HASAN ÇETİN, Faruk ÖKTEM, Ahmet R. ÖRMECİ, Birdal YORGANCIGİL, Güler YAYLI

Çocukluk çağı idrar yolu enfeksiyonlarında Escherichia coli ve antibiyotik direnci

Amaç: Çocukluk çağında idrar yolu enfeksiyonları ve antibiyotik direnci halen önemli bir sağlık sorunudur. Bu çalışmada E. coli ile gelişen idrar yolu enfeksiyonunda antibiyotik direncini ve yıllar içinde antibiyotik direncinde gelişen değişiklikleri ortaya çıkarmayı amaçladık. Yöntem: İdrar yolu enfeksiyonu olan çocukların mikrobiyolojik sonuçlarını retrospektif olarak değerlendirdik. Bulgular: İki yılda E. coli ile gelişen toplumdan kazanılmış idrar yolu enfeksiyonu olan 132 çocuk vardı. Ampisiline %79, ampisilin-sulbaktama %63.2, amoksisilin klavunata %53, ko-trimoksazole %82.2, gentamisine %6.6, netilmisine %10, amikasine %11.5, sefuroksime %21.9 ve seftriaksona %6.8 oranında direnç saptandı. Ko-trimoksazole karşı dirençte 3 yıl içinde anlamlı artış görüldü (p

Anahtar Kelimeler:

İlaç direnci, İdrar yolu enfeksiyonları, Escherichia coli, Anti-bakteriyel ajanlar, Çocuk, Geriyedönük çalışma

Escherichia coli and antibiotic resistance in childhood urinary tract infections

Aim: Urınary tract infections and antibiotic resistance are still a major health problem in childhood. In this study we aimed to detect the antibiotic resistance in urinary tract infection with E. coli and changing ratio in antibiotic resistance by years. Method: We evaluated the microbiologic data of children with urinary tract infection retrospectively. Results: In two years, there were 132 children with community-acquired urinary tract infection by E. coli. Antibiotic resistance were detected as 79% to ampicilline, 63.2% to ampicilline-sulbactam, 53% to amoxicillin-klavunat, 82.2% co-trimoksazole, 6.6% to gentamycine, 10% to netilmycin, 11.5% to amikacin, 21.9% to cefuroxime and 6.8% to ceftriaxone. Antibiotic resistance significantly increased to co-trimoksazole (p<0.01), in three years. In conclusion, in childhood urinary tract infection, pathogen microorganism and antibiotic resistance sould be evaluated periodically. Antimicrobial chemotherapy must be considered with result of in vitro antibiotic susceptibility tests.

Keywords:

Drug Resistance, Urinary Tract Infections, Escherichia coli, Anti-Bacterial Agents, Child, Retrospective Studies,

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1. Elder JS, Urologic disorders in infants and children. In: Behrman RE, Kliegman RM, Jenson HB,eds. Nelson textbook of pediatrics, 17th edn. Philadelphia: WB Saunders, 2004:1785-89.
2. Sirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F. Etiology of chronic renal failure in Turkish children. Pediatr Nephrol. 1995 Oct;9(5):549-52.
3. Krasinski KM. Urinary tract infections. In: Katz SL, Gershon AA, Wilfert CM (ed). Krugman's Infectious Disease of Children (9th Edition). St Louis: CV Mosby, 1998: 605-619.
4. Committee on Quality Improvement. Subcommittee on Urinary Tract Infections. Practise parameter: the diagnosis, treatment, and evaluation of the initial UTI in febrile infants and young children. Pediatrics 1999;103:843-52.
5. Topal Y. Çocuklarda idrar yolu enfeksiyonları. Uzmanlık Tezi. Dr Sami Ulus Çocuk Sağlığı ve Hastalıkları Merkezi Ankara, 1997
6. Gür D, Kanra G, Ceyhan M, et al. Epidemiology and Antibiotic Rezistance of Gram-Negative Urinary Pathogens in Pediatric Patients. Turk J Pediatr 1999;41:37-42.
7. Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection. Arch Dis Child 2003; 88: 215-218
8. Weber G, Riesenberg K, Schlaeffer F, et al. Changing trends in frequency and antimicrobial resistance of urinary pathogens in outpatient clinics and a hospital in Southern Israel, 1991-1995. Eur J Clin Microbiol Infect Dis 1997;16:834-8.
9. Ayata A, Yorgancıgil B, Öktem F, Çetin H, Örmeci AR. Çocukluk çağı idrar yolu enfeksiyonlarından izole edilen E.coli suşlarının antibiyotik duyarlılıkları. SDÜ Tıp Fakültesi Dergisi 1996; 3(3):7-9.
10. Raz R, Okev N, Kennes Y, Gilboa A, Lavi I, Bisharat N. Demographic characteristics of patients with community-acquired bacteriuria and susceptibility of urinary pathogens to antimicrobials in northern Israel. Isr Med Assoc J 2000 Jun; 2(6): 426-9.
11. Obi CL, Tarupiva A, Simango C. Scope of Urinary pathogens isolated in the Public Health Bacteriology Laboratory, Herare: antibiotic susceptibility patterns of isolates and incidence of haemolytic bacteria. Centr Afr J Med 1996 Aug; 42(8):244-9.
12. Goldraich NP, Manfroi A. Febrile urinary tract infection: Escherichia coli susceptibility to oral antimicrobials. Pediatr Nephrol 2002 Mar;17(3): 173-6.
13. Sotto A, De Boever CM, Fabbro-Peray P, Gouby A, Sirot D, Jourdan J. Risk factors for antibiotic-resistant Escherichia coli isolated from hospitalized patients with urinary tract infections: a prospective study. J Clin Microbiol 2001 Feb; 39(2): 438-44.
14. Hoberman A, Wald E, Hickey R, et al. Oral versus initial intravenous therapy for urinary tract infection in young febrile children. Pediatrics 1999;104:79-86
15. Allen UD, MacDonald N, Fuite L, Chan F, Stephens D. Risk factors for resistance to "first-line" antimicrobials among urinary tract isolates of Escherichia coli in children. CMAJ 1999;160:1436-40.
16. Abelson Storby K, Osterlund A, Kahlmeter G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12 year analysis.Acta Paediatr. 2004 Apr;93(4):487-91.
17. Howard AJ, Magee JT, Fitzgerald KA, Dunstan FDJ. Factors associated with antibiotic resistance in coliform organisms from community urinary tract infections in Wales. Journal of Antimicrobial Chemotherapy 2001;47:305-313.
18. Hernandez-Porras M, Salmeron-Arteaga G, Medina-Santillan R. Microbial resistance to antibiotics used to treat urinary tract infections in Mexican children. Proc West Pharmacol Soc. 2004;47:120-1.
19. Anandkumar H, Kapur I, Dayanand A. Increasing prevalence of antibiotic resistance and multi drug resistance among uropathogens.J Commun Dis. 2003 Jun;35(2):102-8.
20. Ladhani S, Gransden W. Increasing antibiotic resistance among urinary tract isolates. Archives of Disease in Childhood 2003;88:444-445