Nuran ESEN, Aykut KEFİ, Bora İRER, Ayriz Tuba GÜNDÜZ, İlhan ÇELEBİ, Zeynep GÜLAY

Akut pyelonefrit tedavisinde in vitro antibiyotik direnci

Amaç: Akut pyelonefrit (APN) ön tanısıyla ampirik antibiyotik tedavisi başlanan hastalarda; in vitro antibiyotik direnci ile diabetes mellitus (DM) gibi sistemik hastalıklar ve altta yatan üriner sistem patolojileri arasındaki ; ilişkinin araştırılması planlandı. Gereç ve yöntem: Ocak 1999 - Nisan 2002 tarihleri arasında APN tanısı ile Dokuz Eylül Üniversitesi Tıp Fakültesi Üroloji servisine yatırılan 47 hasta çalışmaya alındı. İdrar kültürlerinde üreme saptanan hastalarda; ürolitiazis, urogenital anomali ve DM sorgulandı. Hastaların cinsiyetleri de göz önüne alınarak, ek patoloji varlığıyla, in vitro antibiyotik direnci arasındaki ilişki araştırıldı. Bulgular: Hastaların %38'inde idrar kültüründe üreme saptandı. Üreme olan hastaların %83'ünde Escbericbia coli, %17'sinde ise Klebsiella pneumoniae ve Pseudomonas aenıginosa'mn etken olduğu belirlendi. Hastaların %33'ünde DM, %56'sında ise radyolojik görüntüleme yöntemiyle üriner sistem patolojisi saptandı. Erkek hastaların %83'ünde, kadın hastaların ise %42'sinde patoloji gözlendi. .E. coli üreyen hastaların %47'sinde kotrimoksazol, %20'sinde gentamisin, %7'sinde siprofloksasin direnci saptandı. Kotrimoksazol direnci belirlenen grupta, kadın hastalarda ek patolojiye rastlanmazken, erkek hastalarda en az bir patoloji saptandı. Sonuç: APN tanısı alan hastaların ampirik tedavisinde ilk seçenek .olarak siprof-loksasin kullanılması önerilmektedir. Erkek hastalarda üriner sistem patolojisi varlığı ve antibiyotik tedavisine direnç, kadın hastalardan sık gözlendiğinden, bu grupta pyelonefrite yol açabilecek patolojiler detaylı araştırılması önerilmektedir.

Anahtar Kelimeler:

Escherichia coli, İlaç direnci, bakteriyel, Trimetoprim-sulfametoksazol kombinasyonu, Piyelonefrit, Diabetes mellitus, Siprofloksazin

In vitro antibiotic resistance in the treatment of acute pyelonephritis

Objective: In this study, the relationship between in vitro antibiotic resistance and underlying pathologies such as diabetes mellitus (DM) or urinary system pathologies was investigated in patients with the diagnosis of acute pyelonephritis (APN). Materials and method: From January 1999 to April 2002, forty-seven patients who were admitted to Dokuz Eylül University, Medical Faculty, Urology clinic with the diagnosis of APN were included in this study. The underlying pathologies such as urolithiasis, urogenital anomalies and DM were investigated in. patients whose urine cultures were positive. The possible correlation between the underlying pathologies, the gender in culture positive patients and in vitro antibiotic susceptibility test results of the isolates from urine cultures were evaluated. Results: Urine cultures were positive in 38% of patients. From the urine culture positive samples 83% was Eschericbia coli, 17% was Klebsiella pneumoniae and Pseudomonas aernginosa. DM was recognized in 33% of patients. Urinary tract system pathologies were detected in 56% of the study group, 83% of the male and 42% of the female patients. Resistance to cotrimoxazole, gentamicin and ciprofloxacin of E. coli isolates were 47%), 20% and 7% respectively. While the female patients had no pathology, all of the male patients had urinary system pathologies whose isolates were resistant to cotrimoxazole. Conclusion: Ciprofloxacin should be recommended as the first choice of empirical antibiotic treatment of APN. Since urinary system pathologies and antibiotic resistances were observed more often in male patients, it is suggested to investigate underlying pathologies.

Keywords:

Escherichia coli, Drug Resistance, Bacterial, Trimethoprim-Sulfamethoxazole Combination, Pyelonephritis, Diabetes Mellitus, Ciprofloxacin,

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