Erbay TÜMER, Hakan ERÇİL, Mehmet Eflatun DENİZ, Güçlü GÜRLEN, Umut ÜNAL, Ergün ALMA, Zafer Gökhan GÜRBÜZ, Yalçın EVLİYAOĞLU

Üriner Sistem Taş Hastalarında Çoklu İlaca Dirençli Enfeksiyon Oranları

Amaç: Perkütan nefrolitotomi (PCNL) sonrasında meydana gelen üriner enfeksiyon ve sepsise neden olan patojenler arasında çoklu ilaca dirençli enfeksyion (ÇİDE) oranlarını saptamak.Gereç ve Yöntemler: Lokal etik kurul onayı alındıktan sonra prospektif olarak üroloji kliniğimizde Ocak 2013-Temmuz 2017 arasında PCNL yapılan hastaların dosyaları ve alınan kültür sonuçları değerlendirildi. Hastaların preoperatif idrar kültürü, intraoperatif renal ponksiyon kültürü, taş yüzey kültürü ve taş toz kültürleri incelendi. Hastaların demografik özellikleri ve ve tüm alınan kültürlerde üreyen mikroorganizmalar değerlendirildi. Ayrıca tüm dört kültürde de üreyen mikroorganizmalar içerisindeki ÇİDE oranları ve buna sebep olabilecek faktörler istatistiksel olarak değerlendirildi.Bulgular: Çalışmamız yaş ortalaması 40,8 ± 16,6 yıl olan 78’i erkek, 77’si kadın toplam 155 hastadan oluşmaktadıydı. Bu hastaların taşlarının 88’i solda 67’si sağda iken hastaların ortalama taş yükü 3827,74 ± 1932,07 mm3 olarak hesaplandı. Hastaların kültür sonuçları incelendiğinde orta akım idrar kültürü 57 hastada (%36,7 ) intrarenal idrar kültüründe 34 hastada (%21.9), taş yıkama kültüründe 24 hastada (%15.4), taş tozu kültüründe ise 21 hastada üreme görüldü ( %13.5). ÇİDE toplam olarak sekiz hastada görülürken (%5.1) bu hastaların sadece birinde ateş görüldü (%0.69). ÇİDE araştırması için yaptığımız istatiksel analizde alınan dört kültür arasında fark saptanmadı (p>0.05). ÇİDE’ye sebep olabilecek faktörler incelendiğinde; sadece erkek cinsiyet olması ile ÇİDE için bir risk faktörü olduğunu saptadık.Sonuç: Böbrek taşı nedeniyle PCNL yapılan hastalarda erkek cinsiyet olması ÇİDE için bir risk faktörü olduğunu ve postoperatif ateş ve sepsis için bir risk faktörü olarak görülen ÇİDE’ nin uygun proflaksi ve ampirik tedavi uygulandığında ek tedaviye gerek olmadığı sonucuna ulaştık.

Anahtar Kelimeler:

Böbrek taşı, üriner enfeksiyon, perkütan nefrolitotomi

Multiple Drug Resistant Microbia Growth Rates In Urinary System Stone Patient

Objective: To determine the ratios of Multi- drug resistance infection(MDRI) among the pathogens causing urinary infection and sepsis after percutaneous nephrolithotomy (PCNL).Material and Method: After approval of the local ethics committee, the files of the patients who underwent PCNL between January 2013 and July 2017 and the urine culture results obtained were evaluated prospectively in our urology clinic. Pre-op urine culture, intraoperative renal puncture culture, stone washing culture and stone cultures were examined. Demographic characteristics of the patients and microorganisms breeding in all cultures were evaluated. In addition, the ratios of MDRI in microorganisms breeding in all four cultures and the factors that may cause it were evaluated statistically.Results: Our study consisted of 155 patients, 78 of whom were male and 77 were female, with a mean age of 40.8 ± 16.6 years. While 88 of these patients’ stones were on the left and 67 were on the right, the average stone load of the patients was calculated to be 3827,74 ± 1932,07 mm3. When the urine culture results of the patients were examined, it was found that middle stream urine culture was observed in 34 patients (21.9%) in intrarenal urine culture in 57 patients (36.7%), in 24 patients (15.4%) in stone washing culture and in 21 patients in stone culture (13.5%). A total of eight patients (5.1%) had fever (0.69%) in only one of these patients. No statistically significant difference was found between the four cultures for the MDRI study (p> 0.05). When the factors that may cause MDRI are examined; we found that only male gender was a risk factor for MDRI.Conclusion: It was concluded that male sex in patients with PCNL due to renal calculi is a risk factor for MDRI and that no additional treatment is needed when appropriate prophylactic and empirical treatment of MDRI is considered as a risk factor for postoperative fever and sepsis.

Keywords:

kidney stone, urinary infection, percutaneous nephrolithotomy,

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