Antibiotska rezistencija uzročnika infekcija urinarnog trakta kod dece
Sažetak
Ciljevi: Ispitati rezistenciju uropatogena na uobičajene antibiotike koji se ordiniraju u terapiji urinarnih infekcija kod dece. Takođe, uporediti učestalost rezistencije između krajnjih tačaka ispitivanog perioda.
Metodi: U retrospektivnoj studiji analizirana je antibiotska rezistencija mikroorganizama izolovanih iz urinokultura 127 dece mlađe od 6 godina. Svi ispitanici su imali simptome i znake prve vanbolničke urinarne infekcije, zbog čega su hospitalizovani na Klinici za pedijatriju, Kliničkog centra Kragujevac u periodu između 2006. i 2010. godine.
Rezultati: Našli smo veliku učestalost rezistencije uropatogena na ampicilin (35.4%) i neznatno manju učestalost na gentamicin (33.1%) i trimetoprim-sulfametoksazol (27,6%). Identifikovana je zabrinjavajuća rezistencija na cefalosporine treće generacije (37,0%), pri čemu je većina bakterija bila rezistentna na ceftriakson (15,7%). Takođe zabrinjava i rezistencija na cefalosporine prve generacije (29,9%), posebno na cefaleksin (26,8% od ukupnog broja izolovanih bakterija). Nije bilo značajne razlike u učestalosti rezistencije između 2006. i 2010. godine.
Zaključci: Imajući u vidu veliku rezistenciju bakterija na uobičajena antimikrobna sredstva, predlažemo češću primenu drugih ili manje korišćenih antibiotika. Amoksicilin je dobar prvi izbor kod dece starije od godinu dana sa nekomplikovanom infekcijom. Smatramo da je rezistencija na amikacin (18,9%) i ceftriakson (15,7%) prihvatljiva i da su oni još uvek dobar izbor za započinjanje parenteralne terapije posebno kod dece do godinu dana sa prvom urinarnom infekcijom, do pristizanja rezultata testova antimikrobne osetljivosti.
Ključne reči: urinarna infekcija, deca, antibiotici, rezistencija
Reference
Elder JS. Urinary tract infections. In: Kliegman RM, Behrman RE, Stanton BF, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: WB Saunders, 2011: 1785-90.
Larcombe J. Urinary tract infection in children. BMJ 1999; 319: 1173–5.
Chang SL, Shortliffe LD: Pediatric urinary tract infections. Pediatr Clin North Am 2006; 53: 379-400.
Hellerstein S. Acute urinary tract infection - evaluation and treatment. Curr Opin Pediatr 2006; 18:134-8.
Chakupurakal R, Ahmed M, Sobithadevi DN, Chinnappan S, Reynolds T. Urinary tract pathogens and resistance pattern. J Clin Pathol 2010; 63: 652–4.
Wald E. Urinary tract infections in infants and children. Curr Opin Pediatr 2004; 16: 85-8.
Jahnukainen T, Chen M, Celsi G. Mechanisms of renal damage owing to infection. Pediatr Nephrol 2005; 20:1043-53.
Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev 2005; (1): CD003772.
Farrell DJ, Morrissey I, De Rubeis D, Robbins M, Felmingham D. A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. J Infect. 2003; 46(2): 94–100.
Lutter SA, Currie ML, Mitz LB, Greenbaum LA. Antibiotic resistance patterns in children hospitalized for urinary tract infections. Arch Pediatr Adolesc Med 2005; 159: 924-8.
Cheng CH, Tsai MH, Huang YC, et al. Antibiotic resistance patterns of community-acquired urinary tract infections in children with vesicoureteral reflux receiving prophylactic antibiotic therapy. Pediatrics 2008; 122(6): 1212-7.
Yoon JE, Kim WK, Lee JS, et al. Antibiotic susceptibility and imaging findings of the causative microorganisms responsible for acute urinary tract infection in children: a five-year single center study. Korean J Pediatr 2011; 54(2): 79-89.
CW Kwan, H Onyett. Community-acquired urinary tract pathogens and their resistance patterns in hospitalized children in southeastern Ontario between 2002 and 2006. Paediatr Child Health 2008; 13(9): 759-62.
Haller M, Brandis M, Berner R. Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy. Pediatr Nephrol 2004;19:982-6.
Ladhani S, Gransden W. Increasing antibiotic resistance among urinary tract isolates. Arch Dis Child 2003; 88; 444-5.
Allen UD, et al. Risk factors for resistance to “firstline” antimicrobials among urinary tract isolates of Escherichia coli in children. CMAJ 1999; 160: 1436-40.
Das RN, et al. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore Med J 2006; 47: 281-5.
Yüksel S, Oztürk B, Kavaz A, et al. Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections. Int J Antimicrob Agents 2006; 28: 413-6.
Paschke AA, Zaoutis T, Conway P, Xie D, Keren R. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics. 2010; 125(4): 664-72.