생존분석을 이용한 병원성 요로감염 분석

유성미,박경연,윤은영 한국자료분석학회 2010 Journal of the Korean Data Analysis Society Vol.12 No.3

병원성 요로감염의 가장 큰 위험요인은 도뇨관 삽입이다. 그러나, 도뇨관 삽입시점부터 요로감염 발생시점까지의 기간을 고려하여 요로감염발생에 영향을 주는 요인을 규명한 연구는 찾기 힘든 실정이다. 이에 본 연구는 도뇨관 삽입 후 요로감염이 발생하기까지의 시간을 추정하고, 요로감염 발생에 영향을 미치는 위험요인을 규명하고자 하였다. 본 연구는 2003년 1월부터 12월까지 일개 대학병원 중환자실에 입원한 환자 중 소변배양검사에서 양성반응을 보인 유치도뇨관 삽입환자 386명의 의무기록지를 활용한 후향적 조사를 통해 자료를 수집하였다. 요로감염 발생시간의 추정과 환자의 특성 영역별 비교는 Kaplan-Meier 추정법과 로그-순위 검정(log-rank test)을 사용하였으며, 요로감염 발생 위험요인을 규명하기 위한 분석방법으로는 Cox 비례위험모형(Cox proportional hazards model)을 사용하였다. 분석결과 중간 무요로감염 생존시간(median urinary tract infection free survival time)은 8일이었으며, 환자의 나이, 도뇨관 삽입장소, 도뇨관 교환횟수가 요로감염 발생에 영향을 미치는 요인으로 나타났다. The major risk factor for nosocomial urinary tract infections(UTI) is catheter insertion. However, there has been little studies considering the time span from insertion urinary catheter to the occurrence of UTI to identify risk factors for UTI. This study aimed at both estimating the time span from insertion urinary catheter to the occurrence of UTI onset and investigating risk factors that might influence this time span. The subjects were 386 patients who had positive result in urine culture and were hospitalized in ICU between January and December 2003. The data were collected retrospectively from medical records. Kaplan-Meier estimator was used to estimate UTI free survival time. Cox proportional hazards model was used to identify relative risk factors. The risk factor for catheter-associated urinary tract infection were age, place of catheter insertion, and times of foley catheter change.

위장관 증상으로 입원한 환아의 요로계 감염 실태

조수현,백종태,정종승 大韓家庭醫學會 1993 Korean Journal of Family Medicine Vol.14 No.4-5

노인요양시설 요양보호사의 요로감염 예방행위에 대한 지식과 실천

오영주,송영신 사단법인 인문사회과학기술융합학회 2019 예술인문사회융합멀티미디어논문지 Vol.9 No.10

The purpose of this study was to survey the knowledge and practice about preventive behavior for urinary tract infection in caregivers, and ultimately to provide the basic information in terms of urinary tract infection prevention. Participants in this study were caregivers who working at the 7 long-term care facilities in J-city of South Korea. Total 198 were participated in this study. Descriptive statistics, t-test, one-way ANOVA, and scheffe test were performed using SPSS Windows for 21.0 program. The correct answer rate for the knowledge about preventive behavior of urinary tract infection was 79%. The practice of urinary tract infection preventive behavior were significantly differed by the number of nurses, the number of elderly, working time and the experience, perceived importancy, necessity with education for urinary tract infection. The preventive behavior for urinary tract infection in caregivers should be supervised by health care providers. Moreover, it should be needed to educate and apply the basic education program to improve the caregivers' knowledge and practice for preventive behavior in urinary tract infection by healthcare providers. Continuous infection monitor and education by healthcare providers can be contributed the quality of elderly caring services and development of monitoring system for urinary tract infection in long-term care facilities. 본 연구의 목적은 노인요양시설의 요양보호사를 대상으로 요로감염 예방행위와 관련된 지식과 실천 정도를 조사하여 간호사가 요양보호사에게 요로감염 예방행위의 중요성을 인지시키고 지도, 교육하는데 필요한 기초자료를 제공하고자 시도된 서술적 조사연구이다. 연구대상은 J도에 소재한 7개의 노인요양시설에서 근무하는 요양보호사 198명이였다. 자료분석을 위해 t-test, one-way ANOVA, Scheffes test로 분석을 실시하였다. 요로감염 예방행위에 대한 지식의 정답률은 79%였으며, 대상자의 일반적 및 직무관련 특성에 따른 요로감염 예방행위에 대한 실천은 근무하는 간호사의 수, 담당 노인의 수, 근무시간, 교육의 중요성과 필요성을 인지한 군, 교육을 받은 경험에서 통계적으로 유의한 차이가 나타났다. 본 연구결과를 바탕으로 요양보호사를 위한 체계적인 교육을 통한 지식함양 요구의 기초교육뿐 아니라 의료인에 의한 관리 감독 하에 지속적인 요로감염 예방행위의 실천은 노인요양시설의 기본 감염관리 체계를 완성하고 서비스의 질을 향상 시킬 수 있을 것이다.

요로 감염 예방을 위한 유치도뇨 환자의 간호에 대한 조사 연구

남혜경 경원전문대학 1998 論文集 Vol.20 No.-

Urinary tract infection occurs most frequently in nosocomial infection, It is mainly caused by insertion of a indwelling catheter. Therefore, a nurse takes an important role in protecting patients with indwelling catheters from urinary tract infection. In practice, however, care of patients with indwelling catheters has been conducted according to the ward custom or decisions made by an individual nurse. The purpose of this survey is to encourage nurses to acknowledge the importance of care of patients with indwelling catheters and to help them to establish care guideline. The survey was conducted on nurses and patients with indwelling catheters in the same hospital. The nurses were investigated regarding to care both in knowledge and practice. In case they failed to care, the reason was inquired into. The patients were asked of the frequency of care. As a conclusion, we suggest care guideline of patients with indwelling catheters.

포스터 전시 : 다발성 세균 감염증을 동반한 간경변증 1예

정현수,전재윤,김윤재,방승민,안상훈,한광협,문영명 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3(S)

배경/목적: 감염증은 간경변증에 동반되는 흔한 합병증으로 간경변증 환자의 주된 사망 원인 중 하나이다. 특히 자발성 세균성 복막염, 급성 폐렴, 요로 감염증, 패혈증 등은 그 발생 빈도가 높은 편이다. 따라서 감염증이 의심되는 간경변증 환자에서 혈액, 객담, 소변 등의 검체에 대한 세균 배양 검사를 반드시 시행하여야 하며, 복수가 의심될 경우에도 진단적 복강 천자술을 시행하여야 한다. 저자 등은 급성 세균성 폐렴, 자발성 세균성 복막염, 요로 감염증, 양측 하지의 봉와직염 및 패혈증 등 다발성 세균 감염증을 동반한 간경변증 환자의 증례를 경험하였기에 보고하는 바이다. 증례: 47세 남자가 4일 간의 전신 무력증 및 기침을 주소로 내원하였다. 과거력 상 3년 전 B형 간염 바이러스 보유자, 1년 전 간경변증으로 진단 받고 외래 추적 관찰 중이었다. 환자는 전신 무력감, 기침, 호흡 곤란을 호소하였고, 내원 당시 신체 검사에서 만성 병색을 보였으나 의식은 명료하였으며, 공막에 황달을 보였고 좌측 하폐야에 미세 수포음이 청진 되었다. 복부는 팽만하였고, 이동성 탁음이 청진되었으며, 압통은 없었고, 간이나 비장은 촉지되지 않았다. 양측 하지의 전경골부에 홍반성 부종 및 압통이 관찰되었다. 내원 당시 말초 혈액 검사에서 백혈구 17,330/mm3 (다형핵구 90.9%, 임파구 1.7%, 호산구 0.1%, 호염구 0.3%), 혈색소 11 g/dL, 혈소판 24,000/mm3의 소견을 보였다. 혈청 생화학 검사에서 ESR 2 mm/hour, CRP 7.2 mg/dL, BUN/Cr 63.1/3.9 mg/dL, total protein/albumin 5.3/1.6 g/dL, total bilirubin 13.2 mg/dL, AST/ALT 76/24 IU/L, NH3 175 ug/dL, prothrombin time 26%였고, 요 화학 검사는 WBC 2+(5-10 in HPF), 복강 천자 검사에서 WBC 379 /uL (다형핵구 76%), Protein/albumin 600/200 mg/dL이었다. 흉부 단순 촬영은 좌측 하폐야에 경화 소견이 관찰되었으며, 소변 및 혈액 세균배양검사에서 Klebsiella pneumoniae가 동정되었다. 환자는 정맥내 항생제 투약등 전신 다발성 감염증에 대한 치료를 시작하였으나, 내원 24시간뒤 호흡곤란이 악화되어 인공호흡을 시작하였으며 중환자실에서 집중 치료를 시행하였으나 내원 8일뒤 패혈성 쇼크 및 급성 신부전으로 사망하였다.

폐경 후 요로계 변화와 폐경호르몬치료 효과

김준모 ( Jun Mo Kim ),김태희 ( Tae Hee Kim ) 대한폐경학회 2011 대한폐경학회지 Vol.17 No.3

폐경 후 여성호르몬 감소에 따른 요로기능의 변화로 과민성 방광, 복압성 요실금, 재발성 요로감염과 같은 질환의 발생률이 높아지게 된다. 본 연구는 여성호르몬이 하부요로기능에 미치는 영향 및 폐경 후 요로기능의 변화와 함께 여러형태의 폐경호르몬요법에 따른 과민성 방광, 복압성 요실금, 재발성의 치료 또는 예방효과에 대해서 보고자 한다. Because sex hormones influence the lower urinary tract, menopause can cause several urinary diseases including overactive bladder, stress urinary incontinence and recurrent urinary tract infection. However, the results of many clinical studies have indicated that menopausal hormone replacement therapy is not effective for the treatment of previous diseases, especially via the oral route. Although estrogen vaginal cream or pessary is an effective treatment for overactive bladders and can prevent recurrent urinary tract infection, its beneficial effects only last for the duration of the treatment. If patients with previous mentioned urologic disease have other local symptoms and conditions, such as atrophic vaginitis and dyspareunia, local estrogen replacement therapy will be helpful in relieving the local symptoms. However, the potential for breast cancer or return of withdrawal of bleeding, patient`s age, adverse effect of systemic administration, estrogen-progesterone combination therapy, and effectiveness among other treatment modalities must be considered before a treatment decision can be made. In this article, we will review the current issues on the relationship among urinary tract and sex hormone and menopause, and the effectiveness of menopausal hormone replacement therapy for the treatment of overactive bladders, stress urinary tract incontinence and recurrent urinary tract infection. (J Korean Soc Menopause 2011;17:136-141)

지역사회 단순 요로감염에서의 항생제 내성 및 최신 치료

배현주 ( Hyun Joo Pai ) 대한내과학회 2011 대한내과학회지 Vol.81 No.6

Acute uncomplicated urinary tract infections (UTI), episodes of cystitis or pyelonephritis that occur in healthy non-pregnant women with no functional or anatomic abnormalities of the urinary tract, are among the most commonly encountered bacterial infections. Unfortunately, there has been a recent trend of increasing resistance to antibiotics among uropathogens in many countries including Korea. The resistance rates of Escherichia coli from acute uncomplicated UTI during 2009 to ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (SXT) and cefotaxime were 84.1%, 67.2% and 95.4%, respectively. Resistance both to SXT and CIP was detected in 10.6% of the E. coli isolates. Therefore, it is difficult to recommend the antibiotics which would not worsen the resistance problem and would be effective for community-acquired uncomplicated UTI as well. Considering the high resistance of uropathogens in Korea, several academic societies made the guideline for UTI, which will be briefly reviewed in this manuscript. (Korean J Med 2011;81:685-689)

요로감염이 의심되는 환자의 소변검체에서 분리된 Escherichia Coli O26의 임상적 의의

유항조 ( Hang Jo Yoo ),주원덕 ( Won Duk Joo ),김미령 ( Mi Ryung Kim ),이수정 ( Soo Jeong Lee ),구본상 ( Bon Sang Koo ),정윤성 ( Joseph Jeong ),이선호 ( Seon Ho Lee ),김성률 ( Sung Ryul Kim ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.9

Objective: Escherichia coli (E. coli) O26 has been the most common type of non-O157 human isolates and it has been related with urinary tract infection and its sequelae. So we investigated the clinical significance of E. coli O26 among the cases of urinary tract infection. Methods: From January, 2005 to December, 2007, the 22 E. coli isolates that were related with urinary tract infection were analyzed. The isolates were identified biochemically by Vitek 1. We performed antisera test by O157, O26, O111 diagnostic antisera about the 22 E. coli isolates. We reviewed clinical history of the same patients retrospectively. Results: 331 E. coli isolates in the urine specimen were isolated from January, 2005 to December, 2007. 175 E. coli isolates that were related with urinary tract infection were analyzed by O157, O26, O111 antisera test. As a result, 22 isolates (13.5%) were O26 antisera positive. There were 8, 3, and 2 cases of watery diarrhea, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura repectively. Conclusion: In our study, because E. coli O26 was pathogenic and developed major complications, we concluded that patients with urinary tract infection with E. coli. should examine the antisera test about E. coli O157 and O26.

Aerococcus urinae에 의한 합병된 요로감염 패혈증

허창민 ( Chang Min Heo ),조경민 ( Kyeong Min Jo ),장지훈 ( Ji Hoon Jang ),이유진 ( Yoo Jin Lee ),박봉수 ( Bong Soo Park ),김양욱 ( Yang Wook Kim ),박시형 ( Sihyung Park ) 대한내과학회 2016 대한내과학회지 Vol.91 No.2

Aerococcus urinae is a gram-positive coccus that produces alpha-hemolysis on blood agar and is negative for catalase. A. urinae can often be misidentified as a streptococcus, staphylococcus, or enterococcus by most commercial identification systems. Although A. urinae is a rarely reported human pathogen, it can be fatal in some cases. Here we report on a case of urosepsis caused by A. urinae, identified by 16S rRNA gene sequencing in a patient with ureter stones and hydronephrosis, for the first time in Korea. It is important for physicians to consider A. urinae as a potential pathogen and to prescribe the most suitable antibiotics to ensure the best outcome. (Korean J Med 2016;91:229-232)

집중적 감염관리 프로그램이 유치도뇨관을 가진 중환자의 요로감염 정도에 미치는 효과

유정희,박영임 병원간호사회 2004 임상간호연구 Vol.9 No.2

Purpose: To investigate the effects of Intensive Nosocomial Infection Control Program(INICP) on Urinary Tract Infection(UTI) for critically ill patients. Method: This study was designed with nonequivalent control group with time series. The subjects were consisted of 60 ICU patients with indwelling urinary catheter who didn't have UTI on entering to the ICU. Data collection was done from May 20 to July 20, 2002 for control group and from August 5 to September 30, 2002 for experimental group. The Contents of INICP were education, hand culture and frequent monitoring the control activities including hand washing to improve the attitude and the performance of infection control. Data were analyzed by chi-square test, t-test using SPSS/+10.0 for windows program. Result: There was significantly decreased the incidence rates of nosocomial UTI in the experimental group than the control group(p=.041). There was also significantly decreased incidence rates of overall ICU nosocomial infection in the experimental group than the control group(p=.041). The duration of indwelling urinary catheter without UTI was significantly prolonged in the experimental group than the control group(p=.044). The length of stay in ICU without UTI was significantly prolonged in the experimental group than control group(p=.028). WBC trends of urine analysis on last day of surveillance wasn't significantly decreased between experimental group and control group(p=.101). Conclusion: The effects of INICD to decrease the in ICU patients with indwelling urinary catheter was supported. And the continuous emphasis on the study for identifying the effects of INICP will be recommended to control the risk factors of UTI.