Yenidoğan sonrası üriner sistem infeksiyonları ve iki yıllık izlem sonuçları

Amaç: Kliniğimizde ilk semptomatik Üriner sistem infeksiyonu saptanan 160 çocuğun klinik, laboratuar özelliklerinin, 2 yıllık izlem ve komplikasyonlarının değerlendirilmesi amaçlandı. Yöntem: Klinik olarak Üriner sistem infeksiyonunu destekler en az 2 klinik/laboratuar bulgusu (atef, karın veya yan ağrısı, kusma, idrar yaparken ağrı, sık idrar, tam idrar tetkikinde piyüri) ve idrar kültüründe anlamlı üreme olan vakalar çalışmaya alındı. Bulgular: Vakaların 114'ü (% 71) kız, 46'sı (% 29) erkek ve ortalama yaşları 54$pm$44 ay 51-80), yaş gruplarına göre dağılımı 2 ay-23 ay % 33, 2 yaş-5 yaş % 21, >5 yaş % 46 idi. Ateş yüksekliği ve idrar yakınmaları en sık görülen klinik bulgulardı. Büyüme geriliği % 3 vakada saptandı. Vakaların % 31 'inde lökositoz (> 15,000 mm3) vardı, % 55 vakada C RP (>1 mg/dL) pozitif bulundu. Yüzde 44 vakada 30 mm/saat üzerinde olan sedimentasyon hızı ortalama 22±14 mm/saat (3-70) idi. Üre ve kreatin klirensi bir vaka dışında normal sınırlarda idi. Üreyen bakteriler sırasıyla; E.coli (% 62.7), Enterobacter spp (% 16.5), Proteus spp (% 8.9), Klebsiella spp (% 8.9), diğer (% 3) olarak bulundu. Renal ultrasonografi % 30, DMSA % 63 vakada patolojik olup, voiding sistoüretrografide % 23 vakada vezikoüreteral reflü saptandı. Profilaktik antibiyotik endikas-yonu vakaların % 56'sına konuldu, profilaksi öncesi üreme sayısı 1.5$pm$0.9, profilaksi öncesi izlem süresi 2±1 ay idi. Profilakside en sık kotrimoksazol (% 70) ve nitrofurantoin (% 17) verildi. Ortalama l4±7'ay (1-26)profilaksi verildi ve bu sürede ortalama 1$pm$1 üreme saptandı Sonuç: Vakaların izlem sırasında kontrol altına alınamayan Üriner sistem İnfeksiyonları olmadı ve hiçbir vakada ciddi komplikasyon gelişmedi.

Anahtar Kelimeler:

Vezikoüreteral reflü, İdrar yolu enfeksiyonları, Antibiyotik proflaksisi, Süt çocuğu, yenidoğan

Urinary tract infections in postneonatal period and results of two year follow-up

Aim: Clinical and laboratory features and two-years fol-low-up were evaluated in 160 children with the first symptomatic urinary tract infection in our clinic. Method: The patients with a least two clinical/laboratory findings (fever, abdominal/side pain, vomiting, dysuria, pollacuria, and pyuria) plus positive significant urinary culture results were included in the study. Results: Mean age was 54$pm$44 (1-180) months (mean$pm$SD, range), 71 % female (114) and 29 % (46) male, distrubition according to age group; 2 months- 23 months 33 %, 2 years-5 years 21 %, >5 years 46 %. The most prominent clinical findings were fever and urinary symptoms. Growth failure was detected in 3 % of the patients. Thirty-one per-cent of patients had leucocytosis (>15.000), 55 % had elevated CRP (> 1 mg/dL), and 44 % had elevated ESR levels. Urea and creatinin levels were in the normal ranges except for one patient. Urine culture results were revealed as E. coli (62.7 %), Enterobacter spp (16.4 %), Proteus 'spp (8.9 %), Klebsiella spp (8.9 %), and others (3 %). Renal ultrasound was found pathologic in 30 % of the patients (19 % dilatation, 19 % increased echogenity), VUR was detected in 23 % of the patients by VCUG. Sixty-three percent of the patients had pathologic scintigraphic results (23 % scar, 40 % perfusion defects). Prophylactic antibiotic was given 56 % of the patients. The mean number of positive cultures was 1.5±0.5 before prophlaxis (the mean follow-up time 2$pm$1 months), and 1$pm$1 after prophyaxis (the mean follow-up time 14±7 months). There were no un-controlled urinary tract infection in the follow-up, and no case had any complications due to urinary tract infection. Conclusion: There were no uncontrolled urinary tract infection in the follow-up, and no case had any complications due to urinary tract infection.

Keywords:

Vesico-Ureteral Reflux, Urinary Tract Infections, Antibiotic Prophylaxis, Infant, Newborn,

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