Yaşar KANDUR, Sevinç ÖZDEN, BAHAR BÜYÜKKARAGÖZ

Çocukluk çağı üriner sistem enfeksiyonlarında antibiyotik duyarlılığının araştırılması: tek merkezli çalışma

Amaç: Çocukluk çağında üriner sistem enfeksiyonu tedavisinde antimikrobiyal direnç son yıllarda büyüyen bir sorun olarak karşımıza çıkmaktadır. Bu araştırmamızda, merkezimizde poliklinik şartlarında tanı almış çocuklarda saptanan üriner sistem enfeksiyonuna yol açan etkenlerin dağılımını ve antibiyotik duyarlılıklarını araştırmayı amaçladık. Yöntemler: Ocak- 2014 ve Mayıs - 2015 tarihleri arasında merkezimizde takip edilen üriner sistem enfeksiyonu tanısı alan çocuk hastaların tıbbi kayıtları retrospektif olarak incelendi. Bulgular: Yüz yetmiş bir hastada (E/K = 53/118 ; ortalama yaş 56 ± 47.2 ay), 231 patojen izole edilmiştir. En sık izole edilen etkenler Escherichia coli (E. coli) (%70,6), Klebsiella spp (%16,5) , Proteus spp. (%6,5) olarak bulundu. Patojenlerin antibiyotik duyarlılıkları değerlendirildiğinde E.coli etkenine karşı amikasin direnci %1,8, gentamisin %17,8, trimetoprim-sulfometoksazol %60,7, ampisillin %66,9, sefiksim %52,1, seftriakson 46% , sefuroksim %54,6 ve nitrofurantoin direnci: %4,9 olarak bulundu. Sonuç: Trimetoprim-sulfometoksazol'e karşı var olan yüksek direnç oranları ve nitrofurantoinin sık karşılaşılan gastrointestinal yan etkileri nedeniyle, üriner sistem enfeksiyonun ampirik tedavisinde bu antibiyotikler zayıf tercihler olarak karşımıza çıkmaktadır. Bunun yanısıra ikinci ve üçüncü kuşak sefalosporinlere özellikle de sefiksime karşı çalışmamızda da gösterildiği gibi son yıllarda gelişen yüksek direnç oranları nedeniyle, ampirik tedavi alternatifi olarak etkinliklerini kaybetme riski taşımaktadır. Bu nedenle sefalosporinlerin sık tercih edildiği birinci basamak sağlık hizmetlerinde görev yapan hekimlerin üriner sistem enfeksiyonu ampirik antibiyotik seçiminde daha dikkatli olmaları gerektiği sonucuna varılmıştır.

Pediatric-specific Antimicrobial Resistance Patterns of Urinary Tract Infections: A Single-Centre Experience from Turkey

Objectives: Antimicrobial resistance of the causative microorganisms of pediatric urinary tract infection (UTI) is a growing problem. The aim of this study is to determine the changing pattern of antibiotic susceptibility in UTIs in an outpatient setting. Methods: We retrospectively reviewed the medical records of pediatric patients with UTI who were followed-up in our center between January-2014 and May-2015. Results: One hundred and seventy-one patients (M/F= 53/118; mean age 56 ± 47.2 months) with UTI were enrolled in this study. A total of 231 urinary pathogens were isolated from UTI episodes. The most common causative agent was Escherichia coli (E. coli) (70.6%) followed by Klebsiella spp. (16.5%), Proteus spp. (6.5%). One point eight percent of E. coli isolates were resistant to amikacin, 17.8% to gentamicin, 60.7% to TMP-SMX, 66,9% to ampicillin, 52.1% to cefixime, 46% to ceftriaxone, 54.6% to cefuroxime and 4.9% to nitrofurantoin. Conclusions: TMP-SMX and nitrofurantoin are poor empirical choices for pediatric patients due high resistance rates and gastrointestinal side effects, respectively. Second and third -generation cephalosporins (cefixime) may not be considered as appropriate empiric antibiotic alternatives anymore given their high resistance rates in the next few years. Physicians who work in the primary health care should be encouraged for the selection of more appropriate antibiotics.

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