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

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.Genişlemiş spektrumlu beta laktamaz (ESBL) üreten mikroorganizmalarla gelişen üriner sistem enfeksiyonları (ÜSE'ler) önemli bir sağlık sorunudur. ESBL pozitif mikroorganizmalarla gelişen ÜSE'si olan çocukların klinik ve laboratuvar özelliklerini ve ESBL pozitif enfeksiyon açısından risk faktörlerini değerlendirmek için planlanan çalışmamıza 0-17 yaş grubundaki toplumdan kazanılmış ÜSE'si olan vakalar (158 hastanın ESBL pozitif 178 atağı; 162 hastanın ESBL negatif 166 atağı) dahil edilmiştir. ESBL pozitifliği erkeklerde daha fazladır (p=0,046). İdrarda koku ve huzursuzluk ESBL pozitif grupta, hematüri ise ESBL negatif grupta daha fazla bulunmuştur (p=0,006 ve p=0,019). Semptom süresi ESBL pozitif grupta daha uzundur (p<0,001). İdrar incelemesinde lökosit sayısı ESBL negatif grupta daha fazladır (p=0,001). Lökositoz ve periferik yaymada polimorfonükleer lökosit hakimiyeti ESBL pozitif grupta daha az saptanmıştır (p=0,002 ve p<0,001). Her iki grupta en fazla izole edilen bakteri E. coli'dir. ESBL pozitif grupta aminoglikozidlere, kinolonlara, nitrofurantoine, TMP-SMZ'ye direnç daha fazladır. Altta yatan üriner sistem hastalığı, ÜSE için profilaktik antibiyotik kullanımı ve son 3 ay içinde hastanede yatış hikayesi ESBL pozitif ÜSE gelişiminde bağımsız risk faktörü olarak belirlenmiştir. ESBL pozitif ÜSE gelişme riskinin altta yatan bir üriner sistem hastalığı varlığında 2,22 kat (p=0,013), profilaktik antibiyotik kullanımında 2,71 kat (p=0,01) ve son 3 ay içinde hastanede yatma durumunda 3,35 kat (p=0,006) arttığı belirlenmiştir. ESBL pozitif grupta negatif gruba göre ultrasonografide daha fazla anormal bulgu saptanmıştır (p=0,005). ESBL pozitif gruptaki hastaların hastanede daha uzun süre yattığı belirlenmiştir (p=0,044). ÜSE'si olan çocuk hastalar değerlendirilirken ESBL pozitif hastaların klinik özelliklerinin farklılık gösterebileceği göz önünde bulundurulmalıdır. Altta yatan üriner sistem hastalığı olan, profilaktik antibiyotik kullanan ve son 3 ayda hastanede yatan çocuklarda antibiyotik seçimi artmış ESBL pozitif enfeksiyon riski dikkate alınarak yapılmalıdır

Diagnosis: Melanoderma After Hematopoietic Stem Cell Transplantation

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Cytokine profile in serum and gingival crevicular fluid of children with inflammatory bowel disease: A case-control study

Background: To evaluate the cytokine profile in gingival crevicular fluid (GCF) and serum of pediatric inflammatory bowel disease (IBD) patients and determine the cluster patterns of cytokines. Methods: Fifty IBD patients and 21 systemically healthy children were enrolled in the study. The GCF samples were collected from the participants during periodontal examination and periodontal indices were recorded. Based on activity indexes and response to conventional treatment, patients with IBD were further categorized into subgroups as: remission, active disease, and treatment-resistant. Serum samples were obtained from IBD patients to determine serum levels of cytokines. The levels of pro- (interleukin (IL)-1β, IL-12, IL-21, IL-22, IL-23, IL-17A, IL-17F) and anti-inflammatory (IL-4, IL-10) cytokines in serum and GCF were measured using Enzyme-linked Immunosorbent Assay (ELISA) kits. Results: Among 50 IBD patients, 58% were in remission, 20% had active disease, and 22% were defined as treatment-resistant. The severity of gingival inflammation measured by the criteria of Löe had increasing trends in IBD patients with active disease and treatment resistance. GCF IL-1β level was lower and GCF IL-4 and GCF IL-23 levels were higher in IBD patients compared to healthy controls. In the active disease group, more cytokine clusters occurred compared to the control group and other IBD subgroups, as explained by increased cytokine-cytokine interactions. Conclusions: Considering the increased complexity of cytokine interactions and the increased severity of gingival inflammation in patients with active disease, it can be concluded that disease activity might have an impact on gingival inflammation in pediatric patients with IBD