Kuzey Irak'ta Soran şehrinde okul çağındaki çocuklarda İYE'ye neden olan antibiyotik dirençli bakterilerin görülmesi

Year 2023, , 82 - 100, 15.04.2023

Hasan Akan , Rawezh Hakeem Mustafa

https://doi.org/10.38001/ijlsb.1241994

Cited By: 1

Abstract

İdrar yolu enfeksiyonları (İYE) yaygın olarak çocuklarda görülmektedir. Hemen hemen tüm İYE'lere
mikroorganizmalar neden olmaktadır. İYE geçiren çocuklar ve bebeklerde ölüm riski daha yüksektir.
Bakteriyel üropatojenlerde oluşan antibiyotik direnci önemli bir küresel sorun olarak görülmektedir.
Dünya genelinde tedavide yaygın olarak kullanılan antibiyotiklere direnç gösteren üropatojenlerin
özellikle okul çağındaki çocuklarda üriner enfeksiyona neden olması endişe verici bir durum olarak
orataya çıkmaktadır. Bu çalışmada, Irak'ın kuzeyindeki Soran şehrinde yaşayan okul çağındaki çocuklarda
(altı yaşında) çoklu ilaç dirençli üropatojenlerin ortaya çıkışınının araştırılması amaçlanmıştır. Bu çalışma
ile yaş ve cinsiyete göre İYE dağılımı ve enfeksiyona neden olan bakteriyel ajanları antibiyotik
duyarlılıklarına dair veriler elde edilmiştir. Çoklu ilaca dirençli izolatlarda bulunan antibiyotik direnç
genlerinden, etkili olanları tespit edilmiştir. Yapılan te çalışmasında Soran kentindeki Ashti hastanesi ve
doğum hastanelerinde Temmuz 2017'den Mart 2018'e tarihleri arasında tedavi göre İYE’ ye sahip altı
yaşından küçük çocukların, toplam 200 idrar örneği kullanılmıştır. Çalışma sonucunda iki yaşından küçük
çocuklarda (%34.3) İYE’nın görülme sıklığının daha fazla, İYE'e oranının kız çocuklarında (%57.1) erkek
çocularına oranla anlamlı olarak daha yüksek olduğu ortaya konulmuştur. Çalışmada 70 bakteriyel
üropatojen izole edilmiş ve 130 örnek ise negatif kültür göstermiştir. İzolatların incelenmesi sonucu en
yaygın üropatojenin E. coli 27 (%38.6) olurken diğerleri sırasıyla Staphylococcus aureus 13 (%18.6),
koagülaz negatif stafilokok 8 (% 11.4), Klebsiella pnömonisi 7 (%10), Enterococcus faecalis 6 (%8.57),
Streptococcus spp. 4 (%5.71), Pseudomonas aeruginosa 2 (%2.9), Staphylococcus saprophyticus 2 (%2.9)
ve Proteus vulgaris 1 (%1.4) olmuştur. Üropatojenik izolatların çoğu ampisilin, seftazidim, seftriakson ve
sefotaksime direnç göstermiştir. Diğer antibiyotiklere ise orta derecede duyarlılık göstermiştir. En etkili
antibiyotikler, çalışma sırasında tüm izolatlarda yüksek duyarlılık oranları gösteren kinolonlar
(siprofloksasin ve levofloksasin) ve karbapenemler (impenem ve meropenem) olmuştur. RABD-PCR
kullanarak kinolon ve karbapenem direncinden sorumlu qnrA, qnrB, qnrS ve blaKPC'nin varlığını saptamak
için altı çoklu ilaca dirençli izolatı kullanılmıştır. DNA profili, sadece K 61 (Klebsiella pneumoniae)
izolatının qnrB'yi taşıdığını göstermiştir.

Keywords

Antibiyotik direnci, çoklu ilaca dirençli bakteri, IYE, Çocuklar, Okul öncesi

Supporting Institution

Harran Ün

Project Number

Bu çalışma HÜBAK Tarafından Desteklenmiştir. Proje No: 18045

Thanks

Dr. Öğr. Üyesi Ashwaq NOORI’ ye ve Harran Üniversitesi BAP birimine teşekkür ederiz

Occurrence of antibiotic resistant bacteria causing UTIs among children under school age in Soran city, North of Iraq

Abstract

The current study was carried out to investigate the occurrence of multidrug resistant uropathogens among children under school age (six years old) in Soran city, North of Iraq. A total number of 200 urine samples were taken from children under six years old suffering from UTIs, attending Ashti hospital and Childbirth hospitals in Soran city from July 2017 to march 2018. High frequency of UTIs was among children less than two years old (34.3%) and incidence of UTIs was significantly higher in little girls (57.1%) than in little boys. 70 bacterial uropathogens have benn isolated while 130 samples showed negative culture. The diagnosis of isolates showed that the most common uropathogen was E. coli constituting 27 (38.6%), while others included; Staphylococcus aureus 13 (18.6%), coagulase negative staphylococci 8 (11.4)%, Klebsiella pneumonia 7(10%), Enterococcus faecalis 6 (8.6%), Streptococcus spp. 4 (5.7%), Pseudomonas aeruginosa 2 (2.9%), Staphylococcus saprophyticus 2 (2.9%) and Proteus vulgaris 1 (1.4%). Most of uropathogenic isolates have resisted ampicillin, ceftazidime, ceftriaxone and cefotaxime. Other antibiotics differently showed moderate susceptibilities. The most effective antibiotics were quinolones (ciprofloxacin and levofloxacin) and carbapenems (impenem and meropenem) which showed high susceptibility percentages on all isolates under study. Six multidrug have been chosen resistant isolates to detect the presence of qnrA, qnrB, qnrS and blaKPC responsible for quinolones and carbapenem resistance by using RABD-PCR. The DNA profile showed that only the isolate K 61 (Klebsiella pneumoniae) was bearing qnrB.

Keywords

Antibiotic resistance, multidrug resistant bacteria, UTIs, Children, Under school age, Antibiyotik direnci, çoklu ilaca dirençli bakteri

Project Number

Bu çalışma HÜBAK Tarafından Desteklenmiştir. Proje No: 18045

References

• Henffner, V. and M. Geolick, Pediatric urinary tract infection. Clinical Pediatric Emergency Medicine, 2008. 9(4): p. 233-237.
• Breshears, M.A. and A.W. Confer, The urinary system in Pathologic Basis of Veterinary Disease, J. F., Zachary and M.D. McGavin, Editors. 2107, Elsevier: Amsterdam. p. 617-681.
• Tullus, K. and N. Shaikh, Urinary tract infections in children. The Lancet, 2017. 395(10237):1659-1668.
• Quigley, R., Diagnosis of urinary tract infections in children. Current Opinion in Pediatrics, 2009. 21(2): p. 194-98.
• Leung, A.K.C., et al. Urinary tract infection in children. Recent Patents on Inflammation & Allergy Drug Discovery, 2019. 13 (1): p. 2-18. doi: 10.2174/1872213X13666181228154940
• Larcombe, J., Urinary tract infection in children: recurrent infections. BMJ Clinical Evidence, 2015. 5:0306.
• Greenhow TL., et al. The changing epidemiology of serious bacterial infections in young infants. The Pediatric Infectious Disease Journal, 2014. 33(6): p. 595-599. doi: 10.1097/INF.0000000000000225.
• Kaufman, J., Temple-Smith, and M., Sanci, L., Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open, 2019. 3 (1):e000487. doi: 10.1136/bmjpo-2019-000487.
• Wilson, C.B. et al. Remington and Klein's infectious diseases of the fetus and newborn infant. 2015. Elsevier Health Sciences.
• Hindi, N., Hasson, S., and Hindi, S., Bacteriological study of urinary tract infections with antibiotics susceptibility to bacterial isolates among honeymoon women in al Qassim hospital, Babylon province, Iraq. British Biotechnology Journal, 2013. 3(3): p.332-340. Hooton, T., Pathogenesis of urinary tract infections: an update. Journal of Antimicrobial Chemotherapy, 2000. 46(suppl1): p. 1-7
• Kasper, D., et al. Harrison′s principles of internal medicine. 2005, New York: McGraw-Hill Companies Inc.
• Chamberlain, NL., The big picture medical microbiology. 2009, New York: McGraw-Hill Companies Inc.
• Geffers, C. and P. Gastmeier, Nosocomial infections and multidrug resistance organisms–epidemiological data from KISS. Deutsches Ärzteblatt International, 2011. 108(6): p.87–93.
• Klevens, R., et al. Estimating health care associated infections and deaths in US hospitals 2002. Public Health Reports, 2007. 122(2): p. 160-166.
• Wilson, M. and L. Gaido, Laboratory diagnosis of urinary tract infections in adult patients. Clinical Infectious Diseases, 2004. 38 (8): p. 1150–1158.
• Beyene, G. and W. Tsegaye, Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in Jimma university specialized hospital, south west Ethiopia. Ethiopian Journal of Health Science, 2011. 21(2): p.141-146.
• Abdulrazzaq, G., Pattern of antibiotic sensitivity and resistance of uropathogens among pediatric patients with urinary tract infection. Iraqi Journal of Pharmacy, 2013. 13(1): p. 64-76.
• Sweih, N., Jamal, W., and Rotimi, V., Spectrum and antibiotic resistance of uropathogens isolated from hospital and community patients with urinary tract infections in two large hospitals in Kuwait. Medical Principles and Practicet, 2005. 14(6): p. 401–407.
• Francesco, M., et al. Urinary tract infections in Brescia, Italy: Etiology of uropathogens and antimicrobial resistance of common uropathogens. Medical Science Monitor, 2007. 13(6): p.136–144.
• Shaaban, M., H. Ghozlan, and M. El Maghraby, Susceptibility of bacteria infecting urinary tract to some antibiotics and essential oils. Journal of Applied Pharmaceutical Science (Issue), 2012. 2(4): p. 90-98.
• Al-Sehlawi, Z.A., Bacteriological study on urinary tract infections associated with catheterization of hospitalized patients. Medical Journal of Babylon, 2010. 18 (2): p. 452-461.
• Amin, M., M. Mehdinejad, and Z. Pourdangchi, Study of bacteria isolated from urinary tract infections and determination of their susceptibility to antibiotics. Jundishapur Journal of Microbiology, 2009. 2(3): p. 118-123.
• Martinez, L., et al., Interaction of plasmid and host quinolone resistance. Journal of Antimicrobial Chemotherapy, 2003. 51(4): p. 1037-1039.
• Harley, J., and L. Prescott, Laboratory exercises in microbiology. 2022. New York: The McGraw-Hill Companies.
• Merlino, J., Evaluation of CHROMagar orientation for differentiation and presumptive identification of gram-negative bacilli and Enterococcus species. Journal of Clinical Microbiology, 1996. 34 (7): p. 1788-1793.
• Cheesbrough, M., District laboratory practice in tropical countries. 2005. New York: Cambridge University Press.
• Morello, J., P. Granato, and H. Mizer, Laboratory manual and work book in microbiology applications to patient care. 2003. New York: McGraw-Hill Publishing Company.
• Vandepitte, J., et al., Basic laboratory procedures in clinical bacteriology. 2003. Geneva: World Health Organization.
• Holt, J., et al., Bergey’s manual of determinative bacteriology. 1994. Philadelphia: Williams and Wilkins publishers.
• Mcfaddin, J., Biochemical testes for identification of medical bacteria. 2000. Philadelphia: Williams and Wilkins publishers.
• Bauer, A., Antibiotic susceptibility testing by a standardized single disk method. American Journal of Clinical Pathology, 1966. 45(4): p. 493–496.
• Clsi, E., Clinical and Laboratory Standards institute, performance standards for antimicrobial susceptibility testing; twenty-first informational supplement m100-S21. 2011. Pennsylvania:Wayne.
• Sambrook, J., and D. Russell, Molecular cloning a laboratory manual. 2001. New York: Cold Spring Harbor Press.
• Alsammani, MA., MI. Ahmed, and NF. Abdelatif, Bacterial uropathogens isolates and antibiograms in children under 5 years of age. Medical Archives, 2014. 68(4): p. 239-243.
• Sharma, A., et al., Clinical and bacteriological profile of urinary tract infection in children at Nepal medical college teaching hospital. Nepal Medical College Journal, 2011. 13(1): p. 24-26.
• Akram, M., M. Shahid, and A. Khan, Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in JNMC Hospital Aligarh, India. Annals of Clinical Microbiology and Antimicrobials, 2007. 6(4): p. 1-7.
• Islam, M., et al. Urinary tract infection in children in a tertiary level hospital in Bangladesh. Mymensingh Medical Journal, 2010. 19(4): p. 482-486.
• Mantadakis, E., et al., Antimicrobial susceptibility of pediatric uropathogens in Thrace, Greece. International Urology and Nephrology, 2011. 43 (2): p. 549-555.
• Schlager, T., Urinary tract infections in children younger than 5 years of age. Paediatric Drugs, 2001. 3(3): p. 219-227.
• Ouno, G., et al., Isolation identificationand characterization of urinary tract infections bacteria and the effect of different antibiotics. Journal of Natural Sciences Research, 2013. 3(6): p. 150-159.
• Ramazan, M., et al. Risk factors in urinary tract infection. Gomal Journal of Medical Sciences, 2004. 2(1): p. 1-4.
• Kolawole, A., et al. Prevalence of urinary tract infections (UTI) among patients attending Dalhatu Araf specialist Hospital, Lafia, Nasarawa State, Nigeria. International Journal of Medicine and Medical Sciences, 2009. 1(5): p. 163-167.
• Holt, J., et al., Inducible production of c-fos antisense RNA inhibits 3T3 cell proliferation. Proceedings of the National Academy of Sciences, 1986. 83(13): p. 4794-4798.
• Zuckerman, J., F. Qamar, and B. Bono, Macrolides, ketolides, and glycylcyclines: azithromycin, clarithromycin, telithromycin, tigecycline. Infectious Disease Clinics, 2009. 23(4): p. 997-1026.
• Bush, K., G. Jacoy, and A. Medeiros, A functional classification scheme for β-lactamases and its correlation with molecular structure. Antimicrobial Agents and Chemotherapy, 1995. 39(6): p. 1211-1233.
• Diver, J. and R. Wise, Morphological and biochemical changes in Escherichia coli after exposure to ciprofloxacin. Journal of Antimicrobial Chemotherapy, 1986. 18: p. 31-41.
• Drlica, K. and X. Zhao, DNA gyrase, topoisomerase IV, and the 4-quinolones. Microbiology and molecular biology reviews, 1997. 61(3): p. 377–92.
• Shalini, JMC., MK. Rashid, and HS. Joshi, Study of antibiotic sensitivity pattern in urinary tract infection at a tertiary hospital. National Journal of Integrated Research in Medicine, 2011. 2 (3): p. 43-46.
• Mezal, T., N. Ajeel, and H. Hasony, Antimicrobial resistance of uropa-thogens in Basrah. The Medical Journal of Basrah University, 2011. 29 (1-2): p. 13-18.
• Jha, N., and SK. Bapat, A study of sensitivity and resistance of pathogenic microorganisms causing UTI in Kathmandu valley. Kathmandu University Medical Journal, 2005. 3(2): p.123-129.
• Hussein, N., Clinical, etiology and antibiotic susceptibility profiles of community acquired urinary tract infection in a Baghdad hospital. Medical and Surgical Urology, 2014. 3(2): p. 1-5.
• Yasmeen, B., et al., Prevalence of urinary tract infection, its causative agents and antibiotic sensitivity pattern: A study in Northern International Medical College Hospital, Dhaka. Northern International Medical College Journal, 2015. 7(1): p. 105-109.
• Kyoung, Ho Ryu., Results of urine culture and antimicrobial sensitivity tests according to the voiding method over 10 years in patients withspinal Cord Injury. Korean Journal of Urology, 2011. 52(5): 345–349.
• Abera, B., and M. Kibret, Azithromycin, fluoroquinolone and chloramphenicol resistance of non-chlamydia conjunctival bacteria in rural community of Ethiopia. Indian Journal of Ophthalmology, 2014. 62(2): p. 236-239.
• Kim, J., et al. Network rewiring is an important mechanism of gene essentiality change. Scientific reports, 2012. 2 (1): 900.
• Strahilevitz, J., et al. Changes in qnr prevalence and fluoroquinolone resistance in clinical isolates of Klebsiella pneumoniae and Enterobacter spp. collected from 1990 to 2005. Antimicrobial agents and chemotherapy, 2007. 51 (8): p. 3001–3003.
• Chen, Z., et al. Prevalence of antibiotic-resistant Escherichia coli in drinking water sources in Hangzhou City. Frontiers in Microbiology, 2017. 8:1133.