Erişkin hastalarda toplum kaynaklı üriner sistem enfeksiyonlarından izole edilen Escherichia coli suşlarının antibiyotik duyarlılıklarının yıllara göre değişimi 2010-2014

Year 2015, Volume: 72 Issue: 4, 273 - 368, 01.12.2015

Murat Duman

Abstract

Amaç: Üriner sistem enfeksiyonları ÜSE , toplumda en sık görülen enfeksiyon hastalıklarından biridir. ÜSE’nin etkenleri arasında Gram negatif çomaklar ve özellikle de %70-80 görülme sıklığı ile Escherichia coli ilk sırada yer almaktadır. Üriner sistem enfeksiyonları için çoğu zaman kültür ve antimikrobiyal duyarlılık testleri beklenmeden ampirik tedaviye başlanmaktadır. Çalışmamızda, hastanemize üriner sistem enfeksiyonu şikayeti ile başvuran hastalara ait idrar örneklerinden izole edilen E. coli suşlarının ampirik tedavide sık kullanılan antibiyotiklere duyarlılıklarındaki değişim incelenmiştir. Yöntemler: Hastanemiz laboratuvarına 1 Ocak 2010 – 30 Aralık 2014 tarihleri arasında çeşitli polikliniklerden gönderilen idrar örneklerine ait sonuçlar retrospektif olarak incelenmiştir. ÜSE ön tanısı konulan hastalardan uygun şartlarda alınan orta akım idrar örnekleri 0,4 mm çaplı kalibre öze ile %5 koyun kanlı agar ve EMB agara ekilerek aerop koşullarda 37°C’de 24-48 saat inkübe edilmiştir. E. coli suşlarının identifikasyonu konvansiyonel yöntemlerle yapılmış ve antibiyotik duyarlılıkları ve fenotipik genişlemiş spektrumlu beta laktamaz GSBL doğrulaması disk difüzyon yöntem ile güncel Klinik ve Laboratuvar Standardları Enstitüsü CLSI standardlarına göre değerlendirilmiştir. Bulgular: Toplam 99.997 örneğin 17.857 %17,8 ’sinde üreme saptanmış ve bunların 11.594 64,9 ’si E. coli olarak tanımlanmıştır. İdrar kültürü örneklerinden E. coli üremesi saptanan hastaların %72,5 8401 ’i kadın, %27,5 3193 ’i erkektir. E. coli suşlarının en duyarlı olduğu antibiyotikler fosfomisin %99,6 , nitrofurantoin %96,7 ve norfloksasin %80,6 olarak tespit edilmiştir. Amoksisilin/ klavulanik asit, ampisilin/sulbaktam, ampisilin ve sefuroksimin direncinde yıllar içinde azalma olduğu gözlenmiştir. Siprofloksasin, levofloksasin, norfloksasin, nitrofurantoin, sefazolinin direncinde ve GSBL oranlarında ise yıllar içinde artış olduğu görülmüştür. Sonuç: Sonuç olarak hastanemizde izole edilen toplum kökenli üropatojen E. coli suşları için nitrofurantoin %3,3 ve fosfomisinin %0,4 düşük direnç oranları ile ÜSE tedavisinde en etkili antibiyotikler olduğu izlenmiştir

Keywords

E. coli, fosfomisin, üriner sistem enfeksiyonları

The antibiotic susceptibility changes of the Escerichia coli strains isolated from community-acquired urinary tract infections in adults according to the years 2010-2014

Abstract

Objective: Urinary tract infections UTI are one of the most common infectious diseases in the community. Gram- negative bacilli and especially with the prevalence of %70-80, Escherichia coli are in the first place among the effects of UTI. Most of the time for urinary tract infections empirical treatment is started without waiting the culture and antimicrobial susceptibility tests. In our study the susceptibility changes of the E. coli strains isolated from urine samples of the patients who applied to our hospital with the complaints of urinary tract infections to the antibiotics which are frequently used in empirical treatment were examined for the last five years period. Methods: The results of urine samples sent to the laboratory of our hospital from various clinics between 1 January 2010 - 30 December 2014 were analyzed retrospectively. Medium current urine samples which were taken from UTI prediagnosed patients at appropriate conditions, were inoculated on 5% sheep blood agar and EMB agar with 0.4 mm diameter calibrated loop and were incubated in aerobic conditions at 37°C for 24-48 hours.The identification of E. coli strains were made by conventional methods and their antibiotic sensitivity and phenotypic extended spectrum beta –lactamase ESBL confirmation was evaluated by the disk diffusion method according to the current Clinical and Laboratory Standards Institute CLSI standards. Results: Reproduction has been detected in 17.857 17,8% from the total of 99.997 examples and 11.594 64,9% of them have been identified as E. coli. The 72.5% of patients having E. coli reproduction from urine culture samples 8401 were female and 27.5% 3193 were male. The antibiotics that the E. coli strains were mostly sensitive were detected as fosfomycin 99.6% . nitrofurantoin 96.7% and norfloxacin 80.6% . It was observed that there was a decrease in the resistance of amoxicillin/clavulanic acid, ampicillin/sulbactam, ampicillin and cefuroxime over the years. On the hand it was seen that there was an increase in the resistance of ciprofloxacin, levofloxacin, norfloxacin, nitrofurantain, cefazolin and ESBL rates within the years. Conclusion: As a result, for the E. coli strains isolated in our hospital from community-acquired urinary, nitrofurantoin 3.3% and the fosfomycin 0.4% with urinary pathogen low rate of resistance were observed to be the most effective antibiotics in the treatment of UTI.

Keywords

E. coli, fosfomycin, urinary tract infections

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