İdrar yolu enfeksiyonlarında kültürden izole edilen bakteriler ve antibiyotik duyarlılıkları

Öz

Amaç: İdrar yolu enfeksiyonu tüm enfeksiyon hastalıkları içinde ikinci sıklıkta görülmektedir. Kostovertebral açı hassasiyeti, ateş, suprapubik hassasiyet, dizüri, pollaküri ve idrar kaçırma gibi klinik bulgularla birlikte bakteriüri ve/veya piyüri bulunması idrar yolu enfeksiyonu olarak tanımlanır. Akut enfeksiyonlarda en sık izole edilen bakteri Escherichia coli’dir. Bu çalışmanın amacı idrar yolu enfeksiyonu olan hastaların idrar kültürlerinden izole edilen bakterileri saptamak ve bu bakterilerin antibiyogram sonuçlarını inceleyerek tedavide yaygın olarak kullanılan antibiyotiklere karşı duyarlılıklarını ve direnç durumlarını araştırmaktır.Yöntem: Bu çalışmada idrar yolu enfeksiyonu tanısı ile 1 Aralık 2014 ile 1 Ekim 2016 tarihleri arasında üçüncü basamak bir hastanenin klinik mikrobiyoloji laboratuvarına gönderilen idrar kültürleri retrospektif olarak incelenmiştir. Tam otomatik idrar tetkikinde piyürisi ve kültürde 105 koloni/mL üremesi olan idrar yolu enfeksiyonu tanısı konmuş hastalar çalışmaya alınmıştır. Üreyen etkenlerin tanımlanması ve antibiyotik duyarlılık testleri disk difüzyon yöntemiyle Avrupa Antimikrobiyal Duyarlılık Testi Komitesi European Committee on Antimicrobial Susceptibility Testing EUCAST . The data was expressed as numbers and percentages.Results: The urine culture results of 76 patients were evaluated. 48 strains isolated from urine cultures and antibiogram results of these strains were examined. The most frequently isolated microorganism was E. coli 69% and 33 strains were detected. Expanded spectrum betalactamase ESBL -positive E.coli 20 42% , ESBL-negative E. coli 13 27% , ESBL-positive Klebsiella pneumoniae 5 10% in 48 100% strains isolated and ESBL-negative K. pneumoniae 2 4% , other gram negative and positive bacteria were detected as 8 17% strains. Proteus mirabilis, Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Streptococcus agalactiae, Stenotrophomonas maltophilia and Acinetobacter lwoffii have been identified as other factors. Sensitivity of imipenem, meropenem, cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and nitrofurantoin was 100% and tobramycin was 92.31% in ESBL-negative E. coli.cefepime, ciprofloxacin, Conclusion: ESBL-positive E. coli was detected at 42%. This rate supports the increasing antibiotic resistance results over the years. The resistance to ciprofloxacin, cefuroxime, which are often preferred in the treatment of empirical antibiotics, increases. Therefore, empirical antibiotic treatment selection should be revised in patients with urinary tract infections.trimethoprim-sulfamethoxazole and Sonuç: GSBL-pozitif E. coli %42 oranında saptanmıştır. Bu oran yıllar içinde artan antibiyotik direnci antibiyotik siprofloksasin, sefuroksime karşı direnç artmaktadır. Bu nedenle idrar yolu enfeksiyonu olan olgularda ampirik antibiyotik tedavi seçiminin gözden geçirilmesi gerekmektedir.sonuçlarını desteklemektedir. Ampirik edilen tedavisinde sıklıkla trimetoprim-sulfametoksazol tercih ve

Anahtar Kelimeler

• İdrar yolu enfeksiyonu, idrar kültürü, antibiyotik duyarlılık

The isolated bacteria from culture and antibiotic susceptibilities in urinary tract infections

Abstract

Objective: Urinary tract infection is the second most common among all infectious diseases. Urinary tract infection is defined as presence of bacteriuria and/or pyuria with clinical findings such as costovertebral angle sensitivity, fever, suprapubic tenderness, dysuria, pollacuria and urinary incontinence. The most commonly isolated bacterium in acute infections is Escherichia coli. The aim of this study is to determine the bacteria isolated from the urine cultures of patients with urinary tract infections and to investigate the antibiogram results of these bacteria and to investigate their susceptibility and resistance to antibiotics commonly used in treatment.Methods: In this study, urine cultures sent to the clinical microbiology laboratory of a tertiary hospital between December 1, 2014 and October 1, 2016 with the diagnosis of urinary tract infection were retrospectively analyzed. Patients diagnosed with urinary tract infection with pyuria and 105 colony/mL growth in culture in a fully automated urine test were included in the study. Identification of the reproductive factors and antibiotic susceptibility tests were performed by disc diffusion method according to the recommendations of The hastalıkları içinde ikinci sıklıkta görülmektedir. İdrar yolu enfeksiyonları tüm enfeksiyon European Committee on Antimicrobial Susceptibility Testing EUCAST . The data was expressed as numbers and percentages.Results: The urine culture results of 76 patients were evaluated. 48 strains isolated from urine cultures and antibiogram results of these strains were examined. The most frequently isolated microorganism was E. coli 69% and 33 strains were detected. Expanded spectrum betalactamase ESBL -positive E.coli 20 42% , ESBL-negative E. coli 13 27% , ESBL-positive Klebsiella pneumoniae 5 10% in 48 100% strains isolated and ESBL-negative K. pneumoniae 2 4% , other gram negative and positive bacteria were detected as 8 17% strains. Proteus mirabilis, Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Streptococcus agalactiae, Stenotrophomonas maltophilia and Acinetobacter lwoffii have been identified as other factors. Sensitivity of imipenem, meropenem, cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and nitrofurantoin was 100% and tobramycin was 92.31% in ESBL-negative E. coli.cefepime, ciprofloxacin, Conclusion: ESBL-positive E. coli was detected at 42%. This rate supports the increasing antibiotic resistance results over the years. The resistance to ciprofloxacin, cefuroxime, which are often preferred in the treatment of empirical antibiotics, increases. Therefore, empirical antibiotic treatment selection should be revised in patients with urinary tract infections.trimethoprim-sulfamethoxazole and

Keywords

• Urinary tract infection, urine culture, antibiotic susceptibility

References

1. 1. Forbes BA, Sahm DF, Weissfeld AS, Bailey WR. Bailey and Scott’s Diagnostic Microbiology. 12th ed. St. Louis, Mo:Elsevier Mosby, 2007.
2. 2. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon, 2003;49:53-70.
3. 3. Topcu AW, Soyletir G, Doğanay M. Enfeksiyon Hastalıkları ve Mikrobiyolojisi 3.Baskı, Ankara: Nobel Tıp Kitabevleri 2008. Cilt 1.
4. 4. Sobel JD, Kaye D. Urinary Tract Infections. Mandell GL, Bennett JE, Dolin R (eds). Principles and Practice of Infectious Disease, 5th ed. Philadelphia: Elsevier, 2000: 773-800.
5. 5. Sucu N, Aktoz-Boz G, Bayraktar Ö, Çaylan R, Aydın K, Köksal İ. Üropatojen Escherichia coli suşlarının antibiyotik duyarlılıklarının yıllar içerisindeki değişimi. Klimik Derg 2004;17:128-31.
6. 6. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009, International clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis, 2010;50(5):625–63.
7. 7. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015 ;13(5): 269–84.
8. 8. Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asymptomatic bacteriuria in older adults. Infect Dis Clin N Am, 2017; 31: 673–88.

9. 9. Wright SW, Wrenn KD, Haynes ML. Trimethoprimsulfamethoxazole resistance among urinary coliform isolates. J Gen Intern Med, 1999;14:606- 9.
10. 10. Saraçoğlu KT, Fidan V, Pekel Ö, Saraçoğlu A, Kalkandelen S, Arpalı E. İdrar kültürlerinde izole edilen bakterilerin antibiyotik duyarlılıkları. J Clin and Exp Invest 2013; 4 (3): 356-9.
11. 11. Gupta K, Bhadelia N. Management of urinary tract infections from multidrug-resistant organisms. Infect Dis Clin North Am, 2014; 28:49–59.
12. 12. Pendleton JN, Gorman SP, Gilmore BF. Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther, 2013; 11:297–308.
13. 13. Sanchez GV, Babiker A, Master RN, et al. Antibiotic resistance among urinary isolates from female outpatients in the United States in 2003 and 2012. Antimicrob Agents Chemother, 2016;60(5):2680–3.
14. 14. Storby KA, Osterlund A, Kahlmeter G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12 year analysis. Acta Paediatr, 2004; 93: 487-91.
15. 15. Gozükücük R, Cakıroğlu B, Nas Y. Toplum kaynaklı üriner sistem enfeksiyonu etkeni olarak saptanan Escherichia coli izolatlarının antibiyotik duyarlılıkları. JAREM, 2012; 2: 101-3.
16. 16. Garza-Montúfar ME, Treviño-Valdez PD, De la Garza-Salinas LH. Comorbidities and antimicrobial resistance in urological outpatients with positive urine culture. Rev Med Inst Mex Seguro Soc, 2018; 56(4):347-53.
17. 17. Sierra-Díaz E, Hernández-Ríos CJ, Bravo-Cuellar A. Antibiotic resistance: microbiological profile of urinary tract infections in Mexico. Cir Cir, 2019;87(2):176-82.
18. 18. Abbas HA, El-Ganiny AM, Kamel HA Phenotypic and genotypic detection of antibiotic resistance of Pseudomonas aeruginosa isolated from urinary tract infections. Afr Health Sci, 2018;18(1):11-21.
19. 19. Baenas DF, Palmieri HJ, Alomar JM, Álvarez Garzón JH, Berenguer L, Vilaró M, et al. Uncomplicated urinary tract infection in women: etiology and antimicrobial resistance. Rev Fac Cien Med Univ Nac Cordoba, 2017;74(3):180-5.
20. 20. Kengne M , Dounia AT , Nwobegahay JM Bacteriological profile and antimicrobial susceptibility patterns of urine culture isolates from patients in Ndjamena, Chad. Pan Afr Med J. 2017;28:258.
21. 21. Dromigny JA, Ndoye B, Macondo EA, Nabeth P, Siby T, Perrier-Gros-Claude JD. Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Dakar, Senegal: a multicenter study. Diagn Microbiol Infect Dis, 2003; 47: 595-600.
22. 22. Rock W, Colodner R, Chazan B, Elias M, Raz P. Ten years surveillance of antimicrobial susceptibility of communityacquired Escherichia coli and other uropathogens in Northern Israel (1995-2005). Isr Med Assoc J, 2007; 9: 803-5.
23. 23. Arslan H, Azap OK, Ergonul O, Timurkaynak F; Urinary tract infection study group. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother, 2005; 56: 914-8.