Üriner sistem enfeksiyonları etkeni genişlemiş spektrumlu beta laktamaz üreten escherichia coli için risk faktörlerinin değerlendirilmesi
Küçük Resim Yok
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Üriner sistem enfeksiyonları sık görülen enfeksiyonlardan olup en sık etken Escherichia coli'dir. E. coli suşlarında genişlemiş spektrumlu beta laktamaz üretimi nedeniyle üçüncü kuşak sefalosporinlere, penisilinlere ve aztreonama artan direnç ÜSE tedavisinde güçlüklere neden olmaktadır.Çalışmamızda E. coli'ye bağlı toplum kökenli ÜSE atakları incelenerek GSBL risk faktörleri ve oral tedavi seçeneklerinin değerlendirilmesi amaçlandı. 1 Ocak 2008 -1 Ocak 2018 tarihleri arasında E. coli'ye bağlı 379 ÜSE atağı saptandı. GSBL pozitif E. coli üreyen 117 (%30,9) atak vaka grubunu, GSBL negatif E. coli üreyen 262 (%69,1) atak kontrol grubunu oluşturdu. Gruplar yaş, cinsiyet, komorbid hastalıklar, kronik üriner patoloji varlığı, üriner kateterizasyon varlığı, son altı ayda ürolojik işlem öyküsü, son üç ayda hastanede yatış öyküsü, son üç ayda antibiyotik kullanımı ve tekrarlayan ÜSE varlığı açısından karşılaştırıldı.E. coli suşlarının amoksisilin klavulanik asit, piperasilin tazobaktam, siprofloksasin, levofloksasin, trimetoprim sulfametoksazol, fosfomisin ve nitrofurantoin duyarlılıkları değerlendirildi. Tek değişkenli analizlerde genç yaş (p=0.034), solid organda malignite (p=0.000), kronik üriner patoloji varlığı (p=0.004), üriner kateterizasyon (p=0.000), son altı ayda ürolojik işlem (p=0.000), son üç ayda hastanede yatış öyküsü (p=0.000), son üç ayda antibiyotik kullanımı (p=0.000) ve tekrarlayan ÜSE (p=0.000) vaka grubunda daha yüksek saptandı. Çok değişkenli analizde ise malignite (OR: 2,267; GA:1,205-4,266; p=0,011), üriner kateterizasyon (OR: 2,266; GA:1,186-4,330; p=0,013) ve son üç ayda antibiyotik kullanımı (OR:5,050; GA:3,038-8,395; p=0,000) GSBL pozitif E. coli'ye bağlı ÜSE için bağımsız risk faktörü saptandı. Amoksisilin klavulanik asit, piperasilin tazobaktam, siprofloksasin, levofloksasin ve trimetoprim sulfametoksazol direnç oranlarının hem vaka hem de kontrol grubunda yüksek olduğu için empirik tedavi seçeneği olarak kullanılamayacağı saptandı.
Urinary tract infections (UTI) are one of the most common diseases and generally caused by Escherichia coli. Due to production of extended-spectrum beta-lactamase (ESBL) on E. coli strains, increased resistance against third generationcephalosporins, penicillins and aztreonam leads to difficulties in UTI treatment. Our study objective is to evaluate ESBL risk factors and oral treatment options by examining community acquired UTI attacks. Between the dates of 1 January 2008 and 1 January 2018, 379 UTI attacks were detected which hadurine culture positive for E. coli.The studygroup contained 117 (%30,9) ESBL producing E. coliattacks and the control group contained 262 (%69,1) non-ESBL producing E. coli attacks. The groups were compared in terms of age, gender, co-morbid diseases, urinary tract abnormalities presence,urinary catheterization,history of urological procedure in last six months, history of hospitalization in last three months, history of antibiotic use in last three months and recurrent UTI.E. coli strains were evaluated for amoxicillin clavulanic acid, piperacilintazobactam, ciprofloxacin, levofloxacin, trimethoprim sulfamethoxazole,fosfomycin and nitrofurantoin susceptibility. In univariate analysis young age (p=0.034), solid tumors presence (p=0.000), urinary tract abnormalities presence (p=0.004), urinary catheterization(p=0.000), history of urological procedure in last six months(p=0.000), history of hospitalization in last three months(p=0.000),history of antibiotic use in last three months(p=0.000) and recurrent UTI(p=0.000) were detected higher in study group. On the other hand, in multivariate analysis solid tumors presence (OR: 2,267; CI:1,205-4,266; p=0,011), urinary catheterization(OR: 2,266; CI: 1,186-4,330; p=0,013) and history of antibiotic use in last three months(OR: 5,050; CI: 3,038-8,395; p=0,000) were detected independent risk factors for UTI caused by ESBL producing E. coli. Both in study group and control group resistancerates of amoxicillin clavulanic acid, piperacilin tazobactam, ciprofloxacin, levofloxacin and trimethoprim sulfamethoxazole were too high,so they areinappropriate choices for empirical treatment.
Urinary tract infections (UTI) are one of the most common diseases and generally caused by Escherichia coli. Due to production of extended-spectrum beta-lactamase (ESBL) on E. coli strains, increased resistance against third generationcephalosporins, penicillins and aztreonam leads to difficulties in UTI treatment. Our study objective is to evaluate ESBL risk factors and oral treatment options by examining community acquired UTI attacks. Between the dates of 1 January 2008 and 1 January 2018, 379 UTI attacks were detected which hadurine culture positive for E. coli.The studygroup contained 117 (%30,9) ESBL producing E. coliattacks and the control group contained 262 (%69,1) non-ESBL producing E. coli attacks. The groups were compared in terms of age, gender, co-morbid diseases, urinary tract abnormalities presence,urinary catheterization,history of urological procedure in last six months, history of hospitalization in last three months, history of antibiotic use in last three months and recurrent UTI.E. coli strains were evaluated for amoxicillin clavulanic acid, piperacilintazobactam, ciprofloxacin, levofloxacin, trimethoprim sulfamethoxazole,fosfomycin and nitrofurantoin susceptibility. In univariate analysis young age (p=0.034), solid tumors presence (p=0.000), urinary tract abnormalities presence (p=0.004), urinary catheterization(p=0.000), history of urological procedure in last six months(p=0.000), history of hospitalization in last three months(p=0.000),history of antibiotic use in last three months(p=0.000) and recurrent UTI(p=0.000) were detected higher in study group. On the other hand, in multivariate analysis solid tumors presence (OR: 2,267; CI:1,205-4,266; p=0,011), urinary catheterization(OR: 2,266; CI: 1,186-4,330; p=0,013) and history of antibiotic use in last three months(OR: 5,050; CI: 3,038-8,395; p=0,000) were detected independent risk factors for UTI caused by ESBL producing E. coli. Both in study group and control group resistancerates of amoxicillin clavulanic acid, piperacilin tazobactam, ciprofloxacin, levofloxacin and trimethoprim sulfamethoxazole were too high,so they areinappropriate choices for empirical treatment.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases
