Birgül KAÇMAZ, Nedim SULTAN, Altan AKSOY

İdrar örneklerinden izole edilen Escherichia coli izolatlarında oral antibiyotiklere karşı direncin araştırılması

Amaç: Üriner sistem enfeksiyonu (ÜSE) toplumda en sık rastlanan bakteri enfeksiyonlarındandır. Son yıllarda antibiyotiklere karşı direncin giderek artması nedeniyle ÜSE'lerin ampirik tedavisinde sorunlar başlamıştır. Bu çalışmada üropatojen Escherichia coll izolatlarımn tedavi de kullanılan oral antibiyotiklere karşı dirençleri araştırılmıştır. Yöntem: Orta akım idrar örneklerinden koloni morfolojisi, Gram yöntemiyle boyanma özelliği ve biyokimyasal test sonuçlarıyla E.coli olarak izole edilen, 107ml ve üzeri CFU oluşturan izolatlar değerlendirmeye alınmıştır. İzolatlann duyarlılıkları NCCLS kriterlerine uygun olarak disk difüzyon yöntemi ile değerlendirilmiş ve kontrol susu olarak E.coü ATCC 25922 kullanılmıştır. İstatistiksel değerlendirmede ki kare testi kullanılmıştır. Bulgular: İzolatlarda en düşük direnç oranı nitrofurantoin, fosfomisin trometamol ve sefiksime, en yüksek direnç oranı da ampisilin ve amoksisiline karşı saptanmıştır. Sonuç: Bölgemizde üriner sistem enfeksiyonları ampirik tedavisinde ampisilin, amoksisüin, ampisilin/sulbaktam, amoksisilin/klavulonik asit ve trimetoprim/ sulfometaksazol kullanımı başarısızlığa neden olabilir. Kinolonlann yaygın tüketimini ve direnç gelişimini azaltmak için bu grup ilaçların yerine ikinci veya üçüncü kuşak oral sefalosporinlerin kullanılması düşünülebilir. Komplike olmayan ÜSE'lerin tedavisinde nitrofurantoin ve fosfomisin uygun bir seçenek olarak görülmektedir.

The investigation of resistance to oral antibiotics in Escherichia coli isolates obtained from urine

Objective: Urinary tract infection is one of the most common bacterial diseases. As a result of the increasing resistance to antibiotics in recent years, some problems have been encountered in empiric treatment of urinary tract infection. The aim of the present study is to assess the resistance of uropathogen Escherichia coli isolates to oral antibiotics. Method: Samples were taken from middle urine and were counted for F. coli. Isolates were then prepared from the ones with an F. coli count of 107ml or more. The isolates were analysed by using colonial morphology, gram staining and biochemical test results. The susceptibility of the isolates was evaluated by disc diffusion method in compliance with NCCLS susceptibility testing guidelines. F. coli ATCC 25922 was used as the control strain. Results were evaluated by Chi-square test. Results: The F. coli of the isolates were found to have low resistance rates to nitrofurantoin, fosfomisin, trometamol and cefixime; and high resistance rates to ampicillin and amoxicillin. Conclusion: Based on the results, ampicillin, amoxicillin, ampicillin/sulbaktam, amoxicillin /clavulonic acid and trimetoprim /sulfometaksazol may prove to be ineffective in the empiric treatment of urinary tract infection in our region. In order to reduce the resistance development and the common use of quinolones, second and third generation oral cefalosporins can be used in place of these medicines. NIT and FMT are thought to be suitable alternatives in the treatment of uncomplicated urinary tract infection.

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