Gram Negatif İdrar Yolu Enfeksiyonu Etkenlerinin Antibiyotik Direnç Dağılımı: Tek Merkez Deneyimi

Abstract

Amaç: İdrar yolu enfeksiyonları (İYE) çocukluk yaş grubunda en sık karşılaşılan enfeksiyonlar arasındadır. Bu çalışma ile üçüncü basamak bir hastanede idrar yolu enfeksiyonlarında etiyolojik ajanların değerlendirilmesi, antimikrobiyal direnç paternlerinin belirlenmesi, ampirik tedavi önerilerinin gözden geçirilmesi amaçlandı.Gereç ve Yöntemler: Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi yataklı servis ve polikliniklerinden 01.01.2012-31.12.2015 tarihleri arasında hastanemiz mikrobiyoloji laboratuvarına gönderilen ve Gram negatif (-) üreme saptanan 4421 idrar örneğinin kültür ve antibiyogram sonuçları retrospektif olarak değerlendirildi.Bulgular: Gram negatif üreme saptanan 4421 örnekten %64.1’inde Escherichia coli, %17.1’inde Klebsiella spp, %7.4’ünde Proteus spp üremesi saptandı. Tüm gram negatif mikroorganizmalar birlikte değerlendirildiğinde; en yüksek direnç ampisilin (%75.1), sefazolin (%59), ampisilin-sulbaktam (%49.7), trimetoprim-sulfametoksazol (TMP-SMX) (%45.2), sefiksim (%33.1) ve seftriaksona (%31.4) karşı saptandı. En düşük direnç meropenem (%3.2), ertapenem (%3.4), kolistin (%7.2), amikasin (%16.2), siprofloksasin (%21.1), piperasilin tazobaktama karşı (%23.2)’di.Sonuç: Çalışmamızda çocukluk çağı idrar yolu enfeksiyonlarında ilk seçenek olarak kullanılan birinci kuşak sefalosporinlere, ampisilin, ampisilin-sulbaktam ve TMP-SMX’e karşı yüksek direnç saptanmıştır. Tedavide başarılı olabilmek, morbidite ve uzun dönem sekellerini en aza indirebilmek için İYE nedeni olan patojenlerin sıklığı, yerel veya bölgesel antibiyotik dirençlerinin bilinmesi ve bu doğrultuda ampirik tedavinin düzenlenmesi gereklidir.

Keywords

• Ampirik tedavi, Antibiyotik direnci, Çocuk, İdrar yolu enfeksiyonu

Antibiotic Resistance Distribution of Gram-Negative Urinary Tract Infectious Agents: Single Center Experience

Abstract

Objective: Urinary tract infection (UTI) is one of the most common infections in childhood. The aim of this study was to determine etiologic agents and antimicrobial resistance patterns in urinary tract infections and to evaluate empirical treatment suggestions in a tertiary care hospital.Material and Methods: The culture and antibiogram results of 4,421 urine specimens, sent from Hacettepe University İhsan Doğramacı Children’s Hospital to the microbiology laboratory (between 01.01.2012 and 31.12.2015) were evaluated retrospectively.Results: In 4421 samples where gram-negative (-) growth was detected, Escherichia coli was reported in 64.1%, Klebsiella spp in 17.1% and Proteus spp in 7.4%. Evaluation of all gram-negative microorganisms together, revealed the highest resistance against ampicillin (75.1%), cefazolin (59%), ampicillin-sulbactam (49.7%), trimethoprim-sulfamethoxazole (TMP-SMX) (45.2%), cefixim (33.1%) and ceftriaxone (31.4%). The lowest resistance was against meropenem (3.2%), ertapenem (3.4%), colistin (7.2%), amikacin (16.2%), ciprofloxacin (21.1%) and piperacillin tazobactam (23.2%).Conclusion: In our study, high resistance was detected against ampicillin, ampicillin-sulbactam, first generation cephalosporins and TMP-SMX, commonly used as first-choice treatments in pediatric urinary tract infections. In order to be successful in the treatment and to reduce the morbidity and long-term sequelae, the frequency of pathogenic pathogens and local or regional antibiotic resistance should be known and empirical treatment should be arranged in this direction

Keywords

• Empirical treatment, Antibiotic resistance, Children, Urinary tract infections

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