Yenidoğan Yoğun Bakım Ünitesinde İdrar Yolu Enfeksiyonları: 4 Yıllık Deneyim

Year 2019, , 115 - 122, 22.03.2019

Sara Erol , Nilgün Altuntaş

https://doi.org/10.17098/amj.542422

Cited By: 1

Abstract

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. 

Keywords

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

References

• Bonadio W, Maida G. Urinary tract infection in outpatient febrile infants younger than 30 days of age: a 10-year evaluation. Pediatr Infect Dis J. 2014;33(4):342-4. Levy I, Comarsca J, Davidovits M, Klinger G, Sirota L, Linder N. Urinary tract infection in preterm infants: the protective role of breastfeeding. Pediatr Nephrol 2009;24:527–31.
• Riskin A, Toropine A, Bader D, Hemo M, Srugo I, Kugelman A. Is it justified to include urine cultures in early (< 72 hours) neonatal sepsis evaluations of term and late preterm infants? Am J Perinatol. 2013;30(6):499-504.
• Ismaili K, Lolin K, Damry N, Alexander M, Lepage P, Hall M. Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study. J Pediatr. 2011;158(1):91-4.
• Eliakim A, Dolfin T, Korzets Z, Wolach B, Pomeranz A. Urinary tract infection in premature infants: the role of imaging studies and prophylactic therapy. J Perinatol. 1997;17(4):305-8.
• Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics. 1989;83(6):1011-5.
• Sastre JB1, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC; Grupo de Hospitales Castrillo. Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol. 2007;22(10):1735-41.
• Wallace SS, Zhang W, Mahmood NF et al. Renal Ultrasound for Infants Younger Than 2 Months With a Febrile Urinary Tract Infection. AJR Am J Roentgenol. 2015;205(4):894-8.
• Arshad M, Seed PC. Urinary tract infections in the infant. Clin Perinatol. 2015;42(1):17-28.
• Garcia FJ, Nager AL. Jaundice as an early diagnostic sign of urinary tract infection in infancy. Pediatrics. 2002;109(5):846-51.
• Shahian M1, Rashtian P, Kalani M. Unexplained neonatal jaundice as an early diagnostic sign of urinary tract infection. Int J Infect Dis. 2012;16(7):487-90
• Maherzi M, Guignard JP, Torrado A. Urinary tract infection in high-risk newborn infants. Pediatrics. 1978;62(4):521-3.
• Bergström T, Larson H, Lincoln K, Winberg J. Studies of urinary tract infections in infancy and childhood. XII. Eighty consecutive patients with neonatal infection. J Pediatr. 1972;80(5):858-66.
• Tzimenatos L, Mahajan P, Dayan PS et al. Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics. 2018;141(2). pii: e20173068.
• Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics. 1999;103(4):e54.
• Altuntas N, Tayfur AC, Kocak M, Razi HC, Akkurt S. Midstream clean-catch urine collection in newborns: a randomized controlled study. Eur J Pediatr. 2015;174(5):577-82.
• Herreros Fernández ML, González Merino N, Tagarro García A et al. A new technique for fast and safe collection of urine in newborns. Arch Dis Child. 2013 Jan;98(1):27-9. doi: 10.1136/archdischild-2012-301872. Epub 2012 Nov 21.
• Downey LC, Benjamin DK Jr, Clark RH et al. Urinary tract infection concordance with positive blood and cerebrospinal fluid cultures in the neonatal intensive care unit. J Perinatol. 2013;33(4):302-6.
• Yam AO, Andresen D, Kesson AM, Isaacs D. Incidence of sterile cerebrospinal fluid pleocytosis in infants with urinary tract infection.nJ Paediatr Child Health. 2009 Jun;45(6):364-7.
• Wallace SS, Brown DN, Cruz AT. Prevalence of Concomitant Acute Bacterial Meningitis in Neonates with Febrile Urinary Tract Infection: A Retrospective Cross-Sectional Study. J Pediatr. 2017;184:199-203.
• Parkkinen J, Virkola R, Korhonen TK. Identification of factors in human urine that inhibit the binding of Escherichia coli adhesins. Infect Immun. 1988;56(10):2623-30.
• Pauchard JY1, Chehade H2, Kies CZ1, Girardin E3, Cachat F2, Gehri M1. Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound. Arch Dis Child. 2017;102(9):804-8
• Beetz R. Evaluation and management of urinary tract infections in the neonate. Curr Opin Pediatr. 2012;24(2):205-11.