Klinik Araştırma
Yenidoğan Yoğun Bakım Ünitesinde İdrar Yolu Enfeksiyonuna Yol Açan Mikroorganizmalar ve Antimikrobiyal Direnç Dağılımı: 5 Yıllık Deneyim
Öz
Yenidoğan döneminde idrar yolu enfeksiyonu önemli bir klinik problemdir. Bu çalışmada, kliniğimizde İYE tanısı alan yenidoğan bebeklerin idrar kültürlerinde üreyen mikroorganizmalar ve antibiyotik direnç paternlerinin belirlenmesi amaçlandı. Ocak 2017-Aralık 2021 tarihleri arasında yenidoğan yoğun bakım ünitemizde İYE tanısı alan 126 hastanın retrospektif olarak demografik verileri, idrar kültüründe üreyen mikroorganizmalar ve antimikrobiyal duyarlılık sonuçları kaydedildi. Hastaların 58’i (%46) kız, gestasyon yaşları ortanca 38 hafta idi. Hastaların %38.1’i prematüre iken sezeryan oranı %68.3 idi. İdrar kültüründe; K. pneumonia (%52.4) en sık üreyen mikroorganizma iken, E. coli (%19) ve Enterococcus spp (%15.9) diğer sık saptanan mikroorganizmalar oldu. Ampisilin direnci; K. pneumoniae’da (%100), Enterococcus spp’de (%85.7) ve E. coli’de (%71.4) amikasin direnci; K. pneumoniae’da %54.7 ve E. coli’de %25 bulundu. K. pneumoniae’da meropenem direnci %61.5 ve imipenem direnci %42.2 oranında görülürken E. coli’de meropenem direnci %11.1 ve imipenem direnci %7.1 oranında görüldü. Çalışmamızda K. pneumoniae ve E. coli en sık görülen bakterilerdi. İzole edilen bakterilerde karbapenemler dahil antimikrobiyallere karşı yüksek direnç görüldü. Özellikle yenidoğanlarda İYE’nin ampirik tedavisinde ampisilin, amoksisilin-klavulonat ve TMP-SMX’in yüksek direnç oranı nedeniyle kullanılmasının uygun olmayacağı düşüncesindeyiz.
Anahtar Kelimeler
Kaynakça
- Abuhandan, M., Güzel, B., Oymak, Y., & Çiftçi, H. (2013). Antibiotic sensitivity and resistance in children with urinary tract infection in Sanliurfa. Turkish Journal of Urology, 39(2), 106. https://doi.org/10.5152/tud.2013.022
- Ahmad, S., Alotaibi, H.A., Alkhaibari, S.H., & Alshahrani, B.M. (2020). Enterococcal urinary tract infection in newborns at a pediatric hospital in Saudi Arabia. Dhaka University Journal of Pharmaceutical Sciences, 19(2), 119-124. https://doi.org/10.3329/dujps.v19i2.50626
- Beetz, R. (2012). Evaluation and management of urinary tract infections in the neonate. Current Opinion in Pediatrics, 24(2), 205-211. https://doi.org/10.1097/MOP.0b013e32834f0423
- Bonadio, W., & Maida, G. (2014). Urinary tract infection in outpatient febrile infants younger than 30 days of age: A 10-year evaluation. The Pediatric Infectious Disease Journal, 33(4), 342-344. https://doi.org/10.1097/INF.0000000000000110
- Chen, H.-T., Jeng, M.-J., Soong, W.-J., Yang, C.-F., Tsao, P.-C., Lee, Y.-S., & Tang, R.-B. (2011). Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old. Journal of The Chinese Medical Association, 74(4), 159-163. https://doi.org/10.1016/j.jcma.2011.01.036
- Demir, M., & Kazanasmaz, H. (2020). Uropathogens and antibiotic resistance in the community and hospital-induced urinary tract infected children. Journal of Global Antimicrobial Resistance, 20, 68-73. https://doi.org/10.1016/j.jgar.2019.07.019
- Eliakim, A., Dolfin, T., Korzets, Z., Wolach, B., & Pomeranz, A. (1997). Urinary tract infection in premature infants: The role of imaging studies and prophylactic therapy. Journal of Perinatology: Official Journal of The California Perinatal Association, 17(4), 305-308. PMID: 9280097
- Ergün, M., Akyüz, O., Özdemir, A.A., & Taken, K. (2021). İdrar yolu enfeksiyonu geçiren çocukların idrar kültürlerinde üreyen bakteriler ve antibiyotik dirençleri. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi, 13(1), 29-37. https://dergipark.org.tr/en/pub/gutfd/issue/62344/937783
- Erol, S., & Altuntaş, N. (2019). Yenidoğan yoğun bakım ünitesinde idrar yolu enfeksiyonları: 4 yıllık deneyim. Ankara Medical Journal, 19(1), 115-122. https://doi.org/10.17098/amj.542422
- Ghadage, D.P., Nale, S.S., Kamble, D.S., Muley, V.A., Wankhade, A.B., Mali, R.J., & Bhore, A.V. (2014). Study of etiology and antibiogram of uropathogens in children-A retrospective analysis. Journal of Clinical Diagnostic Research, 8(1), 20-22. https://doi.org/10.7860/JCDR/2014/6282.3907
- Gupta, P., Mandal, J., Krishnamurthy, S., Barathi, D., & Pandit, N. (2015). Profile of urinary tract infections in pediatric patients. The Indian Journal of Medical Research, 141(4), 473. https://doi.org/10.4103/0971-5916.159299
- Gür, D., Kanra, G., Ceyhan, M., Seçmeer, G., Kanra, B., & Kaymakoğlu, I. (1999). Epidemiology and antibiotic resistance of gram negative urinary pathogens in pediatric patients. The Turkish Journal of Pediatrics, 41(1), 37-42. PMID: 10770674
- Ismaili, K., Lolin, K., Damry, N., Alexander, M., Lepage, P., & Hall, M. (2011). Febrile urinary tract infections in 0 to 3 month old infants: A prospective follow-up study. The Journal of Pediatrics, 158(1), 91-94. https://doi.org/10.1016/j.jpeds.2010.06.053
- Konca, C., Tekin, M., Uckardes, F., Akgun, S., Almis, H., Bucak, I.H., & Turgut, M. (2017). Antibacterial resistance patterns of pediatric community acquired urinary infection: Overview. Pediatrics International, 59(3), 309-315. https://doi.org/10.1111/ped.13139
- Kömürlüoğlu, A., Aykaç, K., Özsürekçi, Y., Başaranoğlu, S.T., Biçakçigil, A., Liste, Ü., & Ateş, K. (2018). Gram negatif idrar yolu enfeksiyonu etkenlerinin antibiyotik direnç dağılımı: Tek merkez deneyimi. Türkiye Çocuk Hastalıkları Dergisi, 12(1), 10-17. https://doi.org/10.12956/tjpd.2017.279
- Ladhani, S., & Gransden, W. (2003). Increasing antibiotic resistance among urinary tract isolates. Archives of Disease in Childhood, 88(5), 444-445. https://doi.org/10.1136/adc.88.5.444
- Levy, I., Comarsca, J., Davidovits, M., Klinger, G., Sirota, L., & Linder, N. (2009). Urinary tract infection in preterm infants: The protective role of breastfeeding. Pediatric Nephrology, 24, 527-531. https://doi.org/10.1007/s00467-008-1007-7
- Maraki, S., Mantadakis, E., Michailidis, L., & Samonis, G. (2013). Changing antibiotic susceptibilities of community-acquired uropathogens in Greece, 2005–2010. Journal of Microbiology, Immunology and Infection, 46(3), 202-209. https://doi.org/10.1016/j.jmii.2012.05.012
- Neyzi, O., & Ertuğrul, T. (2002). Pediatri (4th ed.). Nobel Tıp Kitabevi, İstanbul.
- Oliveira, E.A., & Mak, R.H. (2020). Urinary tract infection in pediatrics: An overview. Jornal de Pediatria, 96, 65-79. https://doi.org/10.1016/j.jped.2019.10.006
- Özmen, E., Ceran, B., Fatma, S., Bezirganoğlu, H., Dizdar, E.A., Tayman, C., & Şerife, O. (2020). Yenidoğan yoğun bakım ünitesinde idrar yolu enfeksiyonu tanısı ile izlenen preterm bebeklerin retrospektif değerlendirilmesi. Jinekoloji Obstetrik ve Neonatoloji Tıp Dergisi, 17(2), 328-330. https://doi.org/10.38136/jgon.677916
- Peri, A.M., Doi, Y., Potoski, B.A., Harris, P.N., Paterson, D.L., & Righi, E. (2019). Antimicrobial treatment challenges in the era of carbapenem resistance. Diagnostic Microbiology and Infectious Disease, 94(4), 413-425. https://doi.org/10.1016/j.diagmicrobio.2019.01.020
- Riskin, A., Toropine, A., Bader, D., Hemo, M., Srugo, I., & Kugelman, A. (2012). Is it justified to include urine cultures in early (< 72 hours) neonatal sepsis evaluations of term and late preterm infants?. American Journal of Perinatology, 499-504. https://doi.org/10.1055/s-0032-1329180
- Roberts, K.B., & Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. (2011). 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, 128(3), 595-610. https://doi.org/10.1542/peds.2011-1330
- Samancı, S., Çelik, M., & Köşker, M. (2020). Antibiotic resistance in childhood urinary tract infections: A single center experience. Turkish Archives of Pediatrics/Türk Pediatri Arşivi, 55(4), 386. https://doi.org/10.14744/TurkPediatriArs.2020.22309
- Sharan, R., Kumar, D., & Mukherjee, B. (2013). Bacteriology and antibiotic resistance pattern in community acquired urinary tract infection. Indian Pediatrics, 50, 707. https://doi.org/10.1007/s13312-013-0195-9
- Şahin, E., Külcü, N.U., & Say, Z.A. (2018). İdrar yolu enfeksiyonu olan yenidoğanların değerlendirilmesi. Zeynep Kamil Tıp Bülteni, 50(1), 21-25. https://doi.org/10.16948/zktipb.447389
- Tseng, M.H., Lo, W.T., Lin, W.J., Teng, C.S., Chu, M.L., & Wang, C.C. (2008). Changing trend in antimicrobial resistance of pediatric uropathogens in Taiwan. Pediatrics International, 50(6), 797-800. https://doi.org/10.1111/j.1442-200X.2008.02738.x
- Türk Neonatoloji Derneği (2018). Yenidoğan enfeksiyonları tanı ve tedavi rehberi. http://www.neonatology.org.tr/storage/2020/04/yenidogan-enfeksiyonlari-tani-ve-tedavi_rehberi-2018.pdf
- Yüksel, S., Öztürk, B., Kavaz, A., Özçakar, Z.B., Acar, B., Güriz, H., & Yalçınkaya, F. (2006). Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections. International Journal of Antimicrobial Agents, 28(5), 413-416. https://doi.org/10.1016/j.ijantimicag.2006.08.009
Microorganisms Causing Urinary Tract Infection and Distribution of Antimicrobial Resistance in the Neonatal Intensive Care Unit: 5 Years of Experience
Öz
Urinary tract infection is an important clinical problem in the neonatal period. In this study, it was aimed to determine the microorganisms grown in urine cultures and antibiotic resistance patterns of newborn babies diagnosed with UTI in our clinic. Demographic data, microorganisms grown in urine culture and antimicrobial susceptibility results of 126 patients diagnosed with UTI in our neonatal intensive care unit between January 2017 and December 2021 were recorded retrospectively. 58 (46%) of the patients were girls and their median gestational age was 38 weeks. While 38.1% of the patients were premature, the rate of cesarean section was 68.3%. In urine culture; While K. pneumonia (52.4%) was the most common microorganism, E. coli (19%) and Enterococcus spp (15.9%) were other frequently detected microorganisms. Ampicillin resistance; amikacin resistance in K. pneumoniae (100%), Enterococcus spp (85.7%), and E. coli (71.4%); It was found in 54.7% in K. pneumoniae and 25% in E. coli. While meropenem resistance was seen in 61.5% and imipenem resistance in 42.2% in K. pneumoniae, meropenem resistance was seen in 11.1% and imipenem resistance in 7.1% in E. coli. K. pneumoniae and E. coli were the most common bacteria in our study. High resistance to antimicrobials including carbapenems was seen in isolated bacteria. We think that it would not be appropriate to use ampicillin, amoxicillin-clavulanate and TMP-SMX in the empirical treatment of UTI, especially in newborns, due to their high resistance rate.
Anahtar Kelimeler
Kaynakça
- Abuhandan, M., Güzel, B., Oymak, Y., & Çiftçi, H. (2013). Antibiotic sensitivity and resistance in children with urinary tract infection in Sanliurfa. Turkish Journal of Urology, 39(2), 106. https://doi.org/10.5152/tud.2013.022
- Ahmad, S., Alotaibi, H.A., Alkhaibari, S.H., & Alshahrani, B.M. (2020). Enterococcal urinary tract infection in newborns at a pediatric hospital in Saudi Arabia. Dhaka University Journal of Pharmaceutical Sciences, 19(2), 119-124. https://doi.org/10.3329/dujps.v19i2.50626
- Beetz, R. (2012). Evaluation and management of urinary tract infections in the neonate. Current Opinion in Pediatrics, 24(2), 205-211. https://doi.org/10.1097/MOP.0b013e32834f0423
- Bonadio, W., & Maida, G. (2014). Urinary tract infection in outpatient febrile infants younger than 30 days of age: A 10-year evaluation. The Pediatric Infectious Disease Journal, 33(4), 342-344. https://doi.org/10.1097/INF.0000000000000110
- Chen, H.-T., Jeng, M.-J., Soong, W.-J., Yang, C.-F., Tsao, P.-C., Lee, Y.-S., & Tang, R.-B. (2011). Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old. Journal of The Chinese Medical Association, 74(4), 159-163. https://doi.org/10.1016/j.jcma.2011.01.036
- Demir, M., & Kazanasmaz, H. (2020). Uropathogens and antibiotic resistance in the community and hospital-induced urinary tract infected children. Journal of Global Antimicrobial Resistance, 20, 68-73. https://doi.org/10.1016/j.jgar.2019.07.019
- Eliakim, A., Dolfin, T., Korzets, Z., Wolach, B., & Pomeranz, A. (1997). Urinary tract infection in premature infants: The role of imaging studies and prophylactic therapy. Journal of Perinatology: Official Journal of The California Perinatal Association, 17(4), 305-308. PMID: 9280097
- Ergün, M., Akyüz, O., Özdemir, A.A., & Taken, K. (2021). İdrar yolu enfeksiyonu geçiren çocukların idrar kültürlerinde üreyen bakteriler ve antibiyotik dirençleri. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi, 13(1), 29-37. https://dergipark.org.tr/en/pub/gutfd/issue/62344/937783
- Erol, S., & Altuntaş, N. (2019). Yenidoğan yoğun bakım ünitesinde idrar yolu enfeksiyonları: 4 yıllık deneyim. Ankara Medical Journal, 19(1), 115-122. https://doi.org/10.17098/amj.542422
- Ghadage, D.P., Nale, S.S., Kamble, D.S., Muley, V.A., Wankhade, A.B., Mali, R.J., & Bhore, A.V. (2014). Study of etiology and antibiogram of uropathogens in children-A retrospective analysis. Journal of Clinical Diagnostic Research, 8(1), 20-22. https://doi.org/10.7860/JCDR/2014/6282.3907
- Gupta, P., Mandal, J., Krishnamurthy, S., Barathi, D., & Pandit, N. (2015). Profile of urinary tract infections in pediatric patients. The Indian Journal of Medical Research, 141(4), 473. https://doi.org/10.4103/0971-5916.159299
- Gür, D., Kanra, G., Ceyhan, M., Seçmeer, G., Kanra, B., & Kaymakoğlu, I. (1999). Epidemiology and antibiotic resistance of gram negative urinary pathogens in pediatric patients. The Turkish Journal of Pediatrics, 41(1), 37-42. PMID: 10770674
- Ismaili, K., Lolin, K., Damry, N., Alexander, M., Lepage, P., & Hall, M. (2011). Febrile urinary tract infections in 0 to 3 month old infants: A prospective follow-up study. The Journal of Pediatrics, 158(1), 91-94. https://doi.org/10.1016/j.jpeds.2010.06.053
- Konca, C., Tekin, M., Uckardes, F., Akgun, S., Almis, H., Bucak, I.H., & Turgut, M. (2017). Antibacterial resistance patterns of pediatric community acquired urinary infection: Overview. Pediatrics International, 59(3), 309-315. https://doi.org/10.1111/ped.13139
- Kömürlüoğlu, A., Aykaç, K., Özsürekçi, Y., Başaranoğlu, S.T., Biçakçigil, A., Liste, Ü., & Ateş, K. (2018). Gram negatif idrar yolu enfeksiyonu etkenlerinin antibiyotik direnç dağılımı: Tek merkez deneyimi. Türkiye Çocuk Hastalıkları Dergisi, 12(1), 10-17. https://doi.org/10.12956/tjpd.2017.279
- Ladhani, S., & Gransden, W. (2003). Increasing antibiotic resistance among urinary tract isolates. Archives of Disease in Childhood, 88(5), 444-445. https://doi.org/10.1136/adc.88.5.444
- Levy, I., Comarsca, J., Davidovits, M., Klinger, G., Sirota, L., & Linder, N. (2009). Urinary tract infection in preterm infants: The protective role of breastfeeding. Pediatric Nephrology, 24, 527-531. https://doi.org/10.1007/s00467-008-1007-7
- Maraki, S., Mantadakis, E., Michailidis, L., & Samonis, G. (2013). Changing antibiotic susceptibilities of community-acquired uropathogens in Greece, 2005–2010. Journal of Microbiology, Immunology and Infection, 46(3), 202-209. https://doi.org/10.1016/j.jmii.2012.05.012
- Neyzi, O., & Ertuğrul, T. (2002). Pediatri (4th ed.). Nobel Tıp Kitabevi, İstanbul.
- Oliveira, E.A., & Mak, R.H. (2020). Urinary tract infection in pediatrics: An overview. Jornal de Pediatria, 96, 65-79. https://doi.org/10.1016/j.jped.2019.10.006
- Özmen, E., Ceran, B., Fatma, S., Bezirganoğlu, H., Dizdar, E.A., Tayman, C., & Şerife, O. (2020). Yenidoğan yoğun bakım ünitesinde idrar yolu enfeksiyonu tanısı ile izlenen preterm bebeklerin retrospektif değerlendirilmesi. Jinekoloji Obstetrik ve Neonatoloji Tıp Dergisi, 17(2), 328-330. https://doi.org/10.38136/jgon.677916
- Peri, A.M., Doi, Y., Potoski, B.A., Harris, P.N., Paterson, D.L., & Righi, E. (2019). Antimicrobial treatment challenges in the era of carbapenem resistance. Diagnostic Microbiology and Infectious Disease, 94(4), 413-425. https://doi.org/10.1016/j.diagmicrobio.2019.01.020
- Riskin, A., Toropine, A., Bader, D., Hemo, M., Srugo, I., & Kugelman, A. (2012). Is it justified to include urine cultures in early (< 72 hours) neonatal sepsis evaluations of term and late preterm infants?. American Journal of Perinatology, 499-504. https://doi.org/10.1055/s-0032-1329180
- Roberts, K.B., & Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. (2011). 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, 128(3), 595-610. https://doi.org/10.1542/peds.2011-1330
- Samancı, S., Çelik, M., & Köşker, M. (2020). Antibiotic resistance in childhood urinary tract infections: A single center experience. Turkish Archives of Pediatrics/Türk Pediatri Arşivi, 55(4), 386. https://doi.org/10.14744/TurkPediatriArs.2020.22309
- Sharan, R., Kumar, D., & Mukherjee, B. (2013). Bacteriology and antibiotic resistance pattern in community acquired urinary tract infection. Indian Pediatrics, 50, 707. https://doi.org/10.1007/s13312-013-0195-9
- Şahin, E., Külcü, N.U., & Say, Z.A. (2018). İdrar yolu enfeksiyonu olan yenidoğanların değerlendirilmesi. Zeynep Kamil Tıp Bülteni, 50(1), 21-25. https://doi.org/10.16948/zktipb.447389
- Tseng, M.H., Lo, W.T., Lin, W.J., Teng, C.S., Chu, M.L., & Wang, C.C. (2008). Changing trend in antimicrobial resistance of pediatric uropathogens in Taiwan. Pediatrics International, 50(6), 797-800. https://doi.org/10.1111/j.1442-200X.2008.02738.x
- Türk Neonatoloji Derneği (2018). Yenidoğan enfeksiyonları tanı ve tedavi rehberi. http://www.neonatology.org.tr/storage/2020/04/yenidogan-enfeksiyonlari-tani-ve-tedavi_rehberi-2018.pdf
- Yüksel, S., Öztürk, B., Kavaz, A., Özçakar, Z.B., Acar, B., Güriz, H., & Yalçınkaya, F. (2006). Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections. International Journal of Antimicrobial Agents, 28(5), 413-416. https://doi.org/10.1016/j.ijantimicag.2006.08.009
Toplam 30 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Erken Görünüm Tarihi | 3 Mayıs 2024 |
| Yayımlanma Tarihi | 3 Mayıs 2024 |
| Gönderilme Tarihi | 27 Aralık 2022 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 4 Sayı: 1 |
