Abstract
Urinary tract infections are one of the most common infections in hospitals and society. In cases where culture is not possible, empirical treatment is critical in the treatment of the disease and the prevention of its complications. The aim of this study is to guide the clinician in starting empirical treatment with cumulative antibiogram analysis. The cultures of the urine samples that came to our laboratory between January 2014 and December 2022 were performed. The growing bacteria were identified using conventional methods, disc diffusion, BD Phoenix (BD, USA) and Vitek2 (Biomerieux, France) automated systems, and antibiotic susceptibility tests were performed. Initial isolate data were used when bacteria grown in a patient were of the same species. Antibiotics with a sensitivity rate of over 90% were recommended for empirical treatment. In our study, 86.6% of the factors grown in urine cultures were Gram (-) bacteria and 62.9% of the total were Escherichia coli. Considering all isolates, ciprofloxacin resistance is high and increasing in outpatients (44.6%); It was determined that fosfomycin (10.8%) and nitrofurantoin (13.2%) resistances were low. In hospitalized patients, resistance to intravenous ceftriaxone (63.3%) was found to be high, while resistance to ertapenem (29.3%) was lower. It was observed that nitrofurantoin and ertapenem resistances were below 10% in E. coli isolates grown in outpatients and inpatients, and this was not valid for isolates other than E. coli. The resistance rate to all antibiotics in E. coli isolates was found to be significantly higher in inpatients than in outpatients (P<0.001 for each). Resistance to ciprofloxacin, imipenem and meropenem was found over 60% in patients hospitalized with non-fermenter bacteria. The findings obtained in our study show that nitrofurantoin and fosfomycin may be successful in outpatient treatment, and ertapenem and fosfomycin may be successful in empiric treatment compared to other antibiotics in inpatients, in cases where culture is not possible or until culture antibiogram results are obtained.
Ethical Statement
Bu çalışma yerel etik kurul, Samsun Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylandı (SÜKAEK-2023 7/13) ve retrospektif olarak planlandı. Araştırma Helsinki Deklarasyonu Prensipleri’ne uygun şekilde yapılmıştır.
Thanks
Samsun Gazi Devlet Hastanesi Tıbbi Biyokimya Uzmanı Dr. Tülay Özdemir’e istatistiksel analizlerindeki yardımı ve yorumları için teşekkür ederiz.
References
- Abbott IJ, Peel TN, Cairns KA, Stewardson AJ. 2023. Antibiotic management of urinary tract infections in the post-antibiotic era: a narrative review highlighting diagnostic and antimicrobial stewardship. Clinical microbiology and infection. Official Public European Soc Clin Microbiol Infect Diseas, 29(10): 1254-1266.
- Bader MS, Loeb M, Brooks AA. 2017. An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Medic, 129(2): 242-258.
- Ballén V, Gabasa Y, Ratia C, Ortega R, Tejero M, Soto S. 2021. Antibiotic resistance and virulence profiles of klebsiella pneumoniae strains ısolated from different clinical sources. Front Cellular Infect Microbiol, 11: 738223.
- Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyèr F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Sennevill E, Sotto A, Subtil D, Trivalle C, Etienne M. 2018. Practice guidelines for the management of adult community-acquired urinary tract infections. Medec Maladies Infect, 48(5): 327-358. https://doi.org/10.1016/j.medmal.2018.03.005.
- Chu CM, Lowder JL. 2018. Diagnosis and treatment of urinary tract infections across age groups. American J Obstetrics Gynecol, 219(1): 40-51.
- Haindongo EH, Funtua B, Singu B, Hedimbi M, Kalemeera F, Hamman J, Vainio O, Hakanen AJ, Vuopio J. 2022. Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016-2017. Antimicrobial Resist Infect Cont, 11(1): 33.
- Hooton TM. 2012. Clinical practice. Uncomplicated urinary tract infection. New England J Medic, 366(11): 1028-1037.
- Islam MR, Hoque MJ, Uddin MN, Dewan A, Haque NB, Islam MT, Islam MH, Hasan MA. 2022. Antimicrobial resistance of E coli causing urinary tract ınfection in Bangladesh. Mymensingh Medic J, 31(1): 180-185.
- Keskin BH, Çalışkan E, Kaya S, Köse E, Şahin İ. 2021. Üriner sistem enfeksiyonlarında etken bakteriler ve antibiyotik direnç oranları. Turk Mikrobiyol Cemiy Derg, 51: 254-262.
- Majumder MMI, Mahadi AR, Ahmed T, Ahmed M, Uddin MN, Alam MZ. 2022. Antibiotic resistance pattern of microorganisms causing urinary tract infection: a 10-year comparative analysis in a tertiary care hospital of Bangladesh. Antimicrobial Resist Infect Cont, 11(1): 156.
- Meena M, Kishoria N, Meena DS, Sonwal VS. 2021. Bacteriological profile and antibiotic resistance in patients with urinary tract ınfection in tertiary care teaching hospital in Western Rajasthan India. Infect Disord Drug Targets, 21(2): 257-261.
- Önder H. 2018. Nonparametric statistical methods used in biological experiments. BSJ Eng Sci, 1(1): 1-6.
- Prasada Rao CMM, Vennila T, Kosanam S, Ponsudha P, Suriyakrishnaan K, Alarfaj AA, Hirad AH, Sundaram SR, Surendhar PA, Selvam N. 2022. Assessment of bacterial ısolates from the urine specimens of urinary tract ınfected patient. BioMed Res Int, 2022: 4088187.
- Salh KK. 2022. Antimicrobial resistance in bacteria causing urinary tract ınfections. Combinatorial Chem High Throughput Screen, 25(7): 1219-1229.
- Sastry S, Doi Y. 2016. Fosfomycin: Resurgence of an old companion. J Infect Chemother, 22(5): 273-280.
- Seno A, Yakupogullari Y, Senol FF. 2020. Extended-spectrum [beta]-lactamase-producing escherichia coli and klebsiella spp. in community-acquired urinary tract ınfections and their antimicrobial resistance. KLIMIK J, 33(2): 163-169.
- Sherchan JB, Dongol A, Humagain S, Joshi A, Rana Magar S, Bhandari S. 2022. Antibiotic susceptibility pattern of bacteria causing urinary tract ınfection. J Nepal Health Res Counc, 20(1): 218-224.
- Warzecha D, Pietrzak B, Urban A, Wielgoś M. 2021. How to avoid drug resistance during treatment and prevention of urinary tract infections. Przeglad Menopauzalny, 20(4): 217-221.
Abstract
İdrar yolu enfeksiyonları hastane ve toplumda en sık karşılaşılan enfeksiyonların başında gelmektedir. Kültür imkanı olmayan durumlarda ampirik tedavi hastalığın sağaltım ve komplikasyonlarının önlenmesinde kritik öneme sahiptir. Bu çalışmada amaç kümülatif antibiyogram analizi ile klinisyene ampirik tedaviye başlamada yol gösterici olmaktır. 2014 Ocak - 2022 Aralık arasında laboratuvarımıza gelen idrar örneklerinin kültürleri yapıldı. Üreyen bakteriler konvansiyonel yöntemler, disk difüzyon, BD Phoenix (BD, ABD) ve Vitek2 (Biomerieux, Fransa) otomatize sistemleri ile identifiye edilerek antibiyotik duyarlılık testleri yapıldı. Bir hastada üretilen bakterilerin aynı türden olması durumunda ilk izolat verisi kullanıldı. Duyarlılık oranı %90 üzerinde olan antibiyotikler ampirik tedavide önerildi. Çalışmamızda idrar kültürlerinde üreyen etkenlerin %86,6’sının Gram (-) bakteriler ve toplamın %62,9’unun Escherichia coli olduğu görüldü. Tüm izolatlara bakıldığında ayaktan hastalarda siprofloksasin direncinin yüksek ve artmakta olduğu (%44,6); fosfomisin (%10,8) ve nitrofurantoin (%13,2) dirençlerinin düşük olduğu saptandı. Yatan hastalarda intravenöz olarak tercih edilen seftriakson direncinin (%63,3) yüksek olduğu, ertapenem direncinin (%29,3) daha düşük olduğu görüldü. Ayaktan ve yatan hastalarda üreyen E. coli izolatlarında nitrofurantoin ve ertapenem dirençlerinin %10 altında olduğu, E. coli dışındaki izolatlar için bu durumun geçerli olmadığı görüldü. E. coli izolatlarında tüm antibiyotiklere direnç oranının yatan hastalarda ayakta tedavi görenlere göre anlamlı yüksek olduğu saptandı (her biri için P<0,001). Non-fermenter bakterilerde yatan hastalarda siproflaksasin, imipenem ve meropenem direnci %60’ın üzerinde bulundu. Çalışmamızda elde edilen bulgular kültür imkanı olmayan durumlarda veya kültür antibiyogram sonuçları elde edilene kadar ayaktan tedavide nitrofurantoin ve fosfomisinin, yatan hastalarda ertapenem ve fosfomisinin diğer antibiyotiklere göre ampirik tedavide başarılı olabileceğini göstermektedir.
References
- Abbott IJ, Peel TN, Cairns KA, Stewardson AJ. 2023. Antibiotic management of urinary tract infections in the post-antibiotic era: a narrative review highlighting diagnostic and antimicrobial stewardship. Clinical microbiology and infection. Official Public European Soc Clin Microbiol Infect Diseas, 29(10): 1254-1266.
- Bader MS, Loeb M, Brooks AA. 2017. An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Medic, 129(2): 242-258.
- Ballén V, Gabasa Y, Ratia C, Ortega R, Tejero M, Soto S. 2021. Antibiotic resistance and virulence profiles of klebsiella pneumoniae strains ısolated from different clinical sources. Front Cellular Infect Microbiol, 11: 738223.
- Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyèr F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Sennevill E, Sotto A, Subtil D, Trivalle C, Etienne M. 2018. Practice guidelines for the management of adult community-acquired urinary tract infections. Medec Maladies Infect, 48(5): 327-358. https://doi.org/10.1016/j.medmal.2018.03.005.
- Chu CM, Lowder JL. 2018. Diagnosis and treatment of urinary tract infections across age groups. American J Obstetrics Gynecol, 219(1): 40-51.
- Haindongo EH, Funtua B, Singu B, Hedimbi M, Kalemeera F, Hamman J, Vainio O, Hakanen AJ, Vuopio J. 2022. Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016-2017. Antimicrobial Resist Infect Cont, 11(1): 33.
- Hooton TM. 2012. Clinical practice. Uncomplicated urinary tract infection. New England J Medic, 366(11): 1028-1037.
- Islam MR, Hoque MJ, Uddin MN, Dewan A, Haque NB, Islam MT, Islam MH, Hasan MA. 2022. Antimicrobial resistance of E coli causing urinary tract ınfection in Bangladesh. Mymensingh Medic J, 31(1): 180-185.
- Keskin BH, Çalışkan E, Kaya S, Köse E, Şahin İ. 2021. Üriner sistem enfeksiyonlarında etken bakteriler ve antibiyotik direnç oranları. Turk Mikrobiyol Cemiy Derg, 51: 254-262.
- Majumder MMI, Mahadi AR, Ahmed T, Ahmed M, Uddin MN, Alam MZ. 2022. Antibiotic resistance pattern of microorganisms causing urinary tract infection: a 10-year comparative analysis in a tertiary care hospital of Bangladesh. Antimicrobial Resist Infect Cont, 11(1): 156.
- Meena M, Kishoria N, Meena DS, Sonwal VS. 2021. Bacteriological profile and antibiotic resistance in patients with urinary tract ınfection in tertiary care teaching hospital in Western Rajasthan India. Infect Disord Drug Targets, 21(2): 257-261.
- Önder H. 2018. Nonparametric statistical methods used in biological experiments. BSJ Eng Sci, 1(1): 1-6.
- Prasada Rao CMM, Vennila T, Kosanam S, Ponsudha P, Suriyakrishnaan K, Alarfaj AA, Hirad AH, Sundaram SR, Surendhar PA, Selvam N. 2022. Assessment of bacterial ısolates from the urine specimens of urinary tract ınfected patient. BioMed Res Int, 2022: 4088187.
- Salh KK. 2022. Antimicrobial resistance in bacteria causing urinary tract ınfections. Combinatorial Chem High Throughput Screen, 25(7): 1219-1229.
- Sastry S, Doi Y. 2016. Fosfomycin: Resurgence of an old companion. J Infect Chemother, 22(5): 273-280.
- Seno A, Yakupogullari Y, Senol FF. 2020. Extended-spectrum [beta]-lactamase-producing escherichia coli and klebsiella spp. in community-acquired urinary tract ınfections and their antimicrobial resistance. KLIMIK J, 33(2): 163-169.
- Sherchan JB, Dongol A, Humagain S, Joshi A, Rana Magar S, Bhandari S. 2022. Antibiotic susceptibility pattern of bacteria causing urinary tract ınfection. J Nepal Health Res Counc, 20(1): 218-224.
- Warzecha D, Pietrzak B, Urban A, Wielgoś M. 2021. How to avoid drug resistance during treatment and prevention of urinary tract infections. Przeglad Menopauzalny, 20(4): 217-221.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences (Other), Family Medicine |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | February 12, 2024 |
| Publication Date | March 1, 2024 |
| Submission Date | September 11, 2023 |
| Acceptance Date | January 3, 2024 |
| Published in Issue | Year 2024 Volume: 7 Issue: 2 |
