Üçüncü Basamak Bir Hastanede Görülen Toplum Kaynaklı İlk İdrar Yolu Enfeksiyonlarındaki Üropatojenlerin Antibiyotik Direnç Paternleri

Öz

Amaç: Artan antibiyotik direnci, idrar yolu enfeksiyonlarının (İYE) yönetiminde daha yüksek morbidite, mortalite ve maliyetlerle ilişkili önemli bir sorundur. Bu çalışma, ilk kez toplum kökenli İYE geçiren çocuklardan izole edilen üropatojenlerin antimikrobiyal direnç profilini analiz etmeyi amaçlamaktadır.

Gereç ve Yöntemler: Bu retrospektif kohort çalışması, Ocak 2010-Aralık 2016 tarihleri arasında, üçüncü basamak bir çocuk hastanesinin polikliniklerinde ilk toplum kökenli İYE atağı tanısı konan bir ay ile 18 yaş arasındaki hastalarla yapıldı. Hastaların yaşı, cinsiyeti, İYE öyküsü, başvurudaki klinik bulguları, idrar analizi, idrar kültürü ve antibiyogram sonuçları kaydedildi.

Bulgular: Çalışmaya toplam 1086 hasta ve 1086 kültür dahil edildi. Erkek/kadın oranı 1/5.3’dü. Çocukların yaş ortalaması 73.7±47.1 (0.4-215.9) aydı. %16’sı 1-24 aylıktı. E. coli sıklık olarak %85.1 ile en sık etken etkendi. Genel antimikrobiyal direncin ampisilin için en yüksek olduğu, ampisilini piperasilin ve trimetoprim-sülfametoksazolün (sırasıyla %63.5, %41.6 ve %38.1) takip ettiği bulundu. İmipenem, amikasin ve tobramisin en düşük dirence sahipti (sırasıyla %0.5, 0.5 ve %7.6). Amoksisilin-klavulanat, ampisilin-sulbaktam, sefuroksim, seftriakson’a karşı genel antimikrobiyal direnç oranı sırasıyla %19.4, 24, %25.9 ve %21.1’di. Örneklerin %5.6’sında (n=61) geniş spektrumlu beta-laktamaz pozitifliği saptandı.

Sonuç: Çalışmamız, idrar kültürü ve antibiyotik duyarlılık sonuçları belirlenmeden önce reçete edilen en yaygın antibiyotiklere karşı antimikrobiyal dirençte önemli artış olduğunu göstermiştir. Amoksisilin-klavulanat, ampisilin-sulbaktam, sefuroksim, seftriakson için direnç oranları, ayakta tedavi ortamında ilk İYE atağı olan çocuklarda neredeyse %20 veya üzerindedir.

Anahtar Kelimeler

• üriner sistem enfeksiyonu
• antibiyotik duyarlılığı
• antibiyotik direnci

Antibiotic Drug Resistance Pattern of Uropathogens Seen in The First Episode of Community-Acquired Pediatric Urinary Tract Infections At A Tertiary Care Hospital

Öz

Objective: Increased antibiotic resistance is a significant problem associated with higher morbidity, mortality, and costs in managing urinary tract infections (UTI). This study aims to analyze the antimicrobial resistance profile of uropathogens isolated from children with the first attack of community-acquired UTI.

Material and Methods: This retrospective cohort study was conducted between January 2010-December 2016, with the patients aged one month to 18 years diagnosed with the first attack of community-acquired UTI at the pediatric outpatient clinic of a tertiary care hospital. Patients’ age, sex, UTI history, clinical findings at admission, urine analysis, urine culture, and antibiogram results were recorded.

Results: A total of 1086 patients and 1086 cultures were included in the study. The male/female ratio was 1/5.3. The mean age of the children was 73.7±47.1 (0.4-215.9) months. 16.0% were aged 1-24 months. E. coli was the most common causative agent found to be 85.1% in frequency. The overall antimicrobial resistance was found to be highest for ampicillin, followed by piperacillin and trimethoprim-sulfamethoxazole (63.5, 41.6 and 38.1%, respectively). Imipenem, amikacin, and tobramycin had the least resistance (0.5, 0.5, and 7.6%, respectively). The overall antimicrobial resistance against amoxicillin-clavulanate, ampicillin-sulbactam, cefuroxime, ceftriaxone was 19.4, 24, 25.9 and 21.1%; respectively.Extended-spectrum beta-lactamase positivity was detected in 5.6% (n=61) of samples.

Conclusion: Our study showed significant increase in antimicrobial resistance to the most common antibiotics which are prescribed before urine culture results and antibiotic sensitivities are available. The resistance rates for amoxicillin-clavulanate, ampicillin-sulbactam, cefuroxime, ceftriaxone was almost 20% or above in children with the first UTI attack in an outpatient setting.

Anahtar Kelimeler

• urinary tract infection
• antimicrobial resistance
• antimicrobial susceptibility

Kaynakça

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