Evrim ALYAMAÇ DİZDAR, Handan BEZİRGANOĞLU, Fatma Nur SARI, Cüneyt TAYMAN, Esra BEŞER ÖZMEN, Burak CERAN, Şerife Suna OĞUZ

Yenidoğan Yoğun Bakım Ünitesinde İdrar Yolu Enfeksiyonu Tanısı ile İzlenen Preterm Bebeklerin Retrospektif Değerlendirilmesi

Amaç: Yenidoğan yoğun bakım ünitesinde izlenen çok düşük doğumağırlıklı bebeklerde idrar yolu enfeksiyonu riski artmaktadır. Çalışmamızda, yenidoğan yoğun bakım ünitesinde takip edildiği dönemde idrar yoluenfeksiyonu tanısı alan preterm bebeklerin risk faktörlerini, klinik bulgularını, eşlik eden üriner anomali varlığını, en sık izole edilen patojenivurgulamayı amaçladık.Gereçler ve Yöntem: Ocak 2016 ve Aralık 2017 tarihleri arasında hastanemiz yenidoğan yoğun bakım ünitesinde izlenen ve idrar yolu enfeksiyonu (İYE) tanısı alan 27 hasta retrospektif olarak incelendi.Bulgular: Çalışmaya alınan hastaların %52’si kız (n:14) , %48’i erkekidi (n:13). Ortalama gestasyon haftası 34 hafta; doğum ağırlığı ise 2330gramdı. Hastaların tanı anındaki en sık semptomları sırasıyla beslenmeintoleransı, ateş ve apne idi (sırasıyla, %41, %33, %22). İdrar örnekleri26 hastada üretral kateterle, 1 hastada suprapubik aspirasyon ile alındı.Hastalarda ortalama postnatal 35. günde idrar yolu enfeksiyonu gelişti.En sık izole edilen etken patojen Klebsiella pneumonia (n:17, %63) iken;sıklık sırasına göre Escherichia coli, Enterobacter aerogenes, Entrerokok faecalis, Serratia fonticola diğer izole edilen mikroorganizmalar oldu.Eş zamanlı bakılan kan kültüründe üreme saptanmayan 21 (%78) hasta,izole İYE tanısı aldı. 2 hasta BOS kültüründe Klebsiella pneumonia üremesi olması nedeni ile menenjit tanısı aldı. Postnatal dönemde yapılanultrasonografik değerlendirmede 2 hastada üriner patoloji saptandı. İzlemde hiçbir hastanın üriner enfeksiyonu tekrarlamadı.Sonuç: Yenidoğan yoğun bakım ünitesinde izlenen preterm bebeklerdeidrar yolu enfeksiyonu sık görülmektedir. Klinik semptom varlığında veyageç neonatal sepsis tanısı düşünüldüğünde idrar kültürü geciktirilmedenalınmalıdır.

Retrospective Evaluation of Preterm Infants with Urinary Tract Infections in the Neonatal Intensive Care Unit

Aim: Very low birth weight infants admitted to the neonatal intensive care unit are at increased risk of urinary tract infection (UTI). In this study we aimed to assess the risk factors, clinical findings, presence of urinary anomalies, and most commonly isolated pathogens in preterm infants diagnosed with UTI. Materials and Method: Twenty-seven patients who admitted to the neonatal intensive care unit of our hospital and were diagnosed with UTI between January 2016 and December 2017 were evaluated retrospectively. Results: Fifty-two percent (n=14) of the patients included in the study were female and 48% (n=13) were male. The mean gestational age was 34 weeks and mean birth weight was 2330 grams. The most common symptoms at the time of diagnosis were feeding intolerance (41%), fever (33%), and apnea (22%). Urine samples were collected from 26 patients via urethral catheter and from 1 patient by suprapubic aspiration. Urinary tract infection developed at a mean of 35 days postnatally. The most commonly isolated agent was Klebsiella pneumonia (n=17, 63%), followed by Escherichia coli, Enterobacter aerogenes, Enterococcus faecalis, and Serratia fonticola. Twenty-one patients (78%) with negative blood cultures were diagnosed with isolated UTI. Two patients were diagnosed with meningitis due to Klebsiella pneumoniae growth in cerebrospinal fluid culture. Urinary anomaly was detected in two patients. There was no recurrence of urinary infection during the follow-up. Conclusion: UTIs are common among preterm infants in the neonatal intensive care unit. Urine culture should be performed immediately in the presence of clinical symptoms or if late neonatal sepsis is suspected.

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