resistant groups, and clinical characteristics were compared. Results : Urine culture was positive in 241 out of 367 patients, and E. coli was the most common (90%) isolate. The prevalence of quinolone resistance based on the in vitro ciprofloxacin susceptibility test was found to be 19.5%, and among the E. coli isolates the prevalence of quinolone resistance was 19.8 %. 91 patients had underlying diseases and they were more frequently complicated by urosepsis. The ages and the prevalence of azotemia were not significantly different between two groups. Quinolone- resistant group had a lesser frequency of urosepsis compared with quinolone-susceptible group. Diabetic patients were more frequently quinolone-susceptible than quinolone-resistant. Conclusion : Although the prevalence of quinolone resistance is rather high in community-acquired APN based on the in vitro susceptibility test, the choice of quinolone antibiotics seems to be valid for the empirical therapy. (Korean J Nephrol 2006;25 (4):571-578)

키워드

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