Pediatric Infection and Vaccine

  • 제24권1호
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  • Pages.54-59
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  • 2017
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  • 2384-1079(pISSN)
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  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
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어린 영아의 요로 감염에서 관습적인 요추 천자의 필요성에 대한 단일 기관 연구

A Single Center Study of the Necessity for Routine Lumbar Puncture in Young Infants with Urinary Tract Infection

  • 이창호 (대구가톨릭대학교 의과대학 소아과학교실) ;
  • 이계향 (대구가톨릭대학교 의과대학 소아과학교실)
  • Lee, Chang Ho (Department of Pediatrics, Catholic University of Daegu School of Medicine) ;
  • Lee, Kye Hyang (Department of Pediatrics, Catholic University of Daegu School of Medicine)
  • 투고 : 2016.09.06
  • 심사 : 2016.10.07
  • 발행 : 2017.04.25
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초록

목적: 생후 3개월 이하 어린 영아에서 심각한 세균 감염 가운데 요로 감염이 가장 흔하다. 요추 천자는 발열의 평가 시 기본 검사에 포함되어 시행되는 경우가 많지만, 요로 감염 환자에서 수막염을 진단하기 위해 통상적으로 시행해야 하는 뚜렷한 지침은 없다. 이에 저자들은 어린 영아의 요로 감염에서 동반되는 세균성 수막염 및 무균성 뇌척수액 백혈구증가증의 유병률을 알아보기 위해 연구를 시행하였다. 방법: 2013년 1월부터 2016년 5월 사이 대구가톨릭병원 소아청소년과에서 요로 감염으로 입원하여 요추 천자를 시행한 생후 29일부터 99일 미만 영아 80명의 의무기록을 후향적으로 조사하였다. 분석 변수로는 대상 환자들의 인구학적 특징, 임상 증상, 검사 결과 및 치료를 조사하였고, 뇌척수액 백혈구 증가증을 보이는 군과 그렇지 않은 군을 비교하였다. 결과: 총 80명의 환자 가운데 34명(43%)에서 뇌척수액 백혈구증가증이 관찰되었다. 뇌척수액에서 세균이 배양된 경우는 없었다. 뇌척수액 장바이러스 중합효소연쇄반응은 56명(70%)에서 시행하였고, 뇌척수액 백혈구증가증이 나타나지 않은 환자들 중 2명에서 양성이었다. 뇌척수액 백혈구증가증을 보이는 군과 그렇지 않는 군 간에 인구학적 특징, 검사실 소견, 영상검사, 치료 및 경과에 있어 양 군 간에 유의한 차이가 없었다. 결론: 신생아기 이후 어린 영아의 요로 감염에서 동반되는 뇌척수액 백혈구증가증은 흔하지만, 이의 원인으로 세균이나 바이러스 감염에 의한 가능성은 아주 낮다. 전신 상태나 검사실 소견을 종합하여 요추 천자의 적응증을 개별적으로 평가하여 적용하는 것이 필요하다.

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.

키워드

참고문헌

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