Infekcije mokraćnih puteva kod dece obolele od malignih tumora sa febrilnom neutropenijom – iskustvo jednog centra

  • Nataša Kovač Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Maja Samardžić Lukić Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Nataša Kaćanski Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia
  • Aleksandra Kovač Oncology Institute of Vojvodina, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Tijana Latinović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Jovanka Kolarović Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
DOI: https://doi.org/10.2298/VSP230620057K
Ključne reči: bakteriološke tehnike, deca, neutropenija, febrilna, onkologija, medicinska, urinarni trakt, infekcije, mokraća, analiza

Sažetak


Uvod/Cilj. Infekcije mokraćnih puteva (IMP) kod dece koja su razvila febrilnu neutropeniju (FN) nakon primene hemioterapije, mogu biti praćene atipičnim simptomima i znacima. Odsustvo rutinskog uzimanja uzorka urinokulture (UK) za analizu može dovesti do neprepoznavanja i neadekvatnog lečenja tih bolesnika. Cilj rada bio je da se ukaže na značaj uzimanja UK kod dece kod kojih se razvila FN, na najčešće uzročnike IMP kod ove dece, kao i da se ukaže na osetljivost/rezistenciju na antibiotike izolovanih sojeva uzročnika IMP. Metode. U posmatranom petogodišnjem periodu registrovano je 40 IMP kod 30 bolesnika sa FN. U grupi bolesnika sa FN analiziran je broj IMP, broj ponovljenih IMP, izolovani uzročnici infekcije, njihova osetljivost na antibiotike, karakteristike sedimenta urina, prisustvo lokalnih simptoma IMP i prisustvo urosepse. Dobijeni podaci su upoređivani sa kontrolnom grupom, koju su činila zdrava deca prethodno hospitalizovana zbog urinarne infekcije praćene febrilnošću. Rezultati. Kod bolesnika sa FN, u odnosu na kontrolnu grupu uočena je statistički značajna razlika povezana sa prisustvom simptoma IMP i nalazom sedimenta urina. Registrovan je viši procenat izolovanih rezistentnih sojeva Escherichia coli iz UK bolesnika sa FN, u odnosu na kontrolnu grupu. Tri bolesnika sa IMP imala su prateću urosepsu. Zaključak. Nalaz UK je značajan ne samo u postavljanju dijagnoze IMP i otkrivanju multirezistentnih bakterijskih sojeva, već i u pravilnom odabiru antibiotske terapije i selekciji onih bolesnika sa ponovljenim IMP, koji zahtevaju dalje praćenje i pravovremeno otkrivanje potencijalnih komplikacija.

Reference

Uwaezuoke S, Ayuk A, Muoneke U. Urinary tract infection in children: A review of the established practice guidelines. EMJ Microbiol Infect Dis 2020; 1(1): 57–65.

Hamzeh F, Kanj SS, Uwaydah M. Febrile neutropenia in cancer patients in a tertiary care medical center in Lebanon: microbial spectrum and outcome. J med Liban 2000; 48(3): 136–42.

Munyi ST, Macharia WM, Alwar AJ, Njeru EK. Screening for urinary tract infection in children with cancer. East Afr Med J 1998; 75(5): 264–7.

Sandoval C, Sinaki B, Weiss R, Munoz J, Ozkaynak MF, Tugal O, et al. Urinary tract infections in pediatric oncology patients with fever and neutropenia. Pediatr Hematol Oncol 2012; 29(1): 68–72.

Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011; 52(4): e56–93.

Barton CD, Waugh LK, Nielsen MJ, Paulus S. Febrile neutropenia in children treated for malignancy. J Infect 2015; 71(Suppl 1): S27–35.

Agrawal AK, Feusner J. Supportive Care of Patient’s with can-cer. In: Lanzkowsky P, Lippton JM, Fish JD, editors. Lanzkow-sky’s Manual of Pediatric Hematology and Oncology. 6th ed. London: Elsevier Inc; 2016. p. 621–7.

Haeusler GM, Phillips RS, Lehrenbecher T, Thursky KA, Sung L, Amman RA. Core outcomes and definitions for pediatric fever and neutropenia research: A consensus statement from an in-ternational panel. Pediatr Blood Cancer 2015; 62(3): 483–9.

Davis K, Wilson S. Febrile neutropenia in paediatric oncology. Paediatr Child Health (Oxford) 2019; 30(3): 93–7.

Kar YD, Özdemir ZC, Bör Ö. Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients. Turk Pedi-atri Ars 2017; 52(4): 213–20.

Meckler G, Lindemulder S. Fever and neutropenia in pediatric patients with cancer. Emerg Med Clin North Am 2009; 27(3): 525–44.

Kebudi R, Kizilocak H. Febrile Neutropenia in children with cancer: Approach to diagnosis and treatment. Curr Pediatr Rev 2018; 14(3): 204–9.

Van Tilburg CM, van Gent R, Bierings MB, Otto SA, Sanders EA, Nibbelke EE, et al. Immune reconstitution in children following chemotherapy for haematological malignancies: a long-term follow-up. Br J Haematol 2010; 152(2): 201–10.

Mongkolrattanothai K, Bard JD. Sepsis in children with febrile neutropenia. J Appl Lab Med 2019; 3(4): 530–3.

Penack O, Buchheidt D, Christopeit M, von Lilienfeld-Toal M, Mas-senkeil G, Hentrich M, et al. Management of sepsis in neutro-penic patients: guidelines from the infectious diseases working party of the German Society of Hematology and Oncology. Ann Oncol 2011; 22(5): 1019–29.

Hakim H, Flynn PM, Knapp KM, Srivastava DK, Gaur AH. Eti-ology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2009; 31(9): 623–9.

Rahman AA, Gupta SK, Ferdouse Z, Islam A. Urinary tract infections in pediatric oncology patients with fever and neutropenia. Chattagram Maa-O-Shishu Hosp Med College J 2013; 12(2): 19–22.

Klaassen IL, de Haas V, van Wijk JA, Kaspers GJ, Bijlsma M, Bökenkamp A. Pyuria is absent during urinary tract infections in neutropenic patients. Pediatr Blood Cancer 2011; 56(5): 868–70.

Lee J. Antibiotic-resistant gram-negative bacteremia in febrile neutropenic children. Infect Chemother 2016; 48(3): 249–51.

Kwon JC, Kim SH, Choi JK, Cho SY, Park YJ, Park SH, et al. Epidemiology and clinical features of bloodstream infections in hematology wards: one year experience at the catholic blood and marrow transplantation center. Infect Chemother 2013; 45(1): 51–61.

Hirmas N, Mubarak S, Sultan I. Patterns of microbial growth in urine cultures in a pediatric hematology/oncology unit over a one-year period: a single institution study. Int J Pediatr Ado-lesc Med 2017; 4(3): 95–9.

Fletcher M, Hodgkiss H, Zhang S, Browning R, Hadden C, Hoffman T, et al. Prompt administration of antibiotics is associated with improved outcomes in febrile neutropenia in children with cancer. Pediatr Blood Cancer 2013; 60: 1299–306.

Objavljeno
2024/01/30
Broj časopisa
Vol. 81 Br. 01 (2024): Vojnosanitetski pregled
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Originalni članak