Gebeliğin ikinci trimesterinde Escherichia coli ve Klebsiella pneumoniae enfeksiyonlarıyla ilişkili akut sistitin perinatal sonuçlarının ve antibiyotik duyarlılık modellerinin karşılaştırılması

Abstract

Amaçlar: En sık görülen üropatojenler olan Escherichia coli ve Klebsiella pneumoniae'nin patojenitelerini ve tedavi alternatiflerinin anne ve yenidoğan sağlığı üzerindeki etkilerini, klinik sonuçları ve mikrobiyolojik duyarlılık profillerini analiz ederek araştırmak. Yöntemler: Retrospektif kohort çalışmaya, 14-28. gebelik haftaları arasında akut sistit tanısı almış ve sonrasında doğum yapmış kadınlar dahil edildi. Kronik böbrek hastalığı, hipertansiyon, diabetes mellitusu bulunan, steroid tedavisi alan veya fetal yapısal veya kromozomal bozuklukları olanlar çalışma dışı bırakıldı. Obstetrik, klinik ve laboratuvar özellikleri kaydedildi. Tekrarlayan ataklar, akut piyelonefrit progresyonu ve gebelik ve yenidoğan sonuçları da kaydedildi. Bulgular analiz edildi ve 0,05'ten küçük bir p değeri anlamlı kabul edildi. Bulgular: Akut sistit tanısı alan ve idrar kültürü pozitifliği çalışma kriterlerini karşılayan toplam 276 gebe ile çalışıldı. 148 kadında (%53,7) E. coli üremesi, 42 kadında (%15,2) K. pneumoniae üremesi tespit edildi. E. coli grubundaki hastalar K. pneumoniae grubundakilere göre daha genç ve daha düşük vücut kitle indeksine sahipti (p <0,001). Lökositler ve C-reaktif protein değerleri E. coli enfeksiyonlarında daha yüksek, hematokrit ise daha düşüktü (p <0,001). E. coli üremesi olanlarda ESBL pozitifliği oranı %11,1 (n:16) iken, Klebsiella enfeksiyonu olanlarda bu oran %14,3 (n:6) idi, ancak istatistiksel olarak anlamlı bir fark gözlenmedi. Rekürrens ve akut piyelonefrit progresyonu oranları her iki grupta da benzerdi. Doğum haftaları, doğum ağırlığı, erken doğum, erken membran rüptürü, fetal büyüme kısıtlaması, preeklampsi, yenidoğan yoğun bakım ünitesine yatış, yenidoğan enfeksiyonu veya Apgar skorlarında fark saptanmadı. E. coli patojenlerinde en yüksek direnç oranlarının ampisilin ve amoksisilin-klavulanik aside, K. pneumoniae patojenlerinde ise amoksisilin-klavulanik aside ve seftriaksona karşı olduğu bulundu. Genişlemiş spektrumlu beta-laktamaz pozitifliği (ESBL) pozitif E. coli suşları karbapenemler, nitrofurantoin, piperasilin-tazobaktam ve fosfomisine en duyarlıydı. Benzer şekilde, ESBL pozitif K. pneumoniae suşları karbapenemler, piperasilin-tazobaktam ve fosfomisine en duyarlıydı. Sonuç: Gebelikte idrar yolu enfeksiyonlarında patojenleri tanımlamanın altın standardı, antibiyotik duyarlılık testi ile birlikte idrar kültürüdür. İdrar yolu enfeksiyonlarının erken taranması, doğru tanısı ve zamanında tedavisi, hem anne hem de yenidoğan sağlığını korumak için hayati önem taşır. Obstetrik uygulamada, antimikrobiyal direnç gelişimini en aza indirmek için hem spektrum hem de süre açısından uygun, hedefe yönelik antibiyotiklerin akıllıca kullanımı kritik öneme sahiptir.

Keywords

• Escherichia coli
• Klebsiella pneumoniae
• üropatojenler
• akut sistit
• gebelik
• genişlemiş spektrumlu beta laktamaz

Comparison of the perinatal outcomes and antibiotic susceptibility patterns of acute cystitis associated with Escherichia coli and Klebsiella pneumoniae infections during the second trimester of pregnancy

Abstract

Aims: To investigate the disease-causing potential of the most common uropathogens, Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), as well as the effects of treatment alternatives on maternal and neonatal health, by analysing clinical outcomes and microbiological susceptibility patterns. Methods: The retrospective cohort study included women diagnosed with acute cystitis between 14 and 28 weeks of gestation, who subsequently delivered. Those with chronic kidney disease, hypertension, diabetes mellitus, steroid therapy or fetal structural or chromosomal disorders were excluded. Obstetric, clinical and laboratory characteristics were recorded. Information on patients with recurrent episodes, progression of acute pyelonephritis, and outcomes of pregnancy and neonates was also recorded. The findings were analysed, and a p value of less than 0.05 was considered significant. Results: A total of 276 pregnant women were diagnosed with acute cystitis and met the study criteria of urine culture positivity. E. coli growth was detected in 148 women (53.7%), K. pneumoniae in 42 women (15.2%). Patients in the E. coli group were younger and had a lower body-mass index than those in the K. pneumoniae group (p<0.001). Laboratory values for white blood cells and C-reactive protein were higher in E. coli infections while hematocrit was lower (p<0.001). Among those with E. coli growth, the extended-spectrum beta-laktamase (ESBL) positivity rate was 11.1% (n: 16), compared to 14.3% (n: 6) among those with Klebsiella, however no statistically significant difference was observed. Recurrence of infection and acute pyelonephritis progression rates were comparable in both groups. There was no difference in birth weeks, birth weight, preterm birth, premature rupture of the membranes, fetal growth restriction, preeclampsia, admission to the neonatal intensive care unit, neonatal infection or Apgar scores. The highest resistance rates in E. coli pathogens were found to be to ampicillin and amoxicillin-clavulanic acid, whereas in K. pneumoniae pathogens, resistance was found to be highest to amoxicillin-clavulanic acid and ceftriaxone. Extended-spectrum beta-laktamase positivity (ESBL)-positive E. coli strains were most susceptible to carbapenems, nitrofurantoin, piperacillin-tazobactam and fosfomycin. Similarly, ESBL-positive K. pneumoniae strains were most susceptible to carbapenems, piperacillin-tazobactam and fosfomycin. Conclusion: The gold standard for identifying pathogens in urinary tract infections during pregnancy is remains urine combined culture with antibiotic susceptibility testing. Early screening, accurate diagnosis, and timely treatment of urinary tract infections are essential to safeguard both maternal and neonatal health. In obstetric practice, the judicious use of targeted antibiotics-appropriate in both spectrum and duration-is critical to minimize the development of antimicrobial resistance.

Keywords

• Escherichia coli
• Klebsiella pneumoniae
• uropathogenes
• acute cystitis
• pregnancy
• extended-spectrum beta-laktamase

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