Clinical Risk Factors for Extended Spectrum B-lactamase-producing Bacteriuria in Children with Myelodysplasia Performing Clean Intermittent Catheterization

Objective: To evaluate the clinical risk factors contributing to the development of extended spectrum beta-lactamase (ESBL)- producing asymptomatic bacteriuria in myelodysplastic children performing clean intermittent catheterization (CIC). Materials and Methods: The clinical risk factors for ESBL-producing bacteriuria were retrospectively investigated in 60 myelodysplastic children who had asymptomatic bacteriuria and were performing CIC. A total of 60 children were included in this study, 30 children (17 females, 13 males) with ESBL-positive bacteriuria in urine culture were identified as the study group and 30 age- and gender-matched ESBL-negative children (16 females, 14 males) served as controls. All children had neurogenic bladder due to myelodysplasia and had been used anticholinergics. The two groups were compared in terms of age, gender, presence of constipation and motor deficit, antibiotic prophylaxis, number of hospital admission, ultrasound findings, and presence of renal scarring in dimercapto succinic acid scintigraphy and urodynamic findings. Results: The mean age of the children was 77±50 months in study and 78±69 months in control groups. There was no statistically significant difference in terms of maximum bladder capacity, leak point pressure, constipation status and scarring. In study and control groups, 83% and 46% of children were on antimicrobial prophylaxis, respectively (p=0.007). Conclusion: ESBL-producing bacteriuria was found to be associated with long-term antibiotic prophylaxis. Thus, it was concluded that the use of antibiotics for asymptomatic bacteriuria should be kept to a minimum.

Temiz Aralıklı Kateterizasyon Yapan Miyelodisplazili Çocuklarda Geniş Spektrumlu B-laktamaz Üreten Bakteriüri için Klinik Risk Faktörleri

Amaç: Bu çalışmada, temiz aralıklı kateterizasyon yapan miyelodisplastik çocuklarda genişlemiş spektrumlu beta-laktamaz (ESBL) üreten asemptomatik bakteriüri gelişimine yol açan klinik risk faktörleri araştırıldı. Gereç ve Yöntem: Asemptomatik bakteriürisi bulunan ve temiz aralıklı kateterizasyon yapan 60 miyelodisplastik çocuk ESBL üreten bakteriüri için klinik risk faktörleri açısından geriye dönük olarak incelendi. Bunların 30’unda (17 kız, 13 erkek) idrar kültüründe ESBL pozitif bakteriüri saptandı ve çalışma grubu olarak belirlendi. Yaş ve cinsiyet açısından çalışma grubuna benzer şekilde, kontrol grubu olarak ESBL-negatif üremesi olan 30 (16 kadın, 14 erkek) çocuk çalışmaya dahil edildi. Tüm çocuklarda miyelodisplazi nedeniyle nörojenik mesaneye sahipti ve antikolinerjik kullanmaktaydılar. Gruplar yaş, cinsiyet, kabızlık, antibiyotik profilaksisi, hastaneye başvuru sayısı, ultrason bulguları, dimercapto süksinik asit renal skar ve ürodinamik bulgular açısından karşılaştırıldı. Bulgular: Çocukların yaş ortalaması çalışma grubunda 77±50 ay, kontrol grubunda 78±69 aydı. Tablo 1 ve 2 bu çalışmada değerlendirilen tüm parametreleri göstermektedir. Antimikrobiyal profilaksi açısından gruplar arasında istatistiksel olarak anlamlı fark vardı. Çalışma grubunda çocukların %85’i, kontrol grubunda %46’sı antimikrobiyal profilaksi almaktaydı. Sonuç: Antibiyotik profilaksisi ESBL üreten bakteriüri insidansını artırmaktadır. Bu nedenle, özellikle asemptomatik bakteriüri için antibiyotik kullanımı kısıtlanmalıdır.

Kaynakça

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