Çocuklarda idrar yolu enfeksiyonu etkenlerinin dağılımı ve antibiyotik duyarlılığı ve dirençlerinin değerlendirilmesi: Tek merkez deneyimi

Abstract

Amaç: İdrar yolu enfeksiyonları, çocukluk çağında en sık görülen ve potansiyel olarak ciddi bakteriyel enfeksiyonlardan biridir. İdrar yolu enfeksiyonu tanısı alan çocuklarda idrar kültürü sonuçlarına göre sık görülen etkenleri ve antibiyotik duyarlılık ve direnç durumlarını belirlemeyi amaçladık. Gereç ve Yöntemler: Bu retrospektif çalışmada, Ocak 2017-Ağustos 2022 tarihleri arasında hastanemiz Çocuk Kliniği'ne başvuran çocuklardan alınan idrar izolatlarında etken maddeler ile antimikrobiyal duyarlılık ve direnç pozitifliği değerlendirildi. Bulgular: 239 (%34) erkek, 463 (%66) kız olmak üzere toplam 702 pozitif idrar kültürü saptandı. Kız: erkek oranı 1.93 idi. Hastaların ortanca yaşı 1,1 idi (çeyrekler arası aralık, 5,4). İdrar kültürlerinde en sık saptanan dört mikroorganizma sırasıyla Escherichia coli (%52,3), Klebsiella pneumoniae (%16,1), Enterococcus faecalis (%7,8) ve Proteus mirabilis (%6,4) idi. Escherichia coli (%9,7'ye karşı %42,6) ve Klebsiella pneumoniae (%8,3'e karşı %7,8) hem erkeklerde hem de kızlarda en yaygın iki üropatojendi. Escherichia coli ve Klebsiella pneumoniae ampisilin ve 3. kuşak sefalosporinlere karşı oldukça dirençli iken, aminoglikozidler, meropenem ve imipenem'e karşı oldukça hassastır. Sonuç: Literatürle uyumlu olarak idrar yolu enfeksiyonu geçiren çocuklarda en sık üropatojenin E.coli olduğunu bulduk. Bölgemizde idrar yolu enfeksiyonu olan çocukların tedavisi düzenlenirken antibiyotik direncinin göz önünde bulundurulmasını öneriyoruz.

Keywords

• antibiyotik direnci
• çocuklar
• Escherichia coli
• idrar kültürü
• idrar yolu enfeksiyonu

Project Number

None.

Distribution of urinary tract infection agents and evaluation of antibiotic sensitivity and resistance in children: A single centre experience

Abstract

Aim: Urinary tract infections (UTIs) are one of the most common bacterial infections and potentially serious bacterial infection in childhood. We aimed to determine the common agents and antibiotic sensitivity and resistance status according to the results of urine culture in children diagnosed with urinary tract infection. Materials and Methods: In this retrospective study, we evaluated causative agents and antimicrobial sensitive and resistance in positive urine isolates from the children admitted to our hospital's Pediatrics Clinic between January 2017 and August 2022. Results: A total of 702 positive urine cultures were identified, of which 239 (34%) were from boys and 463 (66%) were from girls. The girl: boy ratio was 1.93. The median age of the patients was 1.1 years (interquartile range, 5.4). The four most frequently detected microorganisms in urine cultures were Escherichia coli (52.3%), Klebsiella pneumoniae (16.1%), Enterococcus faecalis (7.8%) and Proteus mirabilis (6.4%), respectively. Escherichia coli (9.7% vs. 42.6%) and Klebsiella pneumoniae (8.3% vs. 7.8%) were the two most common uropathogens both in boys and girls. Escherichia coli and Klebsiella pneumoniae were highly resistant to ampicillin and 3rd generation cephalosporins, while highly sensitive to aminoglycosides, meropenem and imipenem. Conclusion: We found that E.coli was the most common uropathogen in children with UTIs consistent with the literature. We suggest that when arranging the treatment of children with urinary tract infections in our region, antibiotic resistance should be considered.

Keywords

• antibiotic resistance
• children
• Escherichia coli
• urine culture
• urinary tract infection

Supporting Institution

None.

Project Number

None.

Thanks

None.

References

1. 1. Balighian E, Burke M. Urinary Tract Infections in Children. Pediatr Rev. 2018;39(1):3-12.
2. 2. Tullus K, Shaikh N. Urinary tract infections in children. Lancet. 2020;395(10237):1659-1668.
3. 3. Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open. 2019;3(1):e000487.
4. 4. Leung AKC, Wong AHC, Leung AAM, Hon KL. Urinary Tract Infection in Children. Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):2-18.
5. 5. Başoğlu N, İşlek, İ. The News in Approach to the Urinary Tract Infection in Children. Medical Journal of Bakirkoy. 2019;15:317-22.
6. 6. Buonsenso D, Cataldi L. Urinary tract infections in children: a review. Minerva Pediatr 2012;64:145-57.
7. 7. National Institute for Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and longterm management. 2007. (http://www.nice .org.uk/nicemedia/pdf/ CG54fullguideline .pdf.
8. 8. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.

9. 9. Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children. Pediatrics. 2021;147(2):e2020012138.
10. 10. Oliveira EA, Mak RH. Urinary tract infection in pediatrics: an overview. Jornal de pediatria, 2020;96: 65-79.
11. 11. Esposito S, Biasucci G, Pasini A, et al. Antibiotic Resistance in Paediatric Febrile Urinary Tract Infections. J Glob Antimicrob Resist. 2022;29:499-506.
12. 12. Erol B, Culpan M, Caskurlu 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(2):176.e1-176.e5.
13. 13. Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med. 2011;365(3):239-50.
14. 14. American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Urinary Tract Infection. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843-52.
15. 15. Guidoni EB, Berezin EN, Nigro S, Santiago NA, Benini V, Toporovski J. Antibiotic resistance patterns of pediatric community-acquired urinary infections. Braz J Infect Dis. 2008;12(4):321-3.
16. 16. Vazouras K, Velali K, Tassiou I, et al. Antibiotic treatment and antimicrobial resistance in children with urinary tract infections. J Glob Antimicrob Resist. 2020;20:4-10.
17. 17. Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol. 2013;190(1):222-7.
18. 18. Gunduz S, Uludağ Altun H. Antibiotic resistance patterns of urinary tract pathogens in Turkish children. Glob Health Res Policy. 2018;3:10.
19. 19. Konca C, Tekin M, Uckardes F, et al. Antibacterial resistance patterns of pediatric community-acquired urinary infection: Overview. Pediatr Int. 2017;59(3):309-315.
20. 20. Yilmaz Y, Tazegun ZT, Aydin E, et al. Bacterial uropathogens causing urinary tract infection and their resistance patterns among children in Turkey. Iran Red Crescent Med J 2016;18:e26610.