Gram Negatif İdrar Yolu Enfeksiyonu Etkenlerinin Antibiyotik Direnç Dağılımı: Tek Merkez Deneyimi

Öz

Amaç: İdrar yolu enfeksiyonları (İYE) çocukluk yaş grubunda en sık karşılaşılan enfeksiyonlar arasındadır. Bu çalışma ile üçüncü basamak bir hastanede idrar yolu enfeksiyonlarında etiyolojik ajanların değerlendirilmesi, antimikrobiyal direnç paternlerinin belirlenmesi, ampirik tedavi önerilerinin gözden geçirilmesi amaçlandı.Gereç ve Yöntemler: Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi yataklı servis ve polikliniklerinden 01.01.2012-31.12.2015 tarihleri arasında hastanemiz mikrobiyoloji laboratuvarına gönderilen ve Gram negatif (-) üreme saptanan 4421 idrar örneğinin kültür ve antibiyogram sonuçları retrospektif olarak değerlendirildi.Bulgular: Gram negatif üreme saptanan 4421 örnekten %64.1’inde Escherichia coli, %17.1’inde Klebsiella spp, %7.4’ünde Proteus spp üremesi saptandı. Tüm gram negatif mikroorganizmalar birlikte değerlendirildiğinde; en yüksek direnç ampisilin (%75.1), sefazolin (%59), ampisilin-sulbaktam (%49.7), trimetoprim-sulfametoksazol (TMP-SMX) (%45.2), sefiksim (%33.1) ve seftriaksona (%31.4) karşı saptandı. En düşük direnç meropenem (%3.2), ertapenem (%3.4), kolistin (%7.2), amikasin (%16.2), siprofloksasin (%21.1), piperasilin tazobaktama karşı (%23.2)’di.Sonuç: Çalışmamızda çocukluk çağı idrar yolu enfeksiyonlarında ilk seçenek olarak kullanılan birinci kuşak sefalosporinlere, ampisilin, ampisilin-sulbaktam ve TMP-SMX’e karşı yüksek direnç saptanmıştır. Tedavide başarılı olabilmek, morbidite ve uzun dönem sekellerini en aza indirebilmek için İYE nedeni olan patojenlerin sıklığı, yerel veya bölgesel antibiyotik dirençlerinin bilinmesi ve bu doğrultuda ampirik tedavinin düzenlenmesi gereklidir.

Anahtar Kelimeler

• Ampirik tedavi, Antibiyotik direnci, Çocuk, İdrar yolu enfeksiyonu

Antibiotic Resistance Distribution of Gram-Negative Urinary Tract Infectious Agents: Single Center Experience

Öz

Objective: Urinary tract infection (UTI) is one of the most common infections in childhood. The aim of this study was to determine etiologic agents and antimicrobial resistance patterns in urinary tract infections and to evaluate empirical treatment suggestions in a tertiary care hospital.Material and Methods: The culture and antibiogram results of 4,421 urine specimens, sent from Hacettepe University İhsan Doğramacı Children’s Hospital to the microbiology laboratory (between 01.01.2012 and 31.12.2015) were evaluated retrospectively.Results: In 4421 samples where gram-negative (-) growth was detected, Escherichia coli was reported in 64.1%, Klebsiella spp in 17.1% and Proteus spp in 7.4%. Evaluation of all gram-negative microorganisms together, revealed the highest resistance against ampicillin (75.1%), cefazolin (59%), ampicillin-sulbactam (49.7%), trimethoprim-sulfamethoxazole (TMP-SMX) (45.2%), cefixim (33.1%) and ceftriaxone (31.4%). The lowest resistance was against meropenem (3.2%), ertapenem (3.4%), colistin (7.2%), amikacin (16.2%), ciprofloxacin (21.1%) and piperacillin tazobactam (23.2%).Conclusion: In our study, high resistance was detected against ampicillin, ampicillin-sulbactam, first generation cephalosporins and TMP-SMX, commonly used as first-choice treatments in pediatric urinary tract infections. In order to be successful in the treatment and to reduce the morbidity and long-term sequelae, the frequency of pathogenic pathogens and local or regional antibiotic resistance should be known and empirical treatment should be arranged in this direction

Anahtar Kelimeler

• Empirical treatment, Antibiotic resistance, Children, Urinary tract infections

Kaynakça

1. Calzi A, Grignolo S, Caviglia I, Calevo MG, Losurdo G, Piaggio G. Resistance to oral antibiotics in 4569 Gram-negative rods isolated. Eur J Pediatr 2016;175:1219-25.
2. Pickering LK, Prober CG Long S. Genitourinary tract infections. Principles and Practice of Pediatric Infectious Disease. 4th ed. Saunders, 2012:339–43.
3. Elder JS. Urinary tract infections. Kliegman RM, Stanton B, Gene ST, Schor N, Behrman RE (eds). Nelson’s Textbook of Pediatrics. 20th ed. Philadelphia: Saunders Elsevier, 2015:2556-62.
4. Sefton AM. The impact of resistance on the management of urinary tract infectious. Int J Antimicrob Agents 2000;16:489-91.
5. Taneja N, Chatterjee S, Singh M, Singh S, Sharma M. Pediatric urinary tract infections in a tertiary care center from India. Indian J Med Res 2010;131:101-5.
6. Shepherd AK, Pottinger PS. Management of urinary tract infections in the era of increasing antimicrobial resistance. Med Clin North Am 2013;97:737-57.
7. Stultz JS, Doern CD, Godbout E. Antibiotic resistance in pediatric urinary tract infections. Curr Infect Dis Rep 2016;18:40.
8. Roberts KB, Downs SM, Finnell SM, Hellerstein S, Shortliffe LD, Wald ER, et al. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the ınitial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.

9. Antimicrobial resistance surveillance in Europe Annual report of the European Antimicrobial Resistance Surveillance Network (EARS- Net) 2013, European Centre for Disease Prevention and Control. 2014, doi:10.2900/39777
10. National Institute for Clinical Excellence. Erişim tarihi: 26.12.2016. http://pathways.nice.org.uk/pathways/urinary-tract-infection-in- children.
11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twenty second informational supplement update. CLSI document M100-S22 U. Clinical and Laboratory Standards Institute, Wayne, PA: 2012.
12. Düzova A, Saatçi Ü. İdrar yolu enfeksiyonu. Katkı Pediatri Dergisi 1999;20:329-45.
13. Konca C, Tekin M, Uckardes F, Akgun S, Almis H, Bucak IH, et al. An overview of antibacterial resistance patterns of pediatric community. Pediatr Int 2017;59:309-15.
14. Yolbaş I, Tekin R, Kelekci S, Tekin A, Okur MH, Ece A, et al. Community-acquired urinary tract infections in children: pathogens, antibiotic susceptibility and seasonal changes. Eur Rev Med Pharmacol Sci 2013;17:971-6.
15. Tseng MH, Lo WT, Lin WJ, Teng CS, Chu ML, Wang CC. Changing trend in antimicrobial resistance of pediatric uropathogens in Taiwan. Pediatr Int 2008;50:797-800.
16. Mir S, Erdoğan H, Güler S, Şengül GN, Koyu A. Çocuk yaş grubu idrar yolu enfeksiyonlarında Ege bölgesi antibiyotik direnci. Ege Tıp Dergisi 2002;41:207-10.
17. Mantadakis E, Vouloumanou EK, Panopoulou M, Tsouvala E, Tsalkidis A, Chatzimichael A, Falagas ME. Susceptibility patterns of uropathogens identified in hospitalised children with community- acquired urinary tract infections in Thrace, Greece. J Glob Antimicrob Resist 2015;3:85-90.
18. Maraki S, Mantadakis E, Michailidis L, Samonis G. Changing antibiotic susceptibilities of community-acquired uropathogens in Greece 2005-2010. J Microbiol Immunol Infect 2013;46:202-9.
19. Haller M, Brandis M, Berner R. Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy. Pediatr Nephrol 2004;19:982-6.
20. Bitsori M, Maraki S, Galanakis E. Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis. Pediatr Nephrol 2014;29:1053–58.