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

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

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

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