Genişlemiş Spektrumlu Beta-Laktamaz (ESBL) Üreten Mikroorganizmalarla Gelişen Üriner Enfeksiyonlu Çocukların Klinik ve Laboratuvar Bulguları

Abstract

The urinary tract infections (UTI) caused by extended spectrum beta-lactamases (ESBL) producing microorganisms are an important general health problem. In this study, the community acquired UTI cases from 0-17 age group were included in order to investigate the clinical characteristics and laboratory findings of the children with UTIs caused by ESBL positive microorganisms and to evaluate associated the risk factors. Total of 178 urine samples from 158 patients with positive ESBL and 166 urine samples from 162 patients with negative ESBL were included in this study. The ESBL positive UTIs were more common among male patients (p=0,046). While the discomfort and urine odor were more common in ESBL positive group, hematuria was found to be more common in ESBL negative group (p=0,019 and p=0,006). The duration of symptoms was longer in ESBL positive group (p<0,001). In urinary analysis, the number of leukocyte was higher in ESBL negative group (p=0,001). Leukocytosis and polymorphonuclear leukocyte proportion in peripheral smear were lower in ESBL positive group (p=0,002 and p<0,001). E.coli was the most isolated microorganism in both groups. The resistance rates to aminoglycosides, quinolones, nitrofurantoin, trimethoprim-sulfamethoxazole were higher in ESBL positive group. Logistic regression analysis identified the underlying urinary tract condition, UTI antimicrobial prophylaxis and history of hospitalization in the last three months as independent risk factors, increasing the risk 2,22-fold (p=0,013), 2,71-fold (p=0,01) and 3,35-fold (p=0,006), respectively for ESBL-positive UTI. More abnormal ultrasonography findings were found in ESBL positive group when compared to the ESBL-negative group (p=0,005). The mean duration of hospitalization for patients with ESBL-positive UTI was significantly longer than that for patients with ESBL-negative UTI. While evaluating the children with UTI, it should be taken into consideration that ESBL positive patients may have different clinical characteristics. The ESBL positive infection risk should be taken into consideration while choosing the antibiotics for children who have underlying urinary tract condition, who used prophylactic antibiotic, or who have been hospitalized in the past three months.