Breakthrough Urinary Tract Infection: A Clinical Study of Experience of a Single Center

Bae, Sang-In; Cheon, Chong-Kun; Kim, Su-Young

doi:2010.14.2.203

J Korean Soc Pediatr Nephrol > Volume 14(2); 2010 > Article

J Korean Soc Pediatr Nephrol 2010;14(2): 203-209. doi: https://doi.org/10.3339/jkspn.2010.14.2.203

예방적 항생제 사용중에 발생한 요로감염: 단일 병원에서 경험한 임상연구

배상인, 전종근, 김수영

¹부산대학교 의학전문대학원 소아과학교실
²부산대학교 의학전문대학원 소아과학교실
³부산대학교 의학전문대학원 소아과학교실

Breakthrough Urinary Tract Infection: A Clinical Study of Experience of a Single Center

Sang-In Bae, Chong-Kun Cheon, Su-Young Kim

¹Department of Pediatrics, Pusan National University Collese of Medicine
²Department of Pediatrics, Pusan National University Collese of Medicine
³Department of Pediatrics, Pusan National University Collese of Medicine

Received: September 22, 2010; Revised: October 12, 2010. Accepted: October 18, 2010.

ABSTRACT

Purpose : It has been a common medical practice to use prophylactic antibiotics to prevent recurrent urinary tract infections (UTI) in high risk situations such as urinary tract obstruction, vesicoureteral reflux, neurogenic bladder, or urinary stones. But sometimes, we meet difficult situation of breakthrough infections (BI) which might cause new or progressive renal scarring. The clinical characteristics of children contracting breakthrough UTI experienced in a single center were studied.
Methods : The study was done retrospectively through medical records of 150 pediatric patients who had been cared in pediatric and urologic clinics of Pusan National University Hospital from Jan. 2001 till June 2006 and had prophylactic antibiotics to prevent recurrent UTI.
Results : The starting age of prophylactic antibiotics of 150 patient was 1-76 months, and median age was 5 months. The BI developed 61 times in 43 patients (28.7%), 1.5 times per 100 patient-months. The BI occurred more frequently in patients with higher grade of VUR, and in the cases with abnormal DMSA scan. Co-trimoxazole was more effective than 2nd and 3rd generation cephalosporins to prevent UTI. The distribution of causative organisms was more diverse than usual UTI. The causative organisms were sensitive to the antibiotics used for prophylaxis in 29.5%, and resistant in 59.1%. After experience of BI, 40 percents of patients went to the surgical treatment including endoscopic injection of Deflux, 35% to new antibiotics for prophylaxis, 26% remain on the same antibiotics as the previous one.
Conclusion : Based on our study results, preexisting renal scar might be one of the factors which should be considered in favor of early surgical interventions of VUR. Poor compliance and wrong selection of antibiotics such as cephalosporins are important underlying causes of breakthrough UTIs.

Key words: UTI | vesicoureteral reflux | breakthrough infection