Araştırma Makalesi
BibTex RIS Kaynak Göster

Çocuk Acile Başvuran Hastalarda İdrar Yolu Enfeksiyonlarının Değerlendirilmesi

Yıl 2023, Cilt: 33 Sayı: 2, 199 - 204, 30.04.2023
https://doi.org/10.54005/geneltip.1232538

Öz

Özet
Giriş: İdrar yolu enfeksiyonları çocuklarda en sık görülen enfeksiyonlardandır ve çocuk acil servisine başvuruların önemli nedenlerinden biridir. Çalışmamızda, idrar yolu enfeksiyon tanısı alan hastaların demografik özellikleri, yakınmaları, idrar kültüründe izole edilen mikroorganizmalar ve antibiyotik direnç oranlarının belirlenmesi amaçlanmıştır.
Materyal metod: 01.01.2020 – 31.12.2020 tarihlerinde hastanemize başvuran İYE ön tanısıyla tam idrar tetkiki ve idrar kültürü alınan 18 yaş altı hastaların verileri retrospektif olarak bilgisayar kayıt sisteminden tarandı. Hastaların demografik özellikleri, yakınmaları, idrar kültüründe izole edilen mikroorganizmalar ve antibiyotik dirençleri değerlendirildi.
Bulgular: Çalışmaya dahil edilen toplam 286 hastanın yaş ortalaması 75,5 ± 57,65 ay ve 238’i (%83,2) kız idi. En sık başvuru yakınması %39,9 dizüri, %35,3 ateş ve %26,9 karın ağrısıydı. İdrar kültüründe en sık tespit edilen mikroorganizmalar; 242 (%84,6) hastada E. coli, 21 (%7,3) hastada Proteus spp. ve 16 (%5,6) hastada Klebsiella spp. idi. En yüksek direnç ampisiline %54,9 ve en düşük direnç amikasine %6,6 tespit edilmiştir.
Sonuç: İdrar yolu enfeksiyonlarında uygunsuz tedavi seçimleri ilerleyen dönemlerde ortaya çıkabilecek komplikasyonlar açısından önemlidir. Bu nedenle merkezler belirli aralıklar ile kendi enfeksiyon etkenlerini ve antibiyotik duyarlılıklarını takip ederek ampirik tedavi seçimlerini oluşturmalıdır. Ampirik başlanan tedavilerin idrar kültür ve duyarlılık sonucuna göre yeniden değerlendirilmesi gereklidir.

Kaynakça

  • Quigley R. Diagnosis ofurinary tract infections in children. Curr Opin Pediatr 2009;21:194-8.
  • Shepherd AK, Pottinger PS. Management of urinary tract infections in the era of increasing antimicrobial resistance. Med Clin North Am. 2013;97(4):737-757.
  • Elder JS. Urinary tract infections. In: Kliegman RM, Stanton BF, St Geme JW (eds ). Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders, 2011:1829-34.
  • Okarska-Napierała M, Wasilewska A, Kuchar E. Urinary tract infection in children: Diagnosis, treatment, imaging-Comparison of current guidelines. J Pediatr Urol 2017;13:567-73.
  • Hoberman A, Wald ER, Penchansky L, Reynolds EA, Young S. Enhanced urinalysis as a screening test for urinary tract infection. Pediatrics 1993;91:1196-99
  • Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.
  • Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, et al; Italian Society of Pediatric Nephrology. Febril Urinary Tract Infections in young children. Recommendations for the diagnosis, treatment and follow -up. Acta Paediatr 2012;101:451-7.
  • Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27: 302–308.
  • Stamm, W.E. and S.R. Norrby, Urinary tract infections: disease panorama
  • and challenges. The Journal of infectious diseases, 2001.183(Supplement_1): p.S1-S4.
  • Wald ER. Cystitis and pyelonephritis. In: Feigin RD, Cherry JD, Demler-Harrison GJ (eds). Textbook of Pediatric Infectious Diseases. 6th ed.Philadelphia: Saunders, 2009:554-69.
  • American Academy of Pediatrics. The diagnosis ,treatment and evaluation of the initial urinary tract infection febrile infants and youngchildren. Pediatrics 1999; 103: 843-52.
  • Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am. 2006;53:379-400.
  • Oliveira, Eduardo A., and Robert H. Mak. "Urinary tract infection in pediatrics: an overview." Jornal de pediatria 96 (2020): 65-79.
  • Struthers S, Scanlon J, Parker K, Goddard J, Hallett R. Parental reporting of smelly urine and urinary tract infection. Arch Dis Child. 2003;88:250–2.
  • Wald, Ellen R. "To bag or not to bag." The Journal of pediatrics 147.4 (2005): 418-420.
  • Subcommıttee On Urınary Tract Infectıon. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatrics 2016; 138.
  • NICE Clinical Guidelines (2007). Urinary tract infection in children: Diagnosis, treatment and long-term management. Retrieved May 23, 2014, from http://publications.nice.org.uk/ urinary-tract-infection-in-children-cg54.
  • Hodson EM, Craig JC. Urinary tract infections in children. In: Avner E, Harmon W, Niaudet P, Yoshikawa N, Emma F, Goldstein S, editors. Pediatric Nephrology. 7th ed. Berlin: Springer; 2015. p. 1695-714.
  • Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: An overview of diagnosis and management. BMJ Paediatr Open. 2019;3:e000487.
  • Eremenko R, Barmatz S, Lumelsky N, Colodner R, Strauss M, Alkan Y. Urinary tract infection in outpatient children and adolescents: Risk analysis of antimicrobial resistance. Isr Med Assoc J. 2020;22:236-40.
  • Lin, D.-S., et al., Urinary tract infection in febrile infants younger than eight weeks of age. Pediatrics, 2000. 105(2): p. E20.
  • Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient pediatric urinary tract infections.J Urol 2013; 190: 222-27.
  • Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr 2013; 25: 88-94.
  • Cag, Yakup, et al. "Antibiotic Resistance and Bacteria in Urinary Tract Infections in Pediatric Patients." Medeniyet Medical Journal 36.3 (2021): 217. 25. Didem, Kaya., et al. "Distribution of Microorganisms and Antibiotic Resistance in Children with Urinary Tract Infections, Retrospective Case Series." Journal of Surgery and Medicine 1.1 (2017): 9-11.
  • Neslihan, İdil, Esra Deniz Candan, and Abbas Yousefi Rad. "A Retrospective Study on Urinary Tract Infection Agents Isolated from Children and Their Antibiotic Susceptibility." Hacettepe Journal of Biology and Chemistry 48.3: 265-274.
  • Bozkurt, Hayrunnisa Bekis; Balkan, Çiğdem Eda. Distrubution of Antibiotic Resistance in Urinary Tract Infections in Children; a Five-Year Evaluation. Journal of Pediatric Infection/Cocuk Enfeksiyon Dergisi, 2020, 14.3.
  • Konca C, Tekin M, Uckardes F, et al. An overview of antibacterial resistance patterns of pediatric commu-nity. Pediatr Int. 2017;59(3):309-315.
  • Kömürlüoğlu A, Aykaç K, Özsürekçi Y, ve ark. Gram negatif idrar yolu enfeksiyonu etkenlerinin antibiyotik direnç dağılımı: Tek merkez deneyimi. Türkiye Çocuk Hast Derg. 2018;12(1):10-17.
  • Oh MM, Kim JW, Park MG, Kim JJ, Yoo KH, Moon DG. The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI. Eur J Pediatr 2012;171:565-70.
  • Merga Duffa Y, Terfa Kitila K, Mamuye Gebretsadik D, Bitew A. Prevalence and antimicrobial susceptibility of bacterial uropathogens isolated from pediatric patients at Yekatit 12 hospital medical college, Addis Ababa, Ethiopia. Int J Microbiol 2018.
  • Gökçe, İbrahim, et al. Changes in bacterial resistance patterns of pediatric urinary tract infections and rationale for empirical antibiotic therapy. Balkan medical journal, 2017, 34.5: 432-435.
  • Çaycı, Yeliz Tanrıverdi, et al. "Çocuklarda İdrar Kültüründen İzole Edilen Gram Negatif Bakterilerin ve Antibiyotik Duyarlılıklarının Retrospektif Olarak Değerlendirilmesi." Ahi Evran Medical Journal 6.2 (2021): 168-173.
  • Çoban B, Ülkü N, Kaplan H, Topal B, Erdoğan H, Baskın E. Five-year assessment of causative agents and antibiotic resistances in urinary tract infections. Türk Ped Arş 2014;49:124-9.

Evaluation of Urinary Tract Infections in Pediatric Patients Admitted to the Emergency Department

Yıl 2023, Cilt: 33 Sayı: 2, 199 - 204, 30.04.2023
https://doi.org/10.54005/geneltip.1232538

Öz

Abstract
Background/Aim: Urinary tract infections (UTIs) are among the most common infections in children and one of the important reasons for presentation to the pediatric emergency department. This study aimed to determine demographic characteristics, complaints, microorganisms isolated in urine culture analysis, and antibiotic resistance rates in pediatric patients diagnosed with UTIs.
Material and Method: The data of patients aged under 18 years, who presented to our hospital from January 1, 2020, through December 31, 2020 with a preliminary diagnosis of UTIs and underwent urine culture analysis, were retrospectively screened from the computer registry system. The patients’ demographic characteristics, complaints, microorganisms isolated in urine culture analysis, and antibiotic resistance were evaluated.
Results: The mean age of the 286 patients included in the study was 75.5±57.65 months, and 238 (83.2%) were girls. The most common complaint at presentation was dysuria (39.9%), followed by fever (35.3%) and abdominal pain (26.9%). In urine culture analysis, the most frequently detected microorganisms were Escherichia coli (n=242, 84.6%), Proteus spp. (n=21, 7.3%), and Klebsiella spp. (n=16, 5.6%). The highest antibiotic resistance was observed in ampicillin (54.9%) and the lowest in amikacin (6.6%).
Conclusion: Inappropriate treatment choices in UTIs are important in terms of complications that may occur in future. Therefore, healthcare centers should evaluate their own infectious agents and antibiotic susceptibility at certain intervals and determine appropriate empirical treatment choices. Empirically initiated treatments should be re-evaluated according to urine culture and sensitivity results.

Kaynakça

  • Quigley R. Diagnosis ofurinary tract infections in children. Curr Opin Pediatr 2009;21:194-8.
  • Shepherd AK, Pottinger PS. Management of urinary tract infections in the era of increasing antimicrobial resistance. Med Clin North Am. 2013;97(4):737-757.
  • Elder JS. Urinary tract infections. In: Kliegman RM, Stanton BF, St Geme JW (eds ). Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier Saunders, 2011:1829-34.
  • Okarska-Napierała M, Wasilewska A, Kuchar E. Urinary tract infection in children: Diagnosis, treatment, imaging-Comparison of current guidelines. J Pediatr Urol 2017;13:567-73.
  • Hoberman A, Wald ER, Penchansky L, Reynolds EA, Young S. Enhanced urinalysis as a screening test for urinary tract infection. Pediatrics 1993;91:1196-99
  • Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.
  • Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, et al; Italian Society of Pediatric Nephrology. Febril Urinary Tract Infections in young children. Recommendations for the diagnosis, treatment and follow -up. Acta Paediatr 2012;101:451-7.
  • Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27: 302–308.
  • Stamm, W.E. and S.R. Norrby, Urinary tract infections: disease panorama
  • and challenges. The Journal of infectious diseases, 2001.183(Supplement_1): p.S1-S4.
  • Wald ER. Cystitis and pyelonephritis. In: Feigin RD, Cherry JD, Demler-Harrison GJ (eds). Textbook of Pediatric Infectious Diseases. 6th ed.Philadelphia: Saunders, 2009:554-69.
  • American Academy of Pediatrics. The diagnosis ,treatment and evaluation of the initial urinary tract infection febrile infants and youngchildren. Pediatrics 1999; 103: 843-52.
  • Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am. 2006;53:379-400.
  • Oliveira, Eduardo A., and Robert H. Mak. "Urinary tract infection in pediatrics: an overview." Jornal de pediatria 96 (2020): 65-79.
  • Struthers S, Scanlon J, Parker K, Goddard J, Hallett R. Parental reporting of smelly urine and urinary tract infection. Arch Dis Child. 2003;88:250–2.
  • Wald, Ellen R. "To bag or not to bag." The Journal of pediatrics 147.4 (2005): 418-420.
  • Subcommıttee On Urınary Tract Infectıon. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatrics 2016; 138.
  • NICE Clinical Guidelines (2007). Urinary tract infection in children: Diagnosis, treatment and long-term management. Retrieved May 23, 2014, from http://publications.nice.org.uk/ urinary-tract-infection-in-children-cg54.
  • Hodson EM, Craig JC. Urinary tract infections in children. In: Avner E, Harmon W, Niaudet P, Yoshikawa N, Emma F, Goldstein S, editors. Pediatric Nephrology. 7th ed. Berlin: Springer; 2015. p. 1695-714.
  • Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: An overview of diagnosis and management. BMJ Paediatr Open. 2019;3:e000487.
  • Eremenko R, Barmatz S, Lumelsky N, Colodner R, Strauss M, Alkan Y. Urinary tract infection in outpatient children and adolescents: Risk analysis of antimicrobial resistance. Isr Med Assoc J. 2020;22:236-40.
  • Lin, D.-S., et al., Urinary tract infection in febrile infants younger than eight weeks of age. Pediatrics, 2000. 105(2): p. E20.
  • Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient pediatric urinary tract infections.J Urol 2013; 190: 222-27.
  • Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr 2013; 25: 88-94.
  • Cag, Yakup, et al. "Antibiotic Resistance and Bacteria in Urinary Tract Infections in Pediatric Patients." Medeniyet Medical Journal 36.3 (2021): 217. 25. Didem, Kaya., et al. "Distribution of Microorganisms and Antibiotic Resistance in Children with Urinary Tract Infections, Retrospective Case Series." Journal of Surgery and Medicine 1.1 (2017): 9-11.
  • Neslihan, İdil, Esra Deniz Candan, and Abbas Yousefi Rad. "A Retrospective Study on Urinary Tract Infection Agents Isolated from Children and Their Antibiotic Susceptibility." Hacettepe Journal of Biology and Chemistry 48.3: 265-274.
  • Bozkurt, Hayrunnisa Bekis; Balkan, Çiğdem Eda. Distrubution of Antibiotic Resistance in Urinary Tract Infections in Children; a Five-Year Evaluation. Journal of Pediatric Infection/Cocuk Enfeksiyon Dergisi, 2020, 14.3.
  • Konca C, Tekin M, Uckardes F, et al. An overview of antibacterial resistance patterns of pediatric commu-nity. Pediatr Int. 2017;59(3):309-315.
  • Kömürlüoğlu A, Aykaç K, Özsürekçi Y, ve ark. Gram negatif idrar yolu enfeksiyonu etkenlerinin antibiyotik direnç dağılımı: Tek merkez deneyimi. Türkiye Çocuk Hast Derg. 2018;12(1):10-17.
  • Oh MM, Kim JW, Park MG, Kim JJ, Yoo KH, Moon DG. The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI. Eur J Pediatr 2012;171:565-70.
  • Merga Duffa Y, Terfa Kitila K, Mamuye Gebretsadik D, Bitew A. Prevalence and antimicrobial susceptibility of bacterial uropathogens isolated from pediatric patients at Yekatit 12 hospital medical college, Addis Ababa, Ethiopia. Int J Microbiol 2018.
  • Gökçe, İbrahim, et al. Changes in bacterial resistance patterns of pediatric urinary tract infections and rationale for empirical antibiotic therapy. Balkan medical journal, 2017, 34.5: 432-435.
  • Çaycı, Yeliz Tanrıverdi, et al. "Çocuklarda İdrar Kültüründen İzole Edilen Gram Negatif Bakterilerin ve Antibiyotik Duyarlılıklarının Retrospektif Olarak Değerlendirilmesi." Ahi Evran Medical Journal 6.2 (2021): 168-173.
  • Çoban B, Ülkü N, Kaplan H, Topal B, Erdoğan H, Baskın E. Five-year assessment of causative agents and antibiotic resistances in urinary tract infections. Türk Ped Arş 2014;49:124-9.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Aysun Tekeli 0000-0002-3639-2224

B. Nuray Alpman Bu kişi benim 0000-0001-9565-9016

Merve Tırıs Bu kişi benim 0000-0002-1025-3779

Hilal Işık Bu kişi benim 0000-0002-9383-2257

Cengiz Zeybek Bu kişi benim 0000-0002-4820-0373

Erken Görünüm Tarihi 30 Nisan 2023
Yayımlanma Tarihi 30 Nisan 2023
Gönderilme Tarihi 12 Ocak 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 33 Sayı: 2

Kaynak Göster

Vancouver Tekeli A, Alpman BN, Tırıs M, Işık H, Zeybek C. Evaluation of Urinary Tract Infections in Pediatric Patients Admitted to the Emergency Department. Genel Tıp Derg. 2023;33(2):199-204.