İdrar yolu infeksiyonu olan çocuklardan izole edilen Escherichia coli suşlarında antibiyotik direnci ve çeşitli virulans faktörlerinin araştırılması

İdrar yolu infeksiyonu şüphesi ile poliklinik hasta grubundan izole edilen 100 suş ve yatan hasta grubundan 79 suş olmak üzere toplam 179 E.coli suşunun antimikrobiyallere direnci ve çeşitli virulans özellikleri araştırılmıştır. Ampisiline, ampisilin-sulbaktama, amoksisilin-klavulanik asit ve kotrimoksazole yüksek oranda direnç saptanmıştır. Amoksisilin-klavulanik asit, sefazolin, sefuroksim, seftriakson, sefepim ve gentamisin direnci yatan hasta grubundan izole edilen suşlarda poliklinik hastalarından izole edilenlere göre anlamlı olarak yüksek bulunmuştur. Yatan hasta grubunda % 13, poliklinik hasta grubunda % 1 oranında genişlemiş spektrumlu betalaktamaz (GSBL) saptanmıştır. Yatan hasta grubunda anlamlı olarak daha fazla çoklu dirençli suşa (% 46/ % 19) rastlanmıştır. Virülans faktörleri olarak, yatan ve poliklinik hasta gruplarında sırasıyla; % 46 ve % 41 oranında hemolizin; % 47 ve % 37 oranında serumun bakterisid etkisine direnç; % 11 ve % 18 oranında tip 1 fimbriya saptanmıştır. Yatan ve poliklinik hastalarından izole edilen suşlarda MRHA ve MSHA oranı sırasıyla % 27, % 20 ve % 18, % 28 olarak tespit edilmiştir. Bu özellikler bakımından iki grup suş arasında anlamlı bir fark bulunmamıştır. Hemaglütinasyon tiplemesi sonucu iki grupta da suşların daha çok tip IV-B (hemaglütinasyon negatif) ve tip V-A olduğu görülmüştür. Toplam 29 suş klasik tabloda bulunmayan hemaglütinasyon paternleri göstermiştir. Yatan ve poliklinik hasta grubunda E.coli suşlarının virulans faktörleri açısından anlamlı farklı bulunmadığı fakat hastane kaynaklı suşlarda direnç oranlarının genellikle daha yüksek olduğu, çoklu dirence ve GSBL oluşturan suşlara daha fazla rastlandığı dikkat çekmiştir.

Anahtar Kelimeler:

Çocuk, İlaç direnci, Escherichia coli, İdrar yolu enfeksiyonları, Virulens

Investigation of antibiotic resistance and some virulence factors of Escherichia coli strains isolated from children with urinary tract infections

In this study, antibiotic resistance and some virulence factors of 179 E.coli strains (100 isolates from outpatients and 79 isolates from inpatients) were investigated. The resistance rates for ampicillin, ampicillin-sulbactam, amoxicillin-clavulanic acid and co-trimoxazole were found to be high. The rates of amoxicillin-clavulanic acid, cefazolin, cefuroxime, ceftriaxone, cefepime and gentamicin resistance were found significantly higher in strains from inpatient group than those from outpatient group. Extended spectrum betalactamase (ESBL) producers were 13 % in inpatients’ and 1 % in outpatients’ isolates. The multiple resistance rates were found significantly higher in inpatient group (46 % /19 %). As virulence factors; hemolysin producers were found to be 46 % and 41 %; serum resistance to be 47 % and 37 %; type 1 fimbriae to be 11 % and 18 % in inpatient and outpatient groups, respectively. MRHA and MSHA were detected as 27 % and 20 %, and 18 % and 28 % in these two groups. The differences between two groups of strains for these properties were found to be insignificant. Hemagglutination types were similar in both groups; type IV-B (nonhemaglutinating type) and type V-A were found to be main types. Totally 29 strains gave hemagglutination patterns which are absent in classical table. In conclusion, there was no significant difference in the frequency of virulence factors between inpatient and outpatient groups, but antibiotic resistance rates were generally higher in inpatient group, and multiple resistance and ESBL production were significantly higher in this group.

Keywords:

Child, Drug Resistance, Escherichia coli, Urinary Tract Infections, Virulence,

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