Enfeksiyon hastalıkları servisinde üst üriner sistem enfeksiyonu tanısıyla izlenen hastalarda genişlemiş spektrumlu beta-laktamaz üretimine neden olan risk faktörlerinin araştırılması
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Date
2009
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Trakya Üniversitesi Tıp Fakültesi
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info:eu-repo/semantics/openAccess
Abstract
Genişlemiş spektrumlu beta-laktamaz üreten bakterilerle gelişen enfeksiyonlarda hastanede kalış süresi uzamakta, klinik ve mikrobiyolojik cevap azalmakta, mortalite ve tedavi giderleri artmaktadır. Gram negatif bakteriler arasından son yıllarda giderek artan genişlemiş spektrumlu beta-laktamaz üretimi nedeniyle, üriner sistem enfeksiyonu tanısıyla izlenen hastalardan izole edilen gram negatif bakterilerde genişlemiş spektrumlu beta-laktamaz üretimi ve bu hastalarda genişlemiş spektrumlu beta-laktamaz üretimine neden olan risk faktörlerinin araştırılması amaçlanmıştır. Trakya Üniversitesi Tıp Fakültesi Eğitim Araştırma ve Uygulama Hastanesi Enfeksiyon Hastalıkları Servisi'nde, 1 Mayıs 2007-30 Temmuz 2008 tarihleri arasında 15 aylık süre içerisinde üriner sistem enfeksiyonu tanısıyla izlenen 103 erişkin hastada 116 üriner sistem enfeksiyonu atağı tespit edildi. İdrar kültüründe genişlemiş spektrumlu beta-laktamaz pozitif Escherichia coli ve Klebsiella pneumoniae saptanan 32 olgu çalışma grubunu, aynı süre içerisinde idrar kültüründe genişlemiş spektrumlu beta-laktamaz negatif Escherichia coli ve Klebsiella pneumoniae saptanan 52 olgu kontrol grubunu oluşturdu. Hastalar retrospektif olarak incelendi. Çalışma ve kontrol grupları yaş, cinsiyet, altta yatan hastalık, malignite, immunsupresif tedavi, üriner kateterizasyon, antibiyotik kullanımı, geçirilmiş cerrahi operasyon, hastanade yatış öyküsü, nozokomiyal enfeksiyon ve üreyen etkenin antibiyotik duyarlılıkları açısından karşılaştırıldı. Tek değişkenli istatistiksel analizde; erkek cinsiyet (p=0.052), nozokomiyal enfeksiyon (p=0.000), malignite (p=0.009), karaciğer yetmezliği (p=0.052), nörolojik disfonksiyon (p=0.003), antibiyotik kullanım öyküsü (p=0.000), son altı ay içinde hastanede yatış öyküsü (p=0.000), geçirilmiş cerrahi operasyon öyküsü (p=0.001), üriner kateterizasyon (p=0.011) ve yineleyen üriner sistem enfeksiyonu (p=0.002) anlamlı olarak bulundu. Çok değişkenli ileri analizde ise nozokomiyal enfeksiyon (p=0.032) ve önceden antibiyotik kullanımı (p=0.045) genişlemiş spektrumlu beta-laktamaz üretimini arttıran risk faktörleri olarak saptandı. Hastalara ait bazı özellikler ve çeşitli risk faktörleri gram negatif bakterilerde genişlemiş spektrumlu beta-laktamaz üretimine zemin hazırlamaktadır. Üriner sistem enfeksiyonlarında tanı ve tedavi kanıta dayalı yapıldığı taktirde tedavi başarısızlığı azalacak, antibiyotiklerin aşırı kullanımı engellenerek direnç gelişimi önlenecektir.
Abstract
Infections due to extended spectrum beta-lactamase producing microorganisms cause high mortality, long hospital stay, high treatment cost and decrease clinical and microbiological response. Among gram negative bacteria extended spectrum beta-lactamase producing strains become an increasing problem in recent years. Therefore, the aim of this study was to determine the risk factors for extended spectrum beta-lactamase producing gram negative bacteria isolated from urinary tract infections. In this study between 1 May 2007 to 30 July 2008 during the period of 15 months, 103 adult patients with urinary tract infection were followed up in Infectious Diseases Unit of Trakya University Hospital and 116 urinary tract infection attacks developed. The study group contained 32 patients urine culture positive for extended spectrum beta-lactamase producing Escherichia coli or Klebsiella pneumoniae; the control group contained 52 patients urine culture positive for nonextended spectrum beta-lactamase producing Escherichia coli or Klebsiella pneumoniae. The patients were investigated retrospectively. According to age, sex, underlying systemic disease, malignity, immunsupressive therapy, urinary catheterisation, exposure to antibiotic therapy, previous exposure to surgery, hospitalisation, nosocomial infection and antibiotic suspectibility, the study group compared with the control group. Factors significantly associated with infection on univariate analysis were: male sex (p=0.052), nosocomial infection (p=0.000), malignity (p=0.009), hepatic disfunction (p=0.052), neurologic disfunction (p=0.003), exposure to sistemic antibiotics in the previous one month (p=0.000), hospitalization in the previous six months (p=0.000), previous exposure to surgery (p=0.001), indwelling urinary catheterisation (p=0.011) and recurren urinary tract infection (p=0.002). In advanced multivariabl analyse nosocomial infection (p=0.032) and previous exposure to antibiotics (p=0.045) were determined as risk factors increasing extended spectrum beta-lactamase production. Some features of the patients and various risk factors cause extended spectrum beta-lactamase production of the gram negative bacteriae. An evidence-based approach to the diagnosis and management of urinary tract infections lead to fewer treatment failures and avoid overuse of important antibiotics with emerging resistance.
Abstract
Infections due to extended spectrum beta-lactamase producing microorganisms cause high mortality, long hospital stay, high treatment cost and decrease clinical and microbiological response. Among gram negative bacteria extended spectrum beta-lactamase producing strains become an increasing problem in recent years. Therefore, the aim of this study was to determine the risk factors for extended spectrum beta-lactamase producing gram negative bacteria isolated from urinary tract infections. In this study between 1 May 2007 to 30 July 2008 during the period of 15 months, 103 adult patients with urinary tract infection were followed up in Infectious Diseases Unit of Trakya University Hospital and 116 urinary tract infection attacks developed. The study group contained 32 patients urine culture positive for extended spectrum beta-lactamase producing Escherichia coli or Klebsiella pneumoniae; the control group contained 52 patients urine culture positive for nonextended spectrum beta-lactamase producing Escherichia coli or Klebsiella pneumoniae. The patients were investigated retrospectively. According to age, sex, underlying systemic disease, malignity, immunsupressive therapy, urinary catheterisation, exposure to antibiotic therapy, previous exposure to surgery, hospitalisation, nosocomial infection and antibiotic suspectibility, the study group compared with the control group. Factors significantly associated with infection on univariate analysis were: male sex (p=0.052), nosocomial infection (p=0.000), malignity (p=0.009), hepatic disfunction (p=0.052), neurologic disfunction (p=0.003), exposure to sistemic antibiotics in the previous one month (p=0.000), hospitalization in the previous six months (p=0.000), previous exposure to surgery (p=0.001), indwelling urinary catheterisation (p=0.011) and recurren urinary tract infection (p=0.002). In advanced multivariabl analyse nosocomial infection (p=0.032) and previous exposure to antibiotics (p=0.045) were determined as risk factors increasing extended spectrum beta-lactamase production. Some features of the patients and various risk factors cause extended spectrum beta-lactamase production of the gram negative bacteriae. An evidence-based approach to the diagnosis and management of urinary tract infections lead to fewer treatment failures and avoid overuse of important antibiotics with emerging resistance.
Description
Tıpta Uzmanlık Tezi
Keywords
Enfeksiyon Hastalıkları Servisi, Üriner Sistem Enfeksiyonu, Genişlemiş Spektrumlu Beta-Laktamaz, Risk Faktörleri, Infectious Diseases Unit, Urinary Tract Infection, Extended Spectrum Beta-Bactamase, Risk Factors
