Korean Journal of Family Medicine (가정의학회지)

The Korean Academy of Family Medicine (대한가정의학회)
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A Case Report of Sepsis by Extended-Spectrum ${\beta}$-Lactamase Producing Escherichia Coli

Extended-Spectrum ${\beta}$-Lactamase을 생성하는 Escherichia Coli 감염에 의한 패혈증 1예

  • Lee, Seung-Beom (Department of Family Medicine, Yonsei University College of Medicine) ;
  • Kim, Choon-Ok (Department of Family Medicine, Yonsei University College of Medicine) ;
  • Kang, Hee-Cheol (Department of Family Medicine, Yonsei University College of Medicine)
  • 이승범 (연세대학교 의과대학 가정의학교실) ;
  • 김춘옥 (연세대학교 의과대학 가정의학교실) ;
  • 강희철 (연세대학교 의과대학 가정의학교실)
  • Received : 2009.06.04
  • Accepted : 2010.04.22
  • Published : 2010.05.20
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Abstract

The overall prognosis of acute pyelonephritis is good, but the infections by extended spectrum ${\beta}$-lactamase (ESBL) producing Escherichia coli (E.coli) cause poor responses to empirical antibiotic treatment, and consequently increase mortality. ESBL can hydrolyze the antibiotics with a ${\beta}$-lactam ring and confer resistance to oxyimino-cephalosporins and monobactams. If the patient shows poor responses to empirical antibiotics or severe septic conditions, physicians must switch the antibiotics to other antibiotics covering resistant strains without delay. We report a case of acute pyelonephritis by extended-spectrum ${\beta}$-lactamase producing E.coli in a 29-year-old woman who was empirically treated with oral ciprofloxacin as an initial treatment, but progressed to sepsis.

급성 신우신염은 신실질과 신우를 침범하는 비교적 흔한 감염성 질환으로 여성에서 호발한다. 급성 신우신염은 치료 경과와 예후는 양호한 편이나 초기에 항생제 투여가 적절해야 하며, 세균의 항생제 감수성 결과에 따라서 시기 적절하게 항생제를 변경하는 것도 경과에 중요한 영향을 미친다. 세계적으로 항생제에 내성을 갖는 세균이 증가하고 있으며, 요로 감염의 치료에 흔히 사용되는 ciprofloxacin에 대한 내성도 우려된다. 게다가 extended-spectrum ${\beta}$-lactamase을 생성하는 Escherichia coli의 증가도 중증감염의 위험요인이 되고 있다. 저자들은 29세 여자 환자가 급성 신우신염을 진단 받고 경험적 항생제 치료를 받았으나 폐렴과 패혈증으로 진행된 증례를 보고한다. 본 증례를 통해 항생제 내성 감염균에 대한 경각심을 일깨우고 감염질환의 적절한 항생제 치료에 도움이 되고자 한다.

Keywords

References

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