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Giriş: Bu çalışmada spinal disrafizme bağlı nörojen mesane nedeni ile temiz aralıklı kateterizasyon (TAK) uygulayan hastalar ile nörojen mesanesi olmayan ve tekrarlayan idrar yolu enfeksiyonu olan hastaların idrar kültürlerindeki mikroorganizmaların tipleri, sıklıkları, antibiyotik dirençleri ve direnç gelişimine etki eden faktörler ayrımlanmaya çalışıldı. Gereç-Yöntem: Spinal disrafizm nedeni ile nörojen mesanesi olan ve TAK uygulamakta olan hastalar grup 1, nörojen mesanesi olmayıp tekrarlayan idrar yolu enfeksiyonu ile takip edilen hastalar grup 2 olarak adlandırıldı. Ayrıca grup 1 antibiyotik proflaksisi alan ve almayan olmak üzere, grup 2‘deki hastalar ise vezikoüreteral reflü olup olmamasına göre iki alt gruba ayrıldı ve mikroorganizma türleri ve antibiyotik dirençlerine göre karşılaştırıldı. Bulgular: Nörojen mesane nedeni ile temiz aralıklı kataterizasyon yapılan 26 (ortalama yaş 6,01±4 yıl, 18 kız) hastanın 1 yıl içinde alınan idrar kültürlerinin 99’unda, nörojen mesane olmayan tekrarlayan idrar yolu enfeksiyonu tanısı ile izlenen 76 (ortalama yaş 7,2±4,34 yıl, 56 kız) hastanın 352 idrar kültüründe anlamlı üreme saptandı. Her iki hasta grubunda en sık görülen mikroorganizma türü E. Coli olup görülme sıklıkları açısından fark saptanmadı. Nörojen mesane grubunda genişletilmiş spektrumlu beta laktamaz mikroorganizma (ESBL+) normal mesane grubuna göre daha yüksekti. İki grup arasında antibiyotik direnç oranları karşılaştırıldığında nörojen mesane grubunda piperasilin tazobaktam ve ampisilin dirençleri anlamlı yüksek saptandı. Nörojen mesanesi olup antibiyotik proflaksisi alan grupta (16 hasta, % 61) E. Coli dışı mikroorganizma ile Klebsiella üreme sıklığı ve ampisilin, seftriakson, gentamisin dirençleri anlamlı yüksek saptandı. Normal mesaneli grupta VUR olan hastalarda üreyen mikroorganizmalar ve ESBL+ liği açısından anlamlı fark saptanmazken, ampisilin, trimetoprim/sulfametoksazol, aztreonam, sefepim, seftazidim, gentamisin, fosfomisin dirençleri anlamlı yüksek saptandı. Gruplar arasında en yüksek skar oranı normal mesaneli VUR+ hastalarda saptandı. Sonuç: TAK yapılan hastalarda ESBL+ dirençli mikroorganizmaların yüksek görülmesi TAK yapılmasının dirençte risk faktörü olduğunu göstermektedir. Çalışmada hem en yüksek antibiyotik direnci hem de en yüksek skar oranı normal mesaneli VUR+ hastalarda saptandı. TAK yapılan nörojen mesaneli hastalarda, mikroorganizmalarda antibiyotik direnci gelişmesi nedeni profilaksi kullanılmamalı iken normal mesaneli VUR+ hastalarda skar oranı yüksek olduğu için profilaktik antibiyotik kullanımına devam edilmesi gerektiği sonucuna varılmıştır.
Purpose: In this study, it was aimed to compare the frequency of significant bacteriuria and antibiotic resistance characteristics in children with myelodysplasia-neurogenic bladder in whom clean intermittent catheterization (CIC) and children with normal bladder and recurrent urinary tract infection. Material-Methods: Children with neurogenic bladder in whom CIC group were divided into two subgroups as taking antibiotic prophylaxis and not. Children with normal bladder and recurrent urinary tract infection group were divided into two subgroups as with vesicoureteral reflux and without. Renal scar, vesicoureteral reflux, microorganism types, antibiotic resistance in urine culture antibiogram was compared in all groups. Results: The neurogenic bladder group was composed 99 cultures of 26 patients (mean age:6.01±4.00 years 18 girls) who were found to have significant bacteriuria and the normal bladder group was composed of 352 cultures of 75 children (mean age:7.2±4.34 years 56 girls). Growth of Escherichia coli was found with the highest rate in children with neurogenic bladder and children with normal bladder. However ESBL producing microorganisms were found highest rate in children with neurogenic bladder than children with normal bladder. A significant increase in resistance to ampicillin and piperacillin tazobactam was found in children with neurogenic bladder than children with normal bladder. Not to E. Coli microorganisms such as Klebsiella were found highest rate in children with neurogenic bladder who were using prophylactic antibiotics. A significant increase in resistance to ampicillin, ceftriaxone and gentamicin resistance was also found in the patients who received prophylactic antibiotic compared to the patients who did not receive prophylactic antibiotic in children with neurogenic bladder. A significant increase resistance to ampicillin, gentamicin, trimethoprim-sulfamethoxazole, aztreonam, cefepime, ceftazidime, phosphomycin was also found in the patients with vesicoureteral reflux than without. Conclusion: Early and correct treatment as CIC may easily prevent renal damage in children with myelodysplasia-neurogenic bladder. The use of prophylactic antibiotics may lead to the development of drug resistance in patients with neurogenic bladder. Therefore, the use of prophylactic antibiotics this group may not be necessary. The highest antibiotic resistance was found in patients with normal bladder and vesicoureteral reflux. Also a significant increase renal scar incidence in the same group. Although, it was concluded that prophylactic antibiotic use should be continued as the scar ratio is high in patients with normal bladder and vesicoureteral reflux.
Purpose: In this study, it was aimed to compare the frequency of significant bacteriuria and antibiotic resistance characteristics in children with myelodysplasia-neurogenic bladder in whom clean intermittent catheterization (CIC) and children with normal bladder and recurrent urinary tract infection. Material-Methods: Children with neurogenic bladder in whom CIC group were divided into two subgroups as taking antibiotic prophylaxis and not. Children with normal bladder and recurrent urinary tract infection group were divided in to two subgroups as with vesicoureteral reflux and without. Renal scar, vesicoureteral reflux, microorganism types, antibiotic resistance in urine culture antibiogram was compared in all groups. Results: The neurogenic bladder group was composed 99 cultures of 26 patients (mean age:6.01±4.00 years 18 girls) who were found to have significant bacteriuria and the normal bladder group was composed of 352 cultures of 75 children (mean age:7.2±4.34 years 56 girls). Growth of Escherichia coli was found with the highest rate in children with neurogenic bladder and children with normal bladder. However ESBL producing microorganisms were found highest rate in children with neurogenic bladder than children with normal bladder. A significant increase resistance to ampicillin and piperacillin tazobactam was found in children with neurogenic bladder than children with normal bladder. Non E. Coli microorganisms such as Klebsiella were found highest rate in children with neurogenic bladder who were using prophylactic antibiotic. A significant increase resistance to ampicillin, ceftriaxone and gentamicin resistance was also found in the patients who received prophylactic antibiotic compared to the patients who did not receive prophylactic antibiotic in children with neurogenic bladder. A significant increase resistance to ampicillin, gentamicin, trimethoprim-sulfamethoxazole, aztreonam, cefepime, ceftazidime, fosfomycin was also found in the patients with vesicoureteral reflux than without. Conclusion: Early and correct treatment as CIC may easily prevent renal damage in children with myelodysplasia-neurogenic bladder. The use of prophylactic antibiotics may lead to the development of drug-resistance in patients with neurogenic bladder. Therefore use of prophylactic antibiotics this group may not be necessary. Highest antibiotic resistance was found in the patients with normal bladder and vesicoureteral reflux. Also a significant increase renal scar incidence in same group. Although, it was concluded that prophylactic antibiotic use should be continued as the scar ratio is high in patients with normal bladder and vesicoureteral reflux.
Field : Sağlık Bilimleri
Journal Type : Uluslararası
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