Yenidoğan Yoğun Bakım Ünitesinde İdrar Yolu Enfeksiyonları: 4 Yıllık Deneyim

Öz

Amaç: Yenidoğan döneminde idrar yolu enfeksiyonu, term ve preterm bebekler için önemli bir geç sepsis nedenidir. Bu çalışmanın amacı üçüncü düzey bir yenidoğan yoğun bakım ünitesine idrar yolu enfeksiyonu tanısıyla kabul edilen hastaların klinik, laboratuvar ve radyolojik inceleme sonuçlarını değerlendirmektir.

Materyal ve Metot: Mesane kateterizasyonu ile alınan idrar kültürüne göre idrar yolu enfeksiyonu tanısı alan ve yenidoğan yoğun bakım ünitesine kabul edilen term yenidoğanlara ait klinik, laboratuvar ve radyolojik görüntüleme sonuçlarına geriye dönük olarak bilgisayar kayıtlarından ulaşıldı. Verilerin farklılıkları ve ilişkileri istatistiksel olarak değerlendirildi.

Bulgular: 2015-2018 yılları arasında idrar yolu enfeksiyonu tanısıyla yenidoğan yoğun bakımda izlenen 43 hastanın verileri değerlendirildi. Olguların %77 (n=30)’si erkekti ve ortalama tanı günü median 10 (7-28 gün) olarak bulundu. Olguların 22(%51,16)’si sarılık, 6(%13,96)’sı kusma, 5(%11,62)’i ateş, 4(%9,30)’ü beslenme güçlüğü yakınmaları ile başvururken %13,96’sının başvuru sırasında semptomu yoktu. En sık üreyen mikroorganizmalar %60,46 oranında Escherichia coli ve %20,93 oranında Klebsiella pneumonia idi. Amikasin direncinin Escherichia coli ve Klebsiella pneumonia üreyen hastalarda gentamisin direncine göre anlamlı şekilde düşük olduğu görüldü (sırasıyla p<0,001 ve p=0,046).

Sonuç: Neonatal idrar yolu enfeksiyonları klinik olarak asemptomatik olabilecekleri gibi sepsis ve renal hasara yol açarak önemli morbidite ve mortalite nedeni de olabilirler. Erken ve etkin tedavi için klinik ve laboratuvar bulguların değerlendirilmesi kadar, değişken antibiyotik dirençlerinin dikkate alınarak ampirik antibiyotik tedavisinin başlanması önemlidir. 

Anahtar Kelimeler

• Yenidoğan,idrar yolu enfeksiyonu,antibiyotik direnci

Urinary Tract Infections in Neonatal Intensive Care Unit: 4-Year Experience

Abstract

Objectives: Urinary tract infection in neonatal period is an important cause of late sepsis for term and preterm infants. The aim of this study was to evaluate the results of clinical, laboratory and radiological examinations of patients admitted to the third-level neonatal intensive care unit with urinary tract infection.

Materials and Methods: The results of clinical, laboratory and radiological imaging of term newborns who were diagnosed as urinary tract infection according to urine culture obtained by bladder catheterization and accepted into neonatal intensive care unit were obtained from computer records retrospectively. Differences and relationships of the data were statistically evaluated.

Results: The data of 43 patients who were followed up in the neonatal intensive care unit with the diagnosis of urinary tract infection between 2015-2018 were evaluated. 77 (n=30) % of the cases were male and the diagnosis day was median 10 (7-28 days). 22 (51%) of the cases presented with jaundice, 6 (13.96%) with vomiting, 5 (11.62%) with fever and 4 (9.30%) with feeding difficulties and 13.96% had no symptoms at admission. The most common microorganisms were Escherichia coli (60.46%) and Klebsiella pneumonia (20.93%). Amikacin resistance was significantly lower in patients with Escherichia coli and Klebsiella pneumonia compared to gentamicin resistance (p<0.001 and p = 0.046).

Conclusion: Neonatal urinary tract infections can be clinically asymptomatic or cause sepsis and renal damage and may be a major cause of morbidity and mortality. The initiation of empirical antibiotic therapy according to variable antibiotic resistance is as important as the clinical and laboratory findings for early and effective treatment.

Keywords

• newborn,urinary tract infection,antibiotic resistance

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