Department of Pediatrics, Diyarbakir Children's Diseases Hospital, Yenisehir, Diyarbakir, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Aug;27(16):7680-7687. doi: 10.26355/eurrev_202308_33421.
The aim of our study is to determine the uropathogenic causing urinary tract infections (UTIs) and their incidences, assess their antibiotic resistance, and determine an appropriate empirical antibiotic treatment strategy.
We retrospectively analyzed the culture and antibiogram results of urine cultures of 49,706 patients aged 1 day to 18 years who applied to Diyarbakır Children's Hospital between March 2018 and October 2022.
A total of 4,064 cases meeting the study criteria were recorded. Girls comprised 76.7% of the study population. While reproduction in urine culture was more common in boys in the 0-1 age group, there was a decrease in the number of boys with increasing age, and the most common culture growth was seen in girls in the 5-10 age group (p<0.001). Escherichia coli (E. coli) infections were more common in girls, while non-E. coli infections were more common in boys (p<0.001). Gram-negative bacterial growth in urine cultures was the most common growth type. In descending order, E. coli was grown in 68.1% of all cultures, Klebsiella spp in 12.6%, and Proteus spp in 3.9%. Less commonly, Pseudomonas spp (2.8%), Enterobacter spp (1.5%), and fungi (1.1%) were grown. Antibiotic resistance/sensitivity tests revealed resistance patterns most commonly against ampicillin (73.2%), amoxicillin-clavulanate (57.9%), cefuroxime axetil (46.7%), cefixime (51%), and ceftriaxone (40.5%), and less commonly against meropenem (1.7%), amikacin (2.4%), and nitrofurantoin (9.8%). Escherichia coli showed resistance most commonly against ampicillin (69.8%), amoxicillin-clavulanate (59.7%), and cefixime (51.3%), while non-E.coli bacteria showed resistance most commonly against ampicillin (84.6%), amoxicillin (52.0%), and cefixime (50%). Resistance against nitrofurantoin was lower in E. coli infections than non-E. coli infections, although the difference did not reach statistical significance (3.7% and 27%, respectively; p=0.149). In contrast, resistance against trimethoprim-sulfamethoxazole was more common in E. coli infections than non-E. coli infections, although the difference was not statistically significant (42% and 29.7%, respectively; p=0.093).
Our study revealed that resistance has developed at very high rates against many oral and parenteral antibiotics that we use in the treatment of UTIs. If our rate of antibiotic use continues to increase this way, it is predicted that UTIs will, unfortunately, become untreatable with oral antibiotics. This upsetting point reached by our country, which is the state that uses antibiotics the most in Europe, exemplifies the importance of rational antibiotic use for the whole world.
本研究旨在确定导致尿路感染（UTI）的病原体及其发病率，评估其抗生素耐药性，并确定合适的经验性抗生素治疗策略。
我们回顾性分析了 2018 年 3 月至 2022 年 10 月期间在迪亚巴克尔儿童医院就诊的 1 天至 18 岁的 49706 例患者的尿液培养物的培养和药敏结果。
共记录了 4064 例符合研究标准的病例。研究人群中女孩占 76.7%。虽然男孩在 0-1 岁组中尿液培养的繁殖更为常见，但随着年龄的增长，男孩的数量逐渐减少，而女孩在 5-10 岁组中最常见的培养生长（p<0.001）。女性中大肠杆菌（E. coli）感染更为常见，而男性中非大肠杆菌感染更为常见（p<0.001）。尿液培养物中革兰氏阴性细菌的生长是最常见的生长类型。按降序排列，所有培养物中大肠杆菌生长率为 68.1%，克雷伯菌属生长率为 12.6%，变形杆菌属生长率为 3.9%。较少见的是，铜绿假单胞菌（2.8%）、肠杆菌属（1.5%）和真菌（1.1%）生长。抗生素耐药/药敏试验显示，对氨苄西林（73.2%）、阿莫西林克拉维酸（57.9%）、头孢呋辛酯（46.7%）、头孢克肟（51%）和头孢曲松（40.5%）的耐药模式最为常见，而对美罗培南（1.7%）、阿米卡星（2.4%）和呋喃妥因（9.8%）的耐药性较少。大肠杆菌对氨苄西林（69.8%）、阿莫西林克拉维酸（59.7%）和头孢克肟（51.3%）的耐药性最为常见，而非大肠杆菌对氨苄西林（84.6%）、阿莫西林（52.0%）和头孢克肟（50.0%）的耐药性最为常见。大肠杆菌感染对呋喃妥因的耐药性低于非大肠杆菌感染，尽管差异无统计学意义（分别为 3.7%和 27%；p=0.149）。相反，大肠杆菌感染对磺胺甲噁唑/甲氧苄啶的耐药性高于非大肠杆菌感染，尽管差异无统计学意义（分别为 42%和 29.7%；p=0.093）。
我们的研究表明，许多我们用于治疗尿路感染的口服和注射用抗生素的耐药性已经非常高。如果我们继续以这种方式增加抗生素的使用，预计尿路感染将无法用口服抗生素治疗。我们国家达到了这一点，即欧洲抗生素使用最多的国家，这说明了在全球范围内合理使用抗生素的重要性。
