Üçüncü Basamak Bir Hastanede Görülen Toplum Kaynaklı İlk İdrar Yolu Enfeksiyonlarındaki Üropatojenlerin Antibiyotik Direnç Paternleri

Abstract

Amaç: Artan antibiyotik direnci, idrar yolu enfeksiyonlarının (İYE) yönetiminde daha yüksek morbidite, mortalite ve maliyetlerle ilişkili önemli bir sorundur. Bu çalışma, ilk kez toplum kökenli İYE geçiren çocuklardan izole edilen üropatojenlerin antimikrobiyal direnç profilini analiz etmeyi amaçlamaktadır.

Gereç ve Yöntemler: Bu retrospektif kohort çalışması, Ocak 2010-Aralık 2016 tarihleri arasında, üçüncü basamak bir çocuk hastanesinin polikliniklerinde ilk toplum kökenli İYE atağı tanısı konan bir ay ile 18 yaş arasındaki hastalarla yapıldı. Hastaların yaşı, cinsiyeti, İYE öyküsü, başvurudaki klinik bulguları, idrar analizi, idrar kültürü ve antibiyogram sonuçları kaydedildi.

Bulgular: Çalışmaya toplam 1086 hasta ve 1086 kültür dahil edildi. Erkek/kadın oranı 1/5.3’dü. Çocukların yaş ortalaması 73.7±47.1 (0.4-215.9) aydı. %16’sı 1-24 aylıktı. E. coli sıklık olarak %85.1 ile en sık etken etkendi. Genel antimikrobiyal direncin ampisilin için en yüksek olduğu, ampisilini piperasilin ve trimetoprim-sülfametoksazolün (sırasıyla %63.5, %41.6 ve %38.1) takip ettiği bulundu. İmipenem, amikasin ve tobramisin en düşük dirence sahipti (sırasıyla %0.5, 0.5 ve %7.6). Amoksisilin-klavulanat, ampisilin-sulbaktam, sefuroksim, seftriakson’a karşı genel antimikrobiyal direnç oranı sırasıyla %19.4, 24, %25.9 ve %21.1’di. Örneklerin %5.6’sında (n=61) geniş spektrumlu beta-laktamaz pozitifliği saptandı.

Sonuç: Çalışmamız, idrar kültürü ve antibiyotik duyarlılık sonuçları belirlenmeden önce reçete edilen en yaygın antibiyotiklere karşı antimikrobiyal dirençte önemli artış olduğunu göstermiştir. Amoksisilin-klavulanat, ampisilin-sulbaktam, sefuroksim, seftriakson için direnç oranları, ayakta tedavi ortamında ilk İYE atağı olan çocuklarda neredeyse %20 veya üzerindedir.

Keywords

• üriner sistem enfeksiyonu
• antibiyotik duyarlılığı
• antibiyotik direnci

Antibiotic Drug Resistance Pattern of Uropathogens Seen in The First Episode of Community-Acquired Pediatric Urinary Tract Infections At A Tertiary Care Hospital

Abstract

Objective: Increased antibiotic resistance is a significant problem associated with higher morbidity, mortality, and costs in managing urinary tract infections (UTI). This study aims to analyze the antimicrobial resistance profile of uropathogens isolated from children with the first attack of community-acquired UTI.

Material and Methods: This retrospective cohort study was conducted between January 2010-December 2016, with the patients aged one month to 18 years diagnosed with the first attack of community-acquired UTI at the pediatric outpatient clinic of a tertiary care hospital. Patients’ age, sex, UTI history, clinical findings at admission, urine analysis, urine culture, and antibiogram results were recorded.

Results: A total of 1086 patients and 1086 cultures were included in the study. The male/female ratio was 1/5.3. The mean age of the children was 73.7±47.1 (0.4-215.9) months. 16.0% were aged 1-24 months. E. coli was the most common causative agent found to be 85.1% in frequency. The overall antimicrobial resistance was found to be highest for ampicillin, followed by piperacillin and trimethoprim-sulfamethoxazole (63.5, 41.6 and 38.1%, respectively). Imipenem, amikacin, and tobramycin had the least resistance (0.5, 0.5, and 7.6%, respectively). The overall antimicrobial resistance against amoxicillin-clavulanate, ampicillin-sulbactam, cefuroxime, ceftriaxone was 19.4, 24, 25.9 and 21.1%; respectively.Extended-spectrum beta-lactamase positivity was detected in 5.6% (n=61) of samples.

Conclusion: Our study showed significant increase in antimicrobial resistance to the most common antibiotics which are prescribed before urine culture results and antibiotic sensitivities are available. The resistance rates for amoxicillin-clavulanate, ampicillin-sulbactam, cefuroxime, ceftriaxone was almost 20% or above in children with the first UTI attack in an outpatient setting.

Keywords

• urinary tract infection
• antimicrobial resistance
• antimicrobial susceptibility

References

1. 1. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health. 2017;37:273-9.
2. 2. Konca C, Tekin M, Uckardes F, Akgun S, Almis H, Bucak IH, et al. Antibacterial resistance patterns of pediatric community-acquired urinary infection: Overview. Pediatr Int. 2017;59:309-15.
3. 3. Tullus K. Outcome of post-infectious renal scarring. Pediatr Nephrol. 2015;30:1375-7.
4. 4. Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, et al. Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring. JAMA Pediatr. 2016;170:848-54.
5. 5. Karavanaki KA, Soldatou A, Koufadaki AM, Tsentidis C, Haliotis FA, Stefanidis CJ. Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 2017;106:149-54.
6. 6. Wang J, He L, Sha J, Zhu H, Huang L, Zhu X, et al. Etiology and antimicrobial resistance patterns in pediatric urinary tract infection. Pediatr Int. 2018;60:418-22.
7. 7. Erol B, Culpan M, Caskurlu H, Sari U, Cag Y, Vahaboglu H, et al. Changes in antimicrobial resistance and demographics of UTIs in pediatric patients in a single institution over a 6-year period. J Pediatr Urol. 2018;14:176.e1-176.e5.
8. 8. Kurt-Şükür ED, Özçakar ZB, Doğan Ö, Öztürk M, Karaman M, Çakar N, et al. The changing resistance patterns of bacterial uropathogens in children. Pediatr Int. 2020;62:1058-63

9. 9. Raupach T, Held J, Prokosch HU, Rascher W, Zierk J. Resistance to antibacterial therapy in pediatric febrile urinary tract infections-a single-center analysis. J Pediatr Urol. 2020;16:71-9.
10. 10. Subcommittee on urinary tract infection. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2–24 Months of Age. Pediatrics 2016;138 (6). pii: e20163026.
11. 11. National Committee for Clinical Laboratory Standards: Performance Standards for Antimicrobial Susceptibility Testing. Twelfth Informational Supplement. NCCLS document M100-S12. Wayne, National Committee for Clinical Laboratory Standards, 2002.
12. 12. Rasamiravaka T, Shaista Sheila HS, Rakotomavojaona T, Rakoto-Alson AO, Rasamindrakotroka A. Changing profile and increasing antimicrobial resistance of uropathogenic bacteria in Madagascar. Med Mal Infect. 2015;45:173-6.
13. 13. Wu CT, Lee HY, Chen CL, Tuan PL, Chiu CH. High prevalence and antimicrobial resistance of urinary tract infection isolates in febrile young children without localizing signs in Taiwan. J Microbiol Immunol Infect. 2016;49:243-8.
14. 14. Robinson JL, Le Saux N. Management of urinary tract infections in children in an era of increasing antimicrobial resistance. Expert Rev Anti Infect Ther. 2016;14:809-16.
15. 15. Rezaee MA, Abdinia B. Etiology and Antimicrobial Susceptibility Pattern of Pathogenic Bacteria in Children Subjected to UTI: A Referral Hospital-Based Study in Northwest of Iran. Medicine (Baltimore). 2015; 94:e1606
16. 16. Moore CE, Sona S, Poda S, Putchhat H, Kumar V, Sopheary S, et al. Antimicrobial susceptibility of uropathogens isolated from Cambodian children. Paediatr Int Child Health. 2016; 36:113-7.
17. 17. Sharef SW, El-Naggari M, Al-Nabhani D, Al Sawai A, Al Muharrmi Z, Elnour I. Incidence of antibiotics resistance among uropathogens in Omani children. presenting with a single episode of urinary tract infection. J Infect Public Health. 2015;8:458-65
18. 18. Akhtar MS, Mohsin N, Zahak A, Ain MR, Pillai PK, Kapur P et al. Antimicrobial sensitivity pattern of bacterial pathogens in urinary tract infections in South Delhi, India. Rev Recent Clin Trials. 2014; 9:271-5.
19. 19. Senel S, Karacan C, Erkek N, Gol N. A single-center experience of antimicrobial resistance patterns in pediatric urinary tract infection. Medical Principles and Practice 2010; 19:359-63
20. 20. Koçak M, Büyükkaragöz B, Çelebi Tayfur A, Çaltik A, Köksoy AY, Çizmeci Z, et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int. 2016;58:467-71
21. 21. Ghadage DP, Nale SS, Kamble DS, Muley VA, Wankhade AB, Mali RJ, et al. Study of Aetiology and Anti-biogram of Uropathogens in Children-A Retrospective Analysis. J Clin Diagn Res. 2014;8:20-2.
22. 22. Kothari A, Sagar V. Antibiotic resistance in pathogens causing community-acquired urinary tract infections in India: A multicenter study. J. Infect. Dev. Ctries 2008;2: 354–8.
23. 23. Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community-acquired urinary tract infection. Arch Dis Child .2003;88: 215–8
24. 24. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe in 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). 2017, http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-europe-2015.pdf (accessed May 2019).
25. 25. Demir M, Kazanasmaz H. Uropathogens and antibiotic resistance in the community and hospital-induced urinary tract infected children. J Glob Antimicrob Resist 2020;20:68-73.
26. 26. Abuhandan M, Güzel B, Oymak Y, Çiftçi H. Antibiotic sensitivity and resistance in children with urinary tract infection in Sanliurfa. Turk J Urol. 2013;39:106-10.
27. 27. Tseng MH, Lo WT, Lin WJ, Teng CS, Chu ML, Wang CC. Changing trend in antimicrobial resistance of pediatric uropathogens in Taiwan. Pediatr Int. 2008;50:797-800.
28. 28. Flammang A, Morello R, Vergnaud M, Brouard J, Eckart P. Profile of bacterial resistance in pediatric urinary tract infections in 2014. Arch Pediatr. 2017;24:215-24.
29. 29. Mueller T, Östergren PO. The correlation between regulatory conditions and antibiotic consumption within the WHO European Region. Health Policy. 2016; 120:882-9.
30. 30. Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ. 2016:352:i939.