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Adane Bitew, 1 Nuhamen Zena, 2 Abera Abdeta31 iSebe leNzululwazi yeLebhu yezoNyango, iFaculty yeSayensi yezeMpilo, iYunivesithi yaseAddis Ababa, eAddis Ababa, eTopiya;I-2 Microbiology, iMillennium School of Medicine, iSibhedlele saseSt Paul, i-Addis Ababa, iSebe laseTopiya;I-3 yeNational Reference Laboratory ye-Clinical Bacteriology kunye neMycology, i-Ethiopian Institute of Public Health, i-Addis Ababa, i-Ethiopia uMbhali oFanayo: uAbera Abdeta, iLebhu yeSizwe yeReferensi ye-Clinical Bacteriology kunye neMycology, i-Ethiopian Institute of Health Public, PO Box: 1242, Addis Ababa, Ethiopia , +251911566420, i-imeyile [i-imeyile ekhuselweyo] Imvelaphi: Ii-UTI zizifo ezixhaphakileyo kwi-paediatrics.Ulwazi lwezizathu eziqhelekileyo zokusuleleka kwi-urinary tract, iipatheni zabo zokuchaphazeleka kwe-antimicrobial, kunye nemingcipheko ehambelana nayo kwimimiselo ethile inokunika ubungqina bonyango olufanelekileyo lwamatyala.Iinjongo. : Olu pho nonongo lujolise ekuqinisekiseni i-etiology eqhelekileyo kunye nokuxhaphaka kwe-uropathogens ehambelanayo kunye nosulelo lwe-urinary tract, kunye neeprofayili ze-antibiotic susceptibility profiles ye-bacterial isolates, kunye nokuchonga izinto ezinobungozi ezinxulumene nokusuleleka kwi-urinary tract kwizigulane zabantwana.Izixhobo kunye neendlela: Uphononongo iqhutywe ukususela ngo-Oktobha 2019 ukuya kuJulayi 2020 kwiMillennium School of Medicine, iSibhedlele saseSt. iinkqubo.Uvavanyo lwe-Antibiotic susceptibility test of pathogens bacterial pathogens usebenzisa i-Kirby Bauer disc diffusion method.Izibalo ezichazayo kunye ne-logistic regression zisetyenziselwa ukuqikelela ukulinganisa okuluhlaza kunye ne-95% yexesha lokuzithemba.Iziphumo zexabiso le-P: Ukukhula okuphawulekayo kwebhaktheriya / ifungal kwabonwa kwiisampuli ze-65 nge ukuxhaphaka kwe-28.6%, apho i-75.4% (49 / 65) kunye ne-24.6% (16 / 65) yayiyi-bacterial and fungal pathogens, ngokulandelanayo. Malunga ne-79.6% ye-bacterial etiologies yi-Escherichia coli kunye ne-Klebsiella pneumoniae (i-astampicillin ephezulu yayiyi-astampicillin. I-100%), i-cefazolin (i-92.1%) kunye ne-trimethoprim-sulfamethoxazole (i-84.1%), esetyenziswa ngokuqhelekileyo i-empirically e-Ethiopia.Ubude besibhedlele (P = 0.01) kunye ne-catheterization (P = 0.04) yayinxulumene nezibalo kunye nosulelo lwe-urinary tract. Izigqibo: Uphononongo lwethu lubone ukuxhaphaka okuphezulu kwezifo ze-urinary tract infections.I-Enterobacteriaceae iyona nto ibangela ukuba i-urinary tract infections.Ubude bokuhlala esibhedlele kunye ne-catheterization yayinxulunyaniswa kakhulu nosulelo lwe-urinary tract.Zombini iibhaktheriya ze-Gram-negative kunye ne-Gram-positive zazixhathisa kakhulu I-ampicillin kunye ne-trimethoprim-sulfamethoxazole.Amagama angundoqo: Iipateni ze-Antibiotic susceptibility, Pediatrics, usulelo lwe-Urinary tract, Ethiopia
Usulelo lwe-Urinary tract infections (UTIs) olubangelwa yibhaktheriya kunye negwele sesinye sezona zifo zixhaphakileyo ze-urinary tract kubantwana.Kumazwe asakhasayo, yintsholongwane yesithathu exhaphakileyo kwiqela leminyaka yabantwana emva kokusuleleka kokuphefumula kunye nesisu.2 Izifo zamathumbu kubantwana. zihambelana nokugula kwexesha elifutshane, kubandakanywa nomkhuhlane, i-dysuria, ukukhawuleza, kunye nentlungu ephantsi. I-3 Wennerstrom et al15 ichaze i-renal scarring malunga ne-15% yabantwana emva kwe-UTI yokuqala, igxininisa ukubaluleka kokuxilongwa ngokukhawuleza kunye nokunyangwa kwangaphambili kwezifo ze-urinary tract. I-4 Izifundo ezininzi ze-UTI zabantwana kumazwe ahlukeneyo asakhulayo zibonise ukuba ukuxhaphaka kwe-UTIs kuyahluka ukusuka kwi-16% ukuya kwi-34%.5-9 Ukongezelela, ukuya kwi-8% yabantwana abaneminyaka eyi-1 ukuya kwi-11 iminyaka baya kuphuhlisa ubuncinane i-UTI10 enye, kwaye ukuya kuthi ga kwi-30% yeentsana kunye nabantwana baziwa ukuba banosulelo oluphindaphindiweyo kwiinyanga ezi-6-12 zokuqala emva kwe-UTI yokuqala .11
Iintsholongwane zeGram-negative neGram-positive, kwakunye neentlobo ezithile zeCandida, zinokubangela usulelo lomjelo womchamo.E.coli ngoyena nobangela uxhaphakileyo wokosuleleka ngumchamo, ulandelwa nguKlebsiella pneumoniae.12 Uphononongo lubonise ukuba iintlobo zeCandida, ngakumbi iCandida albicans, zihlala zisona sizathu sixhaphakileyo seCandida UTIs ebantwaneni.13 Ubudala, ubume bokwaluka, kunye neecatheter ezihlala ngaphakathi ziyingozi. izinto ze-UTIs kubantwana.Amakhwenkwe asengozini ngakumbi kunyaka wokuqala wobomi, emva koko, ngenxa yokungafani kwezitho zesini, iziganeko ziphezulu kakhulu kumantombazana, kwaye iintsana zamadoda ezingalukanga zisengozini enkulu.1,33 I-Antibiotic susceptibility Patterns Iintsholongwane ze-uropathogens ziyahluka ngokuhamba kwexesha, indawo yesigulana, indawo yokuhlala, kunye neempawu zonyango.
Izifo ezithathelwanayo ezifana ne-UTI zicatshangelwa ukuba zijongene ne-26% yokufa kwehlabathi, i-98% yazo ivela kumazwe anengeniso ephantsi.14 Uphononongo lwezigulane zabantwana eNepal naseIndiya luchaze ukuxhaphaka kwe-UTIs ye-57% ye-15 kunye ne-48 %,16.Uphononongo lwasesibhedlele lwabantwana baseMzantsi Afrika lubonise ukuba izifo zomchamo zithatha i-11% yosulelo lwezempilo.17 Olunye uphononongo eKenya lufumanise ukuba usulelo lomchamo luthatha malunga ne-11.9% yomthwalo wosulelo lwe-febrile kubantwana abancinci.18
Izifundo ezimbalwa zichonge i-UTIs kwizigulane zabantwana e-Ethiopia: izifundo kwiSibhedlele se-Hawassa Referral, i-Yekatit 12 Hospital, i-Felege-Hiwot Specialist Hospital kunye ne-Gondar University Hospital ibonise i-27.5%, i-19 15.9%, i-20 16.7%, i-21 kunye ne-26.45% kunye ne-22, ngokulandelanayo. .Kumazwe asaphuhlayo, kuquka i-Ethiopia, ukungabikho kweenkcubeko zomchamo kumanqanaba ahlukeneyo ococeko kuhlala kungenakwenzeka ngenxa yokuba i-resource-intensive.Ngoko ke, i-pathogen spectrum ye-UTI kunye neprofayili yokuchaphazeleka kweziyobisi e-Ethiopia ayaziwa. Uphononongo olujolise ekuqinisekiseni ukuxhaphaka kosulelo lwe-urinary tract, ukuhlalutya iintsholongwane ze-bacterial and fungal pathogens ezinxulumene ne-UTIs, ukugqiba iiprofayili ze-antimicrobial susceptibility profiles of bacterial isolate, kunye nokuchonga izinto ezinkulu ezithintekayo ezinxulumene ne-UTIs.
Ukusukela ngo-Okthobha ka-2019 ukuya kuJulayi ka-2020, uphando olusekwe esibhedlele lwaqhutywa kwiSebe leZigulana zeSibhedlele iSt Paul's Millennium Medical College (SPHMMC), eAddis Ababa, e-Ethiopia.
Ngethuba lexesha lokufunda, zonke izigulane zabantwana kunye nezigulana zangaphandle zabonwa kubantwana.
Ngexesha lophononongo, zonke izigulana zabantwana kunye nezigulana zangaphandle ezineempawu ze-UTI kunye neempawu ziye kwindawo yophononongo.
Ubungakanani besampulu bugqitywe kusetyenziswa ifomula yokubala ubungakanani besampulu yomlinganiselo omnye kunye ne-95% yexesha lokuzithemba, i-5% yomda wempazamo, kunye nokuxhaphaka kwe-UTIs kumsebenzi wangaphambili [15.9% okanye P = 0.159)] Merga Duffa et al20 e-Addis Ababa , njengoko kubonisiwe ngezantsi.
I-Z α/2 = i-95% yexesha lokuzithemba ixabiso elibalulekileyo lokusabalalisa okuqhelekileyo, elilingana ne-1.96 (ixabiso le-Z ku-α = 0.05);
D = umda wephutha, ulingana ne-5%, α = yinqanaba lempazamo abantu abazimisele ukunyamezela;iplagi ezi kwifomula, n = (1.96)2 0.159 (1–0.159)/(0.05)2=206 kwaye uthathe 10% engaphendulwanga apho n = 206+206/10 = 227.
Indlela yesampulu efanelekileyo isetyenziswe kolu phando. Qokelela idatha de ubungakanani besampulu obufunwayo buphunyeziwe.
Idatha yaqokelelwa emva kokufumana imvume ebhaliweyo enolwazi oluvela kubazali.Iimpawu ze-sociodemographic (ubudala, isini, kunye nendawo yokuhlala) kunye nemingcipheko ehambelana nayo (i-catheter, i-UTI yangaphambili, isimo se-human immunodeficiency virus (HIV), ulwaluko, kunye nobude besibhedlele) abathathi-nxaxheba bophando baqokelelwa ngabongikazi abaqeqeshiweyo besebenzisa idatha echazwe kwangaphambili.I-questionnaire ecwangcisiweyo yovavanyo.Iimpawu kunye neempawu zesigulane kunye nesifo esisezantsi zabhalwa ngugqirha wabantwana ohambayo.
Ngaphambi kohlalutyo: iimpawu ze-sociodemographic (iminyaka yobudala, isini, njl.) kunye nolwazi lweklinikhi kunye nonyango lwabathathi-nxaxheba bophando baqokelelwa kwiimibuzo.
Uhlalutyo: Ukusebenza kwe-autoclave, i-incubator, i-reagents, i-microscope, kunye nomgangatho we-microbiological we-medium (i-sterility ye-medium kunye nokukhula kokusebenza kwendawo nganye) zihlolwe ngokwemigaqo esemgangathweni ngaphambi kokusetyenziswa.Ukuqokelelwa kunye nokuthuthwa kweesampuli zeklinikhi ziyenziwa. emva kweenkqubo ze-aseptic.I-inoculation yeesampuli zeklinikhi yenziwa phantsi kwekhabhinethi yokhuseleko yesibini.
I-Post-Analysis: Zonke iinkcukacha ezikhutshiweyo (ezifana neziphumo zebhubhoratri) zihlolwe ukufaneleka, ukugqiba kunye nokuhambelana kwaye zirekhodwe ngaphambi kokungena kwizixhobo zezibalo.Idatha iphinda igcinwe kwindawo ekhuselekileyo.Ii-Bacterial and yeast isolates zigcinwe ngokweNkqubo yokuSebenza eMigangatho (Standard Operating Procedure). I-SOP) yeSibhedlele saseSt.
Yonke idatha yophando yafakwa ikhowudi, yafakwa kabini, kwaye yahlalutywa kusetyenziswa iPakethe yeStatistical for the Social Sciences (SPSS) software version 23.Sebenzisa iinkcukacha-manani ezichazayo kunye nohlengahlengiso lobuchule ukuze uqikelele ulungelelwaniso olurhabaxa kunye ne-95% yamathuba okuzithemba kwiinguqu ezahlukeneyo. <0.05 ithathwa njengento ebalulekileyo.
Iisampulu zomchamo zaqokelelwa kwisigulane ngasinye somntwana usebenzisa izitya zomchamo oyinyumba.Abazali okanye abagcini babathathi-nxaxheba bophando banikwa imiyalelo efanelekileyo malunga nendlela yokuqokelela iisampulu zomchamo we-midstream ococekileyo.I-Catheter kunye ne-suprapubic urine isampuli zaqokelelwa ngabahlengikazi abaqeqeshiweyo kunye noogqirha.Ngoko nangoko emva kokuqokelela , iisampulu zathathwa kwi-laboratory ye-Microbiology ye-SPHMMC ukuze iqhubekele phambili. I-1 μL yokulinganisa iluphu.Iisampulu ezishiyekileyo zafakwa kwi-brain heart infusion agar encediswa nechloramphenicol (100 µgml-1) kunye ne-gentamicin (50 µgml-1) (Oxoid, Basingstoke, naseHampshire, eNgilani).
Zonke iipleyiti ezifakwe kwi-incubated aerobically kwi-37 ° C kwiiyure ze-18-48 kwaye zitshekishwa ukuba zikhula kwi-bacterial kunye / okanye i-yeast. Izibalo ze-Colony zebhaktheriya okanye i-yeast evelisa i-≥105 cfu / mL umchamo zazibhekwa njengokukhula okubalulekileyo.Iisampulu zomchamo ezivelisa iintlobo ezintathu okanye ngaphezulu. azikhange ziqwalaselwe uphando oluthe kratya.
I-isolates ezicocekileyo ze-bacterial pathogens ekuqaleni zibonakaliswe yi-colony morphology, i-Gram staining.Iibhaktheriya ze-Gram-positive zibonakaliswe ngakumbi ngokusebenzisa i-catalase, i-bile aescin, i-pyrrolidinopeptidase (PRY) kunye ne-rabbit plasma.I-Gram-negative bacteria ngokusebenzisa iimvavanyo zesiqhelo ze-biochemical ezifana (uvavanyo lwe-urease), uvavanyo lwe-indole, uvavanyo lokusetyenziswa kwe-citrate, uvavanyo lwe-iron trisaccharide, uvavanyo lokuvelisa i-hydrogen sulfide (H2S), i-lysine iron agar test, uvavanyo lwe-motility kunye novavanyo lwe-oxidase) kwinqanaba leentlobo).
Amagwele achongiwe kusetyenziswa iindlela zokuxilonga zesiqhelo ezinje ngokungcoliswa kweGram, iimvavanyo zetyhubhu ye-embryo, ukubiliswa kwekhabhohayidrethi kunye nokuvavanya ukulinganisa kusetyenziswa i-chromogenic medium (CHROMagar Candida medium, bioM'erieux, France) ngokwemiyalelo yomenzi.
Uvavanyo lwe-Antimicrobial susceptibility test lwenziwa yi-Kirby Bauer disc diffusion kwi-Mueller Hinton agar (Oxoid, Basingstoke, eNgilani) ngokwemigaqo ye-Clinical Laboratory Standards Institute (CLSI) izikhokelo24.Ukumiswa kwebhaktheriya nganye yodwa kulungiselelwe kwi-0.5 mL ye-nutrition broth kwaye ilungelelanise ukuxutywa kwe-turbidity. Tshatisa umgangatho we-0.5 McFarland ukuze ufumane malunga ne-1 × 106 ye-colon-forming units (CFUs) nge-mL nganye ye-biomass. Dipha i-swab engcolileyo kwi-suspension kwaye ususe imathiriyeli engaphezulu ngokuyicinezela ecaleni kombhobho. embindini weMueller Hinton agar plate kwaye isasazwe ngokulinganayo phezu kwendawo ephakathi.Iidiski zeAntibiotic zibekwe kwi-Mueller Hinton agar seeded kunye nenye nganye ngaphakathi kwemizuzu eyi-15 yokutofa kwaye ifakwe kwi-35-37 °C kwiiyure ezingama-24. Sebenzisa i-caliper ukulinganisa Idayamitha yezowuni yothintelo.Isithintelo se-Diameter-area satolikwa njengobuthathaka (S), phakathi (I), okanye ukumelana (R) ngokwezikhokelo zeClinical and Laboratory Standards Institute (CLSI)24.Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922) kunye ne-Pseudomonas aeruginosa (ATCC 27853) zisetyenziswe njengeentlobo zokulawula umgangatho ukujonga ukusebenza kwe-antibiotics.
Kwiibhaktheriya zeGram-negative, sisebenzisa iipleyiti ze-antibiotic: i-amoxicillin / clavulanate (30 μg);i-ciprofloxacin (5 μg);i-nitrofurantoin (300 μg);ampicillin (10 μg);i-amikacin (30 μg);I-Meropenem (10 μg);I-Piperacillin-tazobactam (100/10 μg);I-Cefazolin (30 μg);I-Trimethoprim-sulfamethoxazole (1.25 / 23.75 μg).
Iidiski ze-Antibacterial ze-Gram-positive isolate zaziyi: penicillin (iiyunithi ezili-10);cefoxitin (30 μg);i-nitrofurantoin (300 μg);i-vancomycin (30 μg);i-trimethoprim-sulfamethoxazole (1.25 / g) 23.75 μg);I-Ciprofloxacin (5 μg);I-Doxycycline (30 μg) .Zonke iidiski ze-antimicrobial ezisetyenziswe kwisifundo sethu ziyimveliso ye-Oxide, i-Basingstoke kunye ne-Hampshire, eNgilani.
Njengoko kuboniswe kwiThebhile 1, olu pho nonongo lubhalise izigulane ze-227 (227) zabantwana eziye zabonisa okanye zakrokrelwa kakhulu ukuba zine-UTI kwaye zadibana neendlela zokhetho. kunye nomlinganiso webhinqa ukuya kumadoda we-1.6: 1. Inani lezifundo ezifundwayo zaziguquguquka kumaqela eminyaka yobudala, kunye ne-˂ 3-iqela leminyaka ubudala elinezigulane ezininzi (119; 52.4%), ilandelwa yi-13-15- oneminyaka ubudala (37; 16.3%) kunye namaqela 3-6 ubudala ubudala (31; 13.7%), ngokulandelanayo.Iinjongo zophando ikakhulu izixeko, kunye nomlinganiselo wedolophu-maphandleni 2.4:1 (Itheyibhile 1).
Itheyibhile 1 Iimpawu zentlalo yabantu kwizifundo zokufunda kunye nokuphindaphinda kweesampulu ezilungileyo ngokwenkcubeko (N= 227)
Ukukhula okubalulekileyo kwebhaktiriya/igwele kuye kwabonwa kwisampulu zomchamo ezingama-65 zama-227 (227) zokuxhaphaka ngokubanzi kwe-28.6% (65/227), apho i-21.6% (49/227) yayiziintsholongwane zentsholongwane, ngelixa i-7% (16/227) yayizizifo zokungunda.Ukuxhaphaka kwe-UTI kwakuphezulu kwiqela leminyaka yobudala eli-13-15 ku-17/37 (46.0%) kwaye kwiqela leminyaka eyi-10-12 lalisezantsi ngo-2/21 (9.5%).Itheyibhile 2) .Abasetyhini babenezinga eliphezulu le-UTIs, 30/89 (33.7%), xa kuthelekiswa nama-35/138 (25.4%) amadoda.
Kwi-49 ye-bacterial isolate, i-79.6% (39/49) yayiyi-Enterobacteriaceae, apho i-Escherichia coli yayiyeyona bhaktheriya eqhelekileyo ibala i-42.9% (21/49) yee-bacterial isolates, ilandelwa yi-Klebsiella pneumoniae bacteria, i-akhawunti ye-34.6% ( I-17/49) yee-bacterial isolates.I-4 (8.2%) i-isolates imelwe yi-Acinetobacter, i-Gram-negative bacillus engavundiyo.Iibhaktheriya ze-Gram-positive zibalelwa kwi-10.2% (5/49) kuphela ye-bacterial isolate, apho i-3 ( I-60.0%) yayiyi-Enterococcus.Kwi-16 yeast isolate, i-6 (37.5%) imelwe yi-C. albicans.Kwi-26 ye-uropathogens efunyenwe luluntu, i-76.9% (20/26) yayiyi-Escherichia coli kunye ne-Klebsiella pneumoniae.Of the 20 -i-uropathogens efunyenweyo, i-15 / 20 yayiyi-bacterial pathogens.Kwi-uropathogens efunyenwe yi-ICU ye-19, i-10/19 yayiyiyeast.Kwi-65 yeesampuli ze-urine-positive, i-39 (60.0%) yafunyanwa esibhedlele kunye ne-26 (40.0%) ifunyenwe kuluntu (Itheyibhile 3).
Itheyibhile 3 Uhlalutyo lokuhlengahlengiswa kwezinto ezinobungozi ezinxulumene nokusuleleka kwintsholongwane yomchamo kwizigulane zabantwana abane-SPHMMC (n = 227)
Kwizigulane zabantwana ezingama-227, i-129 yalaliswa esibhedlele ixesha elingaphantsi kweentsuku ezi-3, apho ama-25 (19.4%) aye anempilo enkenenkene, i-120 yalaliswa kwikliniki yezigulana ezingalaliswayo, apho ama-25 (20.8%) aye anempilo enkenenkene, kwaye ama-63 aye agula. imbali yosulelo lomjelo womchamo.Phakathi kwabo, i-23 (37.70%) yayilungile kwinkcubeko, i-38 yayikwi-catheter yangaphakathi, i-20 (52.6%) yayiyinkcubeko, kwaye i-71 yayilungile kubushushu bomzimba> 37.5 ° C, apho i-21 (29.6%) zazilungile kwinkcubeko (Itheyibhile 3).
Abaqikeleli be-UTI bahlalutywa nge-bivariately, kwaye babenexabiso lokuhlehliswa kokusebenza ixesha elide lokuhlala iinyanga ezi-3-6 (COR 2.122; 95% CI: 3.31-3.43; P=0.002) kunye ne-catheterization (COR= 3.56; 95) %CI : 1.73–7.1;P = 0.001) .Uhlalutyo oluninzi lwenziwa kwi-bivariately ebalulekileyo yokubikezela kwe-UTI kunye nala maxabiso alandelayo okubuyisela izinto: ubude beenyanga ezi-3-6 (AOR = 6.06, 95% CI: 1.99-18.4; P = 0.01) kunye ne-catheterization (i-catheterization) I-AOR = 0.28; 95% CI: 0.13-0.57, P = 0.04) .Ubude bokuhlala esibhedlele kwiinyanga ze-3-6 zazixhomekeke kakhulu kwi-UTI (P = 0.01). P = 0.04) .Nangona kunjalo, indawo yokuhlala, isondo, ubudala, umthombo wokwamkelwa, imbali yangaphambili ye-UTI, isimo se-HIV, ukushisa komzimba, kunye nokusuleleka okungapheliyo akuzange kufunyanwe ukuba kuhambelana kakhulu ne-UTI (Itheyibhile 3).
Itheyibhile 4 kunye ne-5 ichaza iipatheni zokuchasana kwe-antimicrobial ye-Gram-negative kunye ne-Gram-positive ibhakteria kwii-antibiotics ezisithoba ezivavanyiweyo.I-Amikacin kunye ne-meropenem yayiyeyona mayeza asebenzayo avavanywe kwiibhaktheriya ze-Gram-negative, kunye namazinga okumelana ne-4.6% kunye ne-9.1%, ngokulandelelana.Phakathi kwawo onke amayeza avavanyiweyo, iibhaktheriya zeGram-negative zezona zixhathisayo kwi-ampicillin, cefazolin, kunye ne-trimethoprim-sulfamethoxazole, kunye namazinga okumelana ne-100%, 92.1%, kunye ne-84.1%, ngokulandelanayo.E.coli, olona hlobo luxhaphakileyo olufunyenweyo, lwalunokuxhathisa okuphezulu kwi-ampicillin (100%), i-cefazolin (90.5%), kunye ne-trimethoprim-sulfamethoxazole (80.0%).I-Klebsiella pneumoniae yayiyeyesibini intsholongwane ehlala yodwa, enezinga lokuxhathisa lama-94.1%. ukuya kwi-cefazolin kunye ne-88.2% ukuya kwi-trimethoprim / sulfamethoxazole Itheyibhile 4.Izinga eliphezulu lokuxhathisa (i-100%) yebhaktheriya ye-Gram-positive yabonwa kwi-trimethoprim / sulfamethoxazole, kodwa zonke ii-isolate ze-Gram-positive bacteria (100%) zazichaphazeleka kwi-oxacillin ( itafile 5).
Usulelo lwe-Urinary tract infections (UTIs) luhlala luyenye yezona zizathu zixhaphakileyo zokugula kunyango lwabantwana.Ukuxilongwa kwangethuba kwe-UTI ebantwaneni kubalulekile kuba inokuba ngumqondiso wezintso ezingaqhelekanga ezifana nokukrala, uxinzelelo lwegazi, kunye nesifo sezintso. isifundo sethu, ukuxhaphaka kwezifo ze-urinary tract yi-28.6%, apho i-21.6% ibangelwa yintsholongwane ye-bacterial pathogens kunye ne-7% yi-fungal pathogens.Kuphononongo lwethu, ubungakanani bentsholongwane ye-urinary tract ebangelwa ibhaktheriya yayiphezulu kune-15.9% yokuxhaphaka kwengxelo. e-Ethiopia nguMerga Duffa et al.Ngokufanayo, i-27.5% et al 19 Isiganeko se-UTIs ngenxa yemvubelo e-Ethiopia, ngakumbi abantwana, ayaziwa ngokuba sibhekisela kwireferensi.Oku kungenxa yokuba izifo zefungal ngokuqhelekileyo zithathwa njengento engabalulekanga ngaphezu kwezifo zebhaktheriya kunye nentsholongwane e-Ethiopia.Ngoko ke, iziganeko zegwele. -i-induction ye-urinary tract infection kwizigulane zabantwana ezichazwe kolu phononongo yi-7%, eyokuqala kweli lizwe.Ukuxhaphaka kwe-UTIs okubangelwa imvubelo echazwe kwisifundo sethu kuhambelana nokuxhaphaka kwe-5.2% echazwe kwisifundo kubantwana ngu-Seifi et. al.25 Nangona kunjalo, i-Zarei ibike ukuxhaphaka kwe-16.5% kunye ne-19.0% - i-Mahmoudabad et al 26 kunye ne-Alkilani et al 27 e-Iran nase-Egypt, ngokulandelanayo.Ukuxhaphaka okuphezulu kwezi zifundo zimbini akumangalisi kuba izifundo ezibandakanyiweyo zazizigulane ze-ICU. ngaphandle kokukhetha ubudala.Ukwahluka kokuxhaphaka kwe-UTIs phakathi kwezifundo kunokuvela kumahluko kuyilo lokufunda, iimpawu ze-sociodemographic kwizifundo zokufunda, kunye ne-comorbidities.
Kuphononongo lwangoku, i-60% ye-UTIs yafunyanwa esibhedlele (iyunithi yokunyamekela kakhulu kunye ne-ward-acquired) . Iziphumo ezifanayo (78.5%) zabonwa ngu-Aubron et al.I-28, nangona ukuxhaphaka kwe-UTIs kumazwe asakhasayo kwahluka ngokufunda kunye nommandla, kungekho ntlukwano yengingqi kwi-bacterial and fungal pathogens ebangela i-UTIs.Iibhaktheriya eziqhelekileyo ezifunyenwe kwiinkcubeko zomchamo zaziyi-Gram-negative bacilli, ikakhulukazi i-Escherichia coli, ilandelwa nguKlebsiella. I-pneumoniae.6,29,30 Ngokuhambelana nezifundo ezifanayo zangaphambili, i-29,30 isifundo sethu siphinde sabonisa ukuba i-Escherichia coli yayiyeyona bhaktheriya eqhelekileyo.Iibhaktheriya eziqhelekileyo zibalelwa kwi-42.9% yee-bacterial isolates ezipheleleyo, ezilandelwa yi-Klebsiella pneumoniae, eyabalelwa kwi-34.6%. ye-bacterial isolates.I-Escherichia coli yayiyeyona ndlela ixhaphakileyo ye-bacterial pathogen kuluntu- kunye ne-UTIs efunyenwe esibhedlele (57.1% kunye ne-42.9%, ngokulandelanayo) .Izifundo ezininzi zibonise ukuba i-Candida yimbangela ubuncinane ye-10-15% yesibhedlele esifunyenweyo. ukusuleleka kwe-urinary tract kwizicwangciso zesibhedlele, kwaye i-candida ixhaphake ngokukodwa kwiiyunithi zokunyamekela kakhulu.31-33 Kwisifundo sethu, i-Candida ibalwa kwi-7% ye-UTIs, i-94% yazo yayiyi-nosocomial-acquired, apho i-62.5% yabonwa kwizigulane ze-ICU. .Candida albicans yayingoyena nobangela we-candidiasis, kwaye i-81.1% yeCandida yabekwa yodwa kumchamo ofunyenwe ewodini kunye ne-ICU efunyenwe kwi-ICU. izigulana ezibuthathaka njengezigulana ze-ICU.
Kolu phononongo, abasetyhini bachaphazeleka ngakumbi kunamadoda kwizifo ze-urinary tract, kwaye izigulane ezikwi-12-15 yeqela leminyaka ubudala zazichaphazeleka ngakumbi.Nangona kunjalo, umahluko phakathi kwezi meko zimbini wawungabalulekanga ngokwezibalo.Ukungabikho kobudlelwane phakathi kwe-UTI kunye nesini kunye Ubudala bunokuchazwa liqela eliphambili apho izigulane zaye zafunyanwa khona.Ngenxa yeepateni ze-epidemiological ze-UTIs, iziganeko zamadoda kunye nabasetyhini zibonakala zilingana ebuntwaneni, kunye nobukhulu bendoda kwixesha lokuzala kunye nokugqithiswa kwabasetyhini ebuntwaneni bokuqala. kunye nangexesha lokuqeqeshwa kwendlu yangasese.Phakathi kwezinye izinto ezinobungozi ezihlalutyiweyo, ukuhlala esibhedlele kweentsuku ze-3-30 kwakudityaniswa ne-UTI (P = 0.01) .Ulungelelwaniso phakathi kobude besibhedlele kunye ne-UTI yabonwa kwezinye izifundo.34,35 UTI kwi uphononongo lwethu lwalunxulumene kakhulu ne-catheterization (P = 0.04) .Ngokutsho kweGokula et al.35 kunye noSaint et al.I-36, i-catheterization yandisa ingozi ye-UTIs nge-3 ukuya kwi-10%, kuxhomekeke kubude be-catheterization.Imiba yokukhusela i-sterility ngexesha lokufakwa kwe-catheter, ukutshintshwa kwe-catheter engapheliyo, kunye nokunyamekela kwe-catheter engafanelekanga kunokukhokelela ekunyuseni kwe-catheter-related infections.
Ngethuba lexesha lokufunda, izigulane ezininzi zabantwana abangaphantsi kweminyaka emithathu ubudala zangeniswa esibhedlele kunye neempawu zokusuleleka kwintsholongwane ye-urinary kunamanye amaqela eminyaka.Oku kungenxa yokuba le minyaka yobudala yokuqeqeshwa kweembiza, ehambelana nezinye izifundo.37- 39
Kolu phononongo, iibhaktheriya zeGram-negative zezona zixhathisayo kwi-ampicillin kunye ne-trimethoprim-sulfamethoxazole, kunye namazinga okumelana ne-100% kunye ne-84.1%, ngokulandelanayo.Ezona zifunyenwe rhoqo i-Escherichia coli kunye ne-Klebsiella pneumoniae bezixhathisa ngakumbi kwi-ampicillin (100%) kwaye I-trimethoprim-sulfamethoxazole (81.0%).Ngokufanayo, izinga eliphezulu lokuxhathisa (100%) kwi-Gram-positive ibhaktheriya yabonwa kwi-trimethoprim/sulfamethoxazole.I-Ampicillin kunye ne-trimethoprim-sulfamethoxazole isetyenziswe ngokubanzi njengonyango lokuqala lwe-empiric lwezifo ze-urinary tract. kuzo zonke izibonelelo zempilo e-Ethiopia, njengoko kucetyiswa nguMphathiswa wezeMpilo weSikhokelo soNyango lwezeMpilo (STG) .40-42 Amazinga okumelana ne-gram-negative kunye ne-gram-positive ibhaktheriya kwi-ampicillin kunye ne-trimethoprim-sulfamethoxazole kolu cwaningo.Ukusetyenziswa kwamachiza okuqhubekayo uluntu lwandisa amathuba okukhethwa kunye nokugcinwa kweentlobo ezixhatshazwayo kweso silungiselelo.43-45 Ngakolunye uhlangothi, uphando lwethu lubonise ukuba i-amikacin kunye ne-meropenem yayiyeyona mayeza asebenzayo ngokumelene ne-Gram-negative bacteria kunye ne-oxacillin yayiyeyona nto isebenzayo kwi-Gram. -ibhaktheriya ezintle.Idatha kweli nqaku ithathwe kwiphepha elingashicilelwa nguNuhamen Zena, elifakwe kwi-Addis Ababa University Institutional Repository.46
Ngenxa yeengxaki zezibonelelo, asikwazanga ukwenza uvavanyo lwe-antifungal susceptibility test kwi-pathogens yefungal echongiweyo kolu phononongo.
Ubuninzi be-UTIs bubonke ibingama-28.6%, apho i-75.4% (49/65) ibiyi-UTI enxulumene nebhaktiriya kwaye i-24.6% (19/65) ibizi-UTI ezibangelwa yigwele.I-Enterobacteriaceae ingoyena nobangela wosulelo lomgudu womchamo.Zombini i-C. I-albicans kunye ne-non-albicans C. albicans ziye zadibaniswa ne-UTI ebangelwa imvubelo, ngakumbi kwizigulane ze-ICU.Ubude besibhedlele sokuhlala kunye ne-catheterization ye-3 ukuya kwiinyanga ze-6 zidibene kakhulu ne-UTI.Zombini iibhaktheriya zegram-negative kunye negram-positive ziphezulu kakhulu. ukumelana ne-ampicillin kunye ne-trimethoprim-sulfamethoxazole ekhuthazwa nguMphathiswa wezeMpilo kunyango olunamandla lwe-UTIs.Umsebenzi owongezelelweyo kufuneka wenziwe kwi-UTIs ebantwaneni, kwaye i-ampicillin kunye ne-trimethoprim-sulfamethoxazole kufuneka ithathelwe ingqalelo njengeziyobisi ezikhethiweyo zonyango lwe-UTIs.
Uphononongo luqhutywe ngokuhambelana neSibhengezo se-Helsinki.Zonke ingqwalasela yokuziphatha kunye nezibophelelo zibhekiswe ngokufanelekileyo kwaye uphando lwenziwa ngokuvunywa kokuziphatha kunye nemvume ye-SPHMMC evela kwiBhodi yokuHlola yangaphakathi yeSebe leNzululwazi yezoNyango, i-Faculty of Health Sciences, Addis. IYunivesithi yaseAbaba. Ekubeni isifundo sethu sasibandakanya abantwana (abangaphantsi kweminyaka eyi-16 ubudala), abazange bakwazi ukunika imvume ebhaliweyo yokwenene. Ngoko ke, ifomu yemvume kufuneka igcwaliswe ngumzali / umgcini. izibonelelo zichazwa ngokucacileyo kumzali/umgcini ngamnye.Abazali/abagcini babantwana bayacetyiswa ukuba iinkcukacha zomntwana ngamnye ziya kugcinwa ziyimfihlo.Umzali/umgcini uxelelwa ukuba umntwana wakhe akanyanzelekanga ukuba athathe inxaxheba kolu phando ukuba uyenzile. Ukungavumi ukuthatha inxaxheba kuphononongo.Bakuba bevumile ukuthatha inxaxheba kuphononongo kwaye bengenamdla wokuqhubeka, bakhululekile ukuba barhoxe kuphononongo nangaliphi na ixesha ngexesha lophononongo.
Sithanda ukubulela ugqirha wabantwana ohambayo kwindawo yophando ngokuphononongwa ngokucokisekileyo kwezigulane ngokwembono yenkcazo yeklinikhi.Sikwabulela kakhulu izigulane ezithathe inxaxheba kwisifundo.Singathanda ukubulela uNuhamen Zena ngokusivumela ukuba khupha idatha ebalulekileyo kuphando lwakhe olungapapashwanga, olufakwe kwindawo yokugcina iYunivesithi yaseAddis Ababa.
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Ixesha lokuposa: Apr-14-2022