Cov yam ntxwv ntawm cov kab mob thiab cov kab mob fungal ntawm cov kab mob urinary kab mob hauv cov menyuam yaus

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Adane Bitew, 1 Nuhamen Zena, 2 Abera Abdeta31 Department of Medical Laboratory Sciences, Kws qhia ntawv ntawm Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;2 Microbiology, Millennium School of Medicine, St Paul's Hospital, Addis Ababa, Ethiopia Department;3 National Reference Laboratory for Clinical Bacteriology and Mycology, Ethiopian Institute of Public Health, Addis Ababa, Ethiopia Tus Sau Sau: Abera Abdeta, National Reference Laboratory for Clinical Bacteriology and Mycology, Ethiopian Institute of Public Health, PO Box: 1242, Addis Ababa, Ethiopia , +251911566420, email [email tiv thaiv] keeb kwm yav dhau: UTIs yog cov kab mob sib kis hauv paediatrics.Kev paub txog kev ua rau cov kab mob urinary kab mob, lawv cov qauv ntawm cov tshuaj tiv thaiv kab mob, thiab cov teeb meem muaj feem cuam tshuam hauv cov chaw tshwj xeeb tuaj yeem muab pov thawj rau kev kho mob tsim nyog.Objectives : Txoj kev tshawb no tsom los txiav txim siab txog qhov tshwm sim thiab qhov tshwm sim ntawm cov kab mob uropathogens thiab cov kab mob urinary ib puag ncig, nrog rau cov tshuaj tua kab mob tiv thaiv kab mob ntawm cov kab mob cais tawm, thiab txhawm rau txheeb xyuas cov xwm txheej muaj feem cuam tshuam nrog cov kab mob urinary hauv cov neeg mob. Cov ntaub ntawv thiab cov txheej txheem: Txoj kev tshawb no tau ua txij lub Kaum Hli 2019 txog rau Lub Xya Hli 2020 ntawm Lub Tsev Kawm Ntawv Kho Mob Millennium, St. Paul's Hospital. Cov neeg mob cov zis tau sau aseptically, inoculated rau hauv xov xwm, thiab incubated ntawm 37 ° C rau 18-48 teev. Cov kab mob thiab cov poov xab raug txheeb xyuas raws li tus qauv. Cov txheej txheem.Antibiotic susceptibility testing of bacterial pathogens using the Kirby Bauer disc diffusion method.Descriptive statistics and logistic regression were used to kwv yees raw ratios with 95% trust intervals.P-value results: Cov kab mob loj/fungal loj hlob tau pom nyob rau hauv 65 cov qauv nrog ib tug Feem ntau ntawm 28.6%, ntawm cov uas 75.4% (49/65) thiab 24.6% (16/65) yog cov kab mob thiab cov kab mob fungal, raws li.Hais txog 79.6% ntawm cov kab mob etiologies yog Escherichia coli thiab Klebsiella pneumoniae.Resistance yog siab tshaj (rau ampicillary). 100%), cefazolin (92.1%) thiab trimethoprim-sulfamethoxazole (84.1%), uas yog feem ntau siv empirically hauv Ethiopia. Ntev nyob hauv tsev kho mob (P = 0.01) thiab catheterization (P = 0.04) tau txheeb xyuas nrog cov kab mob urinary. Cov ntsiab lus: Peb txoj kev tshawb fawb pom tias muaj cov kab mob urinary ntau heev.Enterobacteriaceae yog cov kab mob ua rau cov kab mob urinary.Length nyob hauv tsev kho mob thiab catheterization tau cuam tshuam nrog rau cov kab mob urinary.Ob leeg Gram-negative thiab Gram-positive bacteria tau tiv taus heev. ampicillin thiab trimethoprim-sulfamethoxazole.Keywords: Tshuaj tua kab mob susceptibility patterns, Pediatrics, Urinary tract infections, Ethiopia
Kab mob urinary tract infections (UTIs) tshwm sim los ntawm cov kab mob thiab cov poov xab yog ib qho ntawm cov kab mob urinary ntau tshaj plaws hauv cov menyuam yaus.Nyob hauv cov teb chaws tsim, nws yog tus thib peb feem ntau kis kab mob nyob rau hauv cov me nyuam hnub nyoog pab pawg neeg tom qab kab mob ua pa thiab gastrointestinal kab mob.2 kab mob plab hnyuv hauv cov me nyuam muaj feem cuam tshuam nrog rau lub sijhawm luv luv, nrog rau kub taub hau, dysuria, ceev ceev, thiab mob nraub qaum.Nws tseem tuaj yeem ua rau lub raum tsis zoo, xws li lub raum caws pliav thiab teeb meem mus sij hawm ntev, nrog rau cov ntshav siab thiab lub raum tsis ua haujlwm. 3 Wennerstrom et al15 tau piav qhia txog lub raum caws pliav hauv kwv yees li 15% ntawm cov menyuam yaus tom qab UTI thawj zaug, qhia txog qhov tseem ceeb ntawm kev kuaj mob sai thiab kev kho mob thaum ntxov ntawm cov kab mob urinary ib puag ncig. Tsis tas li ntawd, kev siv nyiaj rau kev tswj cov kab mob urinary cuam tshuam nrog kev kho mob yog heev.3, 4 Ntau qhov kev tshawb fawb ntawm UTIs menyuam yaus hauv ntau lub tebchaws tsim kho tau pom tias qhov ntau ntawm UTIs txawv ntawm 16% mus rau 34% 5-9 Ntxiv rau, txog li 8% ntawm cov menyuam hnub nyoog 1 hlis txog 11 xyoo yuav tsim tsawg kawg ib UTI10, thiab txog li 30% ntawm cov me nyuam mos thiab cov me nyuam paub tias muaj tus kab mob rov tshwm sim hauv thawj 6-12 lub hlis tom qab pib UTI .11
Cov kab mob Gram-negative thiab Gram-positive, nrog rau qee hom Candida, tuaj yeem ua rau muaj kab mob urinary.E.coli yog qhov ua rau muaj kab mob urinary ntau tshaj plaws, ua raws li Klebsiella pneumoniae.12 Kev tshawb fawb tau pom tias hom Candida, tshwj xeeb tshaj yog Candida albicans, tseem yog qhov ua rau Candida UTIs ntau tshaj plaws hauv cov menyuam yaus.13 Hnub nyoog, qhov xwm txheej ntawm kev txiav, thiab cov catheters hauv tsev muaj kev pheej hmoo. Cov xwm txheej rau UTIs hauv cov menyuam yaus.Cov tub hluas muaj kev pheej hmoo ntau dua nyob rau thawj xyoo ntawm lub neej, tom qab ntawd, vim qhov sib txawv ntawm cov kab mob sib deev, qhov tshwm sim feem ntau siab dua rau cov ntxhais, thiab cov menyuam mos uas tsis tau txiav plaub hau muaj kev pheej hmoo siab dua.1,33 Cov qauv tshuaj tua kab mob. ntawm cov kab mob uropathogens sib txawv nyob rau lub sijhawm, tus neeg mob thaj chaw nyob, cov pej xeem, thiab cov yam ntxwv kho mob.​​1
Cov kab mob kis tau zoo xws li UTIs tau xav tias yuav muaj lub luag haujlwm rau 26% ntawm cov neeg tuag thoob ntiaj teb, 98% ntawm cov uas tshwm sim hauv cov tebchaws tau nyiaj tsawg.14 Kev tshawb fawb ntawm cov neeg mob menyuam yaus hauv Nepal thiab Is Nrias teb tau tshaj tawm tag nrho cov UTIs ntawm 57% 15 thiab 48. %,16.Ib txoj kev tshawb fawb hauv tsev kho mob ntawm cov menyuam yaus South Africa tau pom tias cov kab mob urinary tau suav txog 11% ntawm kev noj qab haus huv.17 Lwm txoj kev tshawb fawb hauv Kenya pom tias cov kab mob urinary suav txog kwv yees li 11.9% ntawm cov kab mob febrile hauv cov menyuam yaus.18
Ob peb txoj kev tshawb fawb tau txheeb xyuas UTIs hauv cov neeg mob menyuam yaus hauv Ethiopia: kev tshawb fawb ntawm Hawassa Referral Tsev Kho Mob, Yekatit 12 Tsev Kho Mob, Felege-Hiwot Specialist Hospital thiab Gondar University Tsev Kho Mob tau pom 27.5%, 19 15.9%, 20 16.7%, 21 thiab 26.45% thiab hais txog. Nyob rau hauv cov teb chaws tsim, suav nrog Ethiopia, qhov tsis muaj cov kab lis kev cai tso zis ntawm ntau theem ntawm kev huv tseem ua tsis tau zoo vim tias lawv muaj peev xwm siv tau. Yog li ntawd, cov kab mob ntawm UTI thiab nws cov tshuaj tiv thaiv kab mob hauv Ethiopia tsis tshua paub. Txog qhov kawg, qhov no Txoj kev tshawb no tsom los txiav txim siab qhov tshwm sim ntawm cov kab mob urinary, txheeb xyuas cov kab mob thiab cov kab mob fungal cuam tshuam nrog UTIs, txiav txim siab cov kab mob tiv thaiv kab mob ntawm cov kab mob cais tawm, thiab txheeb xyuas cov teeb meem tseem ceeb cuam tshuam nrog UTIs.
Txij lub Kaum Hli 2019 txog Lub Xya Hli 2020, kev tshawb fawb hauv tsev kho mob hla ntu tau ua nyob rau ntawm Paediatrics Department of St Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Thaum lub sijhawm kawm, tag nrho cov neeg mob hauv menyuam yaus thiab cov neeg mob sab nraud tau pom hauv cov menyuam yaus.
Thaum lub sijhawm kawm, txhua tus neeg mob hauv menyuam yaus thiab cov neeg mob sab nraud nrog UTI cov tsos mob thiab cov tsos mob tuaj koom qhov chaw kawm.
Cov qauv loj tau txiav txim siab siv ib qho piv txwv qhov loj me ntawm kev suav cov mis nrog 95% kev ntseeg siab ib ntus, 5% npoo ntawm qhov yuam kev, thiab feem ntau ntawm UTIs hauv kev ua haujlwm dhau los [15.9% lossis P = 0.159)] Merga Duffa thiab al20 hauv Addis Ababa , raws li qhia hauv qab no.
Z α/2 = 95% kev ntseeg siab lub sijhawm tseem ceeb rau kev faib khoom ib txwm muaj, sib npaug rau 1.96 (Z tus nqi ntawm α = 0.05);
D = npoo ntawm qhov yuam kev, sib npaug li 5%, α = yog theem ntawm kev ua yuam kev tib neeg txaus siab zam;ntsaws cov no rau hauv cov qauv, n = (1.96)2 0.159 (1–0.159)/(0.05)2 = 206 thiab xav tias 10% tsis teb qhov twg n = 206 + 206/10 = 227.
Ib txoj hauv kev yooj yim piv txwv tau siv nyob rau hauv txoj kev tshawb no.Sau cov ntaub ntawv kom txog thaum cov qauv xav tau ua tiav.
Cov ntaub ntawv raug sau tom qab tau txais daim ntawv tso cai los ntawm niam txiv.Cov yam ntxwv ntawm kev noj qab haus huv (hnub nyoog, poj niam los txiv neej, thiab qhov chaw nyob) thiab muaj feem cuam tshuam rau cov xwm txheej (catheter, UTI yav dhau los, tib neeg kev tiv thaiv kab mob HIV (HIV) xwm txheej, kev hlais, thiab ntev nyob hauv tsev kho mob) ntawm cov neeg koom nrog kev kawm tau sau los ntawm cov kws saib xyuas neeg mob tsim nyog siv cov ntaub ntawv qhia ua ntej.Ib daim ntawv nug uas tsim nyog rau kev kuaj. Cov tsos mob thiab cov tsos mob ntawm tus neeg mob thiab cov kab mob hauv lub hauv paus raug kaw los ntawm tus kws kho mob uas tuaj koom.
Ua ntej kev tsom xam: cov yam ntxwv ntawm kev noj qab haus huv (hnub nyoog, poj niam los txiv neej, thiab lwm yam) thiab cov ntaub ntawv kho mob thiab kev kho mob ntawm cov neeg koom nrog kev kawm tau raug sau los ntawm daim ntawv nug.
Kev Ntsuam Xyuas: Kev ua haujlwm ntawm autoclave, incubator, reagents, microscope, thiab microbiological zoo ntawm qhov nruab nrab (sterility ntawm nruab nrab thiab kev loj hlob kev ua tau zoo ntawm txhua qhov nruab nrab) raug soj ntsuam raws li cov txheej txheem txheej txheem ua ntej siv.Sau thiab thauj cov tshuaj ntsuam xyuas tau ua. Tom qab aseptic cov txheej txheem.Qhov inoculation ntawm kev kuaj mob tau ua nyob rau hauv ib tug thib ob kev ruaj ntseg txee.
Tom qab Kev Ntsuam Xyuas: Tag nrho cov ntaub ntawv tau muab rho tawm (xws li cov txiaj ntsig hauv chav kuaj) raug kuaj xyuas kom tsim nyog, ua tiav thiab sib xws thiab sau tseg ua ntej nkag mus rau cov cuab yeej txheeb cais.Cov ntaub ntawv kuj tseem khaws cia rau hauv qhov chaw ruaj ntseg. Cov kab mob thiab cov poov xab cais tau khaws cia raws li Cov Txheej Txheem Kev Ua Haujlwm ( SOP) ntawm St. Paul's Hospital Millennium Medical College (SPHMMC).
Tag nrho cov ntaub ntawv rau cov kev tshawb fawb tau raug coded, muab ob npaug rau nkag, thiab tshuaj ntsuam siv cov Statistical Package for the Social Sciences (SPSS) software version 23.Siv piav qhia cov txheeb cais thiab logistic regression los kwv yees qhov sib piv ntxhib nrog 95% kev ntseeg siab lub sijhawm rau ntau qhov sib txawv.P qhov tseem ceeb <0.05 tau suav tias yog qhov tseem ceeb.
Cov zis kuaj tau raug sau los ntawm txhua tus neeg mob uas siv cov tso zis tsis muaj menyuam. Cov niam txiv lossis cov neeg saib xyuas ntawm cov neeg koom nrog kev kawm tau muab cov lus qhia tsim nyog yuav ua li cas sau cov zis hauv nruab nrab ntawm cov zis.Catheter thiab suprapubic urine samples tau sau los ntawm cov kws saib xyuas neeg mob thiab kws kho mob.Tam sim ntawd tom qab sau. , cov qauv raug coj mus rau SPHMMC's microbiology laboratory rau kev ua haujlwm ntxiv.Cov qauv ntawm cov qauv tau muab tso rau hauv MacConkey agar daim hlau (Oxoid, Basingstoke thiab Hampshire, England) thiab ntshav agar (Oxoid, Basingstoke thiab Hampshire, England) xov xwm nyob rau hauv lub txee ruaj ntseg siv a 1 μL calibration loop.Cov qauv seem tau muab tso rau ntawm lub paj hlwb infusion agar ntxiv nrog chloramphenicol (100 µgml-1) thiab gentamicin (50 µgml-1) (Oxoid, Basingstoke, thiab Hampshire, England).
Tag nrho cov inoculated daim hlau tau incubated aerobically ntawm 37 ° C rau 18-48 teev thiab kuaj xyuas cov kab mob thiab/los yog cov poov xab loj hlob.Colony suav ntawm cov kab mob los yog poov xab uas tsim ≥105 cfu/mL zis tau txiav txim loj loj hlob. Cov zis kuaj yielding peb los yog ntau hom. tsis raug txiav txim siab rau kev tshawb nrhiav ntxiv.
Ntshiab cais tawm ntawm cov kab mob pathogens tau pib tshwm sim los ntawm colony morphology, Gram staining.Gram-positive kab mob tau ntxiv tus cwj pwm siv catalase, bile aescin, pyrrolidinopeptidase (PRY) thiab luav plasma.Gram-negative kab mob los ntawm kev kuaj biochemical niaj hnub xws li (urease test, indole test, citrate utilization test, trisaccharide iron test, hydrogen sulfide (H2S) ntau lawm test, lysine iron agar test, motility test thiab oxidase test) mus rau qib hom).
Cov poov xab raug txheeb xyuas siv cov txheej txheem niaj hnub kuaj xyuas xws li Gram staining, embryo tube kuaj, carbohydrate fermentation thiab assimilation assays siv chromogenic nruab nrab (CHROMagar Candida nruab nrab, bioM'erieux, Fabkis) raws li cov chaw tsim khoom cov lus qhia.
Antimicrobial susceptibility testing tau ua los ntawm Kirby Bauer disc diffusion ntawm Mueller Hinton agar (Oxoid, Basingstoke, England) raws li Clinical Laboratory Standards Institute (CLSI) cov lus qhia24.Bacterial suspensions ntawm txhua qhov kev rho tawm tau npaj hauv 0.5 mL ntawm cov zaub mov noj thiab kho rau turbidity. Ua kom haum rau 0.5 McFarland tus qauv kom tau txais kwv yees li 1 × 106 colony-forming units (CFUs) ib mL ntawm biomass.Dip ib sterile swab rau hauv kev ncua thiab tshem tawm cov khoom ntau dhau los ntawm nias nws tawm tsam sab ntawm lub raj.Cov swabs ces smeared hauv Qhov nruab nrab ntawm Mueller Hinton agar phaj thiab muab faib sib npaug ntawm qhov nruab nrab.Cov tshuaj tua kab mob tau muab tso rau ntawm Mueller Hinton agar noob nrog txhua qhov sib cais hauv 15 feeb ntawm inoculation thiab incubated ntawm 35-37 ° C rau 24 teev.Siv lub caliper los ntsuas cov txoj kab uas hla ntawm thaj tsam ntawm inhibition.Diameter-cheeb tsam inhibition tau txhais raws li rhiab (S), nruab nrab (I), lossis resistant (R) raws li Clinical and Laboratory Standards Institute (CLSI) cov lus qhia24.Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922) thiab Pseudomonas aeruginosa (ATCC 27853) tau siv los ua hom kev tswj xyuas kom zoo los xyuas qhov ua tau zoo ntawm cov tshuaj tua kab mob.
Rau cov kab mob Gram-negative, peb siv cov tshuaj tua kab mob: amoxicillin / clavulanate (30 μg);ciprofloxacin (5 μg);nitrofurantoin (300 μg);ampicillin (10 μg);amikacin (30 μg);Meropenem (10 μg);Piperacillin-tazobactam (100/10 μg);Cefazolin (30 μg);Trimethoprim-sulfamethoxazole (1.25/23.75 μg).
Antibacterial discs rau Gram-positive cais yog: penicillin (10 units);cefoxitin (30 μg);nitrofurantoin (300 μg);vancomycin (30 μg);trimethoprim-sulfamethoxazole (1.25/g) 23.75 μg;Ciprofloxacin (5 μg);Doxycycline (30 μg).Tag nrho cov tshuaj tua kab mob siv hauv peb txoj kev tshawb fawb yog cov khoom ntawm Oxide, Basingstoke thiab Hampshire, England.
Raws li pom nyob rau hauv Table 1, txoj kev tshawb no tau cuv npe kawm 227 (227) cov neeg mob menyuam yaus uas tau pom lossis xav tias muaj UTI thiab ua tau raws li cov txheej txheem xaiv.Txiv neej txoj kev kawm (138; 60.8%) outnumbered poj niam koom nrog (89; 39.2%), nrog ib tug poj niam rau txiv neej piv ntawm 1.6: 1.Tus naj npawb ntawm cov kev kawm tau sib txawv ntawm cov hnub nyoog, nrog rau cov hnub nyoog 3 xyoos muaj cov neeg mob ntau tshaj (119; 52.4%), ua raws li 13-15- xyoo-laus (37; 16.3%) thiab 3-6-xyoo-laus pawg (31; 13.7%), ntsig txog.Cov khoom tshawb fawb yog cov nroog loj, nrog rau hauv nroog-nyob deb nroog piv ntawm 2.4: 1 (Table 1).
Table 1 Socio-demographic yam ntxwv ntawm kev kawm cov kev kawm thiab zaus ntawm cov qauv kev coj noj coj ua zoo (N = 227)
Kev loj hlob ntawm cov kab mob / cov poov xab tseem ceeb tau pom nyob rau hauv 65 ntawm 227 (227) cov zis kuaj rau tag nrho ntawm 28.6% (65/227), uas 21.6% (49/227) yog cov kab mob kab mob, thaum 7% (16/227) yog cov kab mob fungal.Qhov feem ntau ntawm UTI yog siab tshaj nyob rau hauv pawg hnub nyoog 13-15 xyoo ntawm 17/37 (46.0%) thiab hauv pawg hnub nyoog 10-12 xyoo nws qis tshaj ntawm 2/21 (9.5%).Table 2). .Cov poj niam muaj feem ntau ntawm UTIs, 30/89 (33.7%), piv rau 35/138 (25.4%) txiv neej.
Ntawm 49 cov kab mob cais tawm, 79.6% (39/49) yog Enterobacteriaceae, ntawm cov Escherichia coli yog cov kab mob ntau tshaj plaws suav nrog 42.9% (21/49) ntawm tag nrho cov kab mob cais tawm, ua raws li cov kab mob Klebsiella pneumoniae, suav txog 34.6% ( 17/49) ntawm cov kab mob isolates.Four (8.2%) cais tau sawv cev los ntawm Acinetobacter, ib tug non-fermenting Gram-negative bacillus.Gram-zoo kab mob account rau tsuas 10.2% (5/49) ntawm cov kab mob cais, ntawm uas 3 ( 60.0%) yog Enterococcus. Ntawm 16 cov poov xab cais, 6 (37.5%) tau sawv cev los ntawm C. albicans. Ntawm 26 lub zej zog tau txais uropathogens, 76.9% (20/26) yog Escherichia coli thiab Klebsiella pneumoniae.Owardf lub -tau txais uropathogens, 15/20 yog cov kab mob bacterial pathogens. Ntawm 19 ICU-acquired uropathogens, 10/19 yog cov poov xab. Ntawm 65 kab lis kev cai-zoo zis kuaj, 39 (60.0%) tau mus tsev kho mob thiab 26 (40.0%) yog zej zog tau txais (Table 3).
Table 3 Logistic regression tsom xam ntawm qhov muaj feem cuam tshuam txog kev kis kab mob urinary hauv cov neeg mob nrog SPHMMC (n = 227)
Ntawm 227 tus neeg mob menyuam yaus, 129 tau pw hauv tsev kho mob tsawg dua 3 hnub, ntawm 25 (19.4%) yog kab lis kev cai zoo, 120 tau mus rau hauv tsev kho mob sab nraud, ntawm 25 (20.8%) yog kab lis kev cai, thiab 63 muaj keeb kwm ntawm kev kis kab mob urinary.Ntawm lawv, 23 (37.70%) tau zoo rau kab lis kev cai, 38 tau rau hauv tsev catheter, 20 (52.6%) tau zoo rau kab lis kev cai, thiab 71 tau zoo rau lub cev kub> 37.5 ° C, ntawm 21 (29.6%). tau zoo rau kab lis kev cai (Table 3).
Predictors ntawm UTI tau soj ntsuam bivariately, thiab lawv muaj logistic regression qhov tseem ceeb rau lub sij hawm nyob twj ywm 3-6 lub hlis (COR 2.122; 95% CI: 3.31-3.43; P = 0.002) thiab catheterization (COR = 3.56; 95)% CI : 1.73–7.1;P = 0.001).Multiple regression analysis tau ua nyob rau hauv bivariately tseem ceeb kwv yees ntawm UTI nrog cov nram qab no logistic regression qhov tseem ceeb: ntev ntawm nyob 3-6 lub hlis (AOR = 6.06, 95% CI: 1.99-18.4; P = 0.01) thiab catheterization ( AOR = 0.28; 95% CI: 0.13–0.57, P = 0.04).Lub sijhawm nyob hauv tsev kho mob ntawm 3-6 lub hlis tau txheeb xyuas nrog UTI (P = 0.01).Kev koom tes ntawm UTI nrog catheterization kuj tseem ceeb heev ( P = 0.04).Txawm li cas los xij, qhov chaw nyob, poj niam txiv neej, hnub nyoog, qhov chaw nkag, keeb kwm yav dhau los ntawm UTI, HIV xwm txheej, lub cev kub, thiab kev kis kab mob ntev tsis pom tias muaj feem cuam tshuam nrog UTI (Table 3).
Tables 4 thiab 5 piav qhia txog tag nrho cov tshuaj tiv thaiv kab mob tsis zoo ntawm cov kab mob Gram-negative thiab Gram-positive rau cuaj cov tshuaj tua kab mob uas tau soj ntsuam.Amikacin thiab meropenem yog cov tshuaj zoo tshaj plaws uas tau sim tawm tsam cov kab mob Gram-negative, nrog rau tus nqi kuj ntawm 4.6% thiab 9.1%, Raws li, ntawm tag nrho cov tshuaj ntsuam xyuas, cov kab mob Gram-negative yog cov feem ntau resistant rau ampicillin, cefazolin, thiab trimethoprim-sulfamethoxazole, nrog rau cov nqi ntawm 100%, 92.1%, thiab 84.1%, feem.coli, hom kab mob zoo tshaj plaws, muaj kev tiv thaiv ntau dua rau ampicillin (100%), cefazolin (90.5%), thiab trimethoprim-sulfamethoxazole (80.0%). rau cefazolin thiab 88.2% rau trimethoprim/sulfamethoxazole Table 4.Qhov siab tshaj plaws zuag qhia tag nrho cov kab mob (100%) ntawm Gram-positive kab mob tau pom nyob rau hauv trimethoprim/sulfamethoxazole, tab sis tag nrho cov cais ntawm Gram-positive kab mob (100%) tau raug oxacillin ( tab 5).
Cov kab mob urinary tract (UTIs) tseem yog ib qho ntawm feem ntau ua rau mob morbidity nyob rau hauv cov me nyuam txoj kev xyaum.Kev kuaj mob thaum ntxov ntawm UTI nyob rau hauv cov me nyuam yog ib qho tseem ceeb vim hais tias nws muaj peev xwm ua tau ib qho kev qhia ntawm lub raum txawv txav xws li caws pliav, kub siab, thiab lub raum theem kawg. peb txoj kev tshawb fawb, qhov tshwm sim ntawm cov kab mob urinary yog 28.6%, ntawm qhov uas 21.6% yog tshwm sim los ntawm cov kab mob kab mob thiab 7% los ntawm cov kab mob fungal.Hauv peb txoj kev tshawb fawb, cov kab mob urinary kab mob tshwm sim los ntawm cov kab mob siab dua li ntawm 15.9% tshaj tawm qhia. hauv Ethiopia los ntawm Merga Duffa et al.Ib yam li ntawd, 27.5% thiab al 19 Qhov tshwm sim ntawm UTIs vim yog cov poov xab hauv Ethiopians, tshwj xeeb tshaj yog cov menyuam yaus, tsis paub txog peb qhov kev siv.Qhov no yog vim cov kab mob fungal feem ntau suav hais tias tsis tshua muaj txiaj ntsig zoo li kab mob thiab kab mob hauv Ethiopia.Yog li ntawd, qhov tshwm sim ntawm cov poov xab. -induced urinary tract infection nyob rau hauv cov me nyuam cov neeg mob qhia nyob rau hauv no txoj kev tshawb no yog 7%, thawj nyob rau hauv lub teb chaws.Qhov ntau ntawm UTIs tshwm sim los ntawm cov poov xab qhia nyob rau hauv peb txoj kev tshawb no yog zoo ib yam li cov prevalence ntawm 5.2% qhia nyob rau hauv ib txoj kev tshawb no nyob rau hauv cov me nyuam los ntawm Seifi et al.25 Txawm li cas los xij, Zarei tau tshaj tawm txog qhov tshwm sim ntawm 16.5% thiab 19.0% - Mahmoudabad li al 26 thiab Alkilani li al 27 hauv Iran thiab Egypt, feem.Qhov ntau dua hauv ob txoj kev tshawb fawb no tsis yog qhov xav tsis thoob vim cov kev kawm suav nrog yog cov neeg mob ICU. tsis muaj hnub nyoog nyiam.Qhov sib txawv ntawm qhov ntau ntawm UTIs ntawm cov kev tshawb fawb yuav tshwm sim los ntawm qhov sib txawv ntawm kev tsim qauv, kev coj noj coj ua ntawm cov kev kawm, thiab kev sib txawv.
Hauv txoj kev tshawb fawb tam sim no, 60% ntawm UTIs tau txais hauv tsev kho mob (cov tsev kho mob hnyav thiab pawg ntseeg tau txais). Cov txiaj ntsig zoo sib xws (78.5%) tau pom los ntawm Aubron li al.28, txawm hais tias feem ntau ntawm UTIs nyob rau hauv cov teb chaws tsim varied los ntawm kev kawm thiab nyob rau hauv ib cheeb tsam, tsis muaj lub regional sib txawv ntawm cov kab mob thiab fungal pathogens ua UTIs.Cov kab mob feem ntau zoo rov qab los ntawm cov zis kab lis kev cai yog Gram-negative bacilli, feem ntau Escherichia coli, ua raws li Klebsiella. pneumoniae.6,29,30 Raws li cov kev tshawb fawb yav dhau los, 29,30 peb txoj kev tshawb fawb kuj tau pom tias Escherichia coli yog cov kab mob ntau tshaj plaws.Cov kab mob feem ntau suav txog 42.9% ntawm tag nrho cov kab mob cais tawm, ua raws li Klebsiella pneumoniae, uas suav txog 34.6%. Escherichia coli yog cov kab mob uas muaj kab mob ntau tshaj plaws hauv zej zog- thiab tsev kho mob tau txais UTIs (57.1% thiab 42.9%, feem). Ntau qhov kev tshawb fawb tau pom tias Candida yog qhov ua rau tsawg kawg 10-15% ntawm tsev kho mob tau txais. Cov kab mob urinary nyob rau hauv tsev kho mob, thiab candida yog tshwj xeeb tshaj yog muaj nyob rau hauv intensive care units.31-33 Nyob rau hauv peb txoj kev tshawb no, Candida suav rau 7% ntawm UTIs, 94% ntawm cov nosocomial-tau, ntawm uas 62.5% tau pom nyob rau hauv cov neeg mob ICU. .Candida albicans yog lub ntsiab ua rau candidiasis, thiab 81.1% ntawm Candida raug cais tawm ntawm pawg ntseeg-tau cov zis kab lis kev cai-zoo thiab ICU-tau txais cov zis kab lis kev cai zoo.Peb cov txiaj ntsig tsis yog qhov xav tsis thoob vim Candida yog ib qho kab mob kis tau zoo uas tuaj yeem ua rau muaj mob hauv lub cev. cov neeg mob immunocompromised xws li cov neeg mob ICU.
Nyob rau hauv txoj kev tshawb no, cov poj niam muaj kev cuam tshuam ntau dua li cov txiv neej rau cov kab mob urinary, thiab cov neeg mob nyob rau hauv 12-15 hnub nyoog pab pawg neeg tau raug ntau dua.Txawm li cas los xij, qhov sib txawv ntawm ob qho xwm txheej tsis tseem ceeb.Qhov tsis muaj kev koom tes ntawm UTI thiab poj niam txiv neej thiab poj niam txiv neej. Lub hnub nyoog tuaj yeem piav qhia los ntawm thawj pab pawg hnub nyoog uas cov neeg mob raug xaiv.Muab cov qauv kev sib kis ntawm UTIs paub, qhov tshwm sim ntawm cov txiv neej thiab poj niam feem ntau zoo li sib npaug ntawm cov me nyuam mos, nrog txiv neej predominance nyob rau hauv lub sij hawm neonatal thiab poj niam predominance nyob rau hauv thaum yau. thiab thaum lub sij hawm kev cob qhia tso quav.Ntawm lwm qhov kev txheeb xyuas qhov kev pheej hmoo, kev nyob hauv tsev kho mob ntawm 3-30 hnub tau txheeb xyuas nrog UTI (P = 0.01).Kev sib raug zoo ntawm qhov ntev ntawm kev nyob hauv tsev kho mob thiab UTI tau pom nyob rau hauv lwm cov kev tshawb fawb.34,35 UTI hauv peb txoj kev tshawb fawb kuj tseem cuam tshuam nrog catheterization (P = 0.04).Raws li Gokula li al.35 thiab Saint et al.36, catheterization nce qhov kev hem thawj ntawm UTIs los ntawm 3 mus rau 10%, nyob ntawm qhov ntev ntawm catheterization.Sterility tiv thaiv teeb meem thaum lub sij hawm catheter insertion, tsis tshua muaj catheter hloov, thiab kev saib xyuas tsis zoo catheter tej zaum yuav nce nyob rau hauv catheter-txog urinary tract infections.
Thaum lub sijhawm kawm, ntau tus neeg mob menyuam yaus hnub nyoog qis dua peb xyoos tau txais mus rau hauv tsev kho mob nrog cov tsos mob ntawm cov kab mob tso zis ntau dua li lwm pawg hnub nyoog.Qhov no yuav yog vim lub hnub nyoog no yog lub hnub nyoog rau kev cob qhia potty, uas zoo ib yam nrog rau lwm yam kev tshawb fawb.37- 39
Nyob rau hauv txoj kev tshawb no, cov kab mob Gram-negative yog cov feem ntau resistant rau ampicillin thiab trimethoprim-sulfamethoxazole, nrog rau tus nqi ntawm 100% thiab 84.1%, feem. trimethoprim-sulfamethoxazole (81.0%).Ib yam li ntawd, qhov siab tshaj plaws ntawm tag nrho cov tiv thaiv (100%) nyob rau hauv Gram-positive kab mob tau pom nyob rau hauv trimethoprim/sulfamethoxazole. nyob rau hauv tag nrho cov chaw kho mob hauv Ethiopia, raws li kev pom zoo los ntawm Ministry of Health's Standard Treatment Guidelines (STG).40-42 Resistance rates of gram-negative and gram-positive bacteria to ampicillin and trimethoprim-sulfamethoxazole hauv txoj kev tshawb no.Tsev siv tshuaj hauv cov zej zog nce kev xaiv thiab kev saib xyuas cov kab mob resistant nyob rau hauv qhov chaw.43-45 Ntawm qhov tod tes, peb txoj kev tshawb fawb pom tias amikacin thiab meropenem yog cov tshuaj zoo tshaj plaws tiv thaiv kab mob Gram-negative thiab oxacillin yog cov tshuaj zoo tshaj plaws tiv thaiv Gram. -cov kab mob zoo.Cov ntaub ntawv hauv kab lus no yog muab los ntawm ib daim ntawv tsis tau tshaj tawm los ntawm Nuhamen Zena, uas tau muab tso rau hauv Addis Ababa University Institutional Repository.46
Vim muaj kev txwv tsis pub, peb tsis tuaj yeem ua qhov kev sim tshuaj tiv thaiv kab mob fungal ntawm cov kab mob fungal uas tau txheeb xyuas hauv txoj kev tshawb no.
Feem ntau ntawm UTIs yog 28.6%, ntawm qhov uas 75.4% (49/65) yog cov kab mob ntsig txog UTIs thiab 24.6% (19/65) yog cov poov xab ua UTIs.Enterobacteriaceae yog cov ua rau muaj kab mob urinary.Ob C. albicans thiab non-albicans C. albicans tau cuam tshuam nrog cov poov xab-induced UTIs, tshwj xeeb tshaj yog nyob rau hauv cov neeg mob ICU. Ntev nyob hauv tsev kho mob thiab catheterization ntawm 3 mus rau 6 lub hlis tau cuam tshuam nrog UTI.Ob leeg cov kab mob gram-negative thiab gram-zoo kab mob yog heev. resistant rau ampicillin thiab trimethoprim-sulfamethoxazole pom zoo los ntawm Ministry of Health rau empiric kev kho mob ntawm UTIs.Ua hauj lwm ntxiv yuav tsum tau ua rau UTIs rau cov me nyuam, thiab ampicillin thiab trimethoprim-sulfamethoxazole yuav tsum tau reconsidered raws li cov tshuaj ntawm kev xaiv rau empiric kev kho mob ntawm UTIs.
Txoj kev tshawb no tau ua raws li Kev Tshaj Tawm ntawm Helsinki.Txhua qhov kev txiav txim siab thiab kev lav phib xaub tau raug hais kom raug thiab cov kev tshawb fawb tau ua nrog kev coj ncaj ncees thiab kev tso cai SPHMMC los ntawm Pawg Saib Xyuas Kev Tshawb Fawb Sab Hauv ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Laboratory Sciences, Kws qhia ntawv ntawm Health Sciences, Addis Ababa University.Txij li peb txoj kev kawm koom nrog cov menyuam yaus (hnub nyoog qis dua 16 xyoos), lawv tsis tuaj yeem muab kev tso cai sau ntawv tiag tiag.Yog li ntawd, daim ntawv tso cai yuav tsum ua kom tiav los ntawm niam txiv / tus saib xyuas. Hauv luv luv, lub hom phiaj ntawm txoj haujlwm thiab nws Cov txiaj ntsig tau piav qhia meej meej rau txhua tus niam txiv/tus neeg saib xyuas.Cov niam txiv/tus saib xyuas tau qhia tias txhua tus menyuam cov ntaub ntawv ntiag tug yuav raug khaws cia tsis pub lwm tus paub.Cov niam txiv/tus saib xyuas raug ceeb toom tias nws tus menyuam tsis muaj lub luag haujlwm los koom nrog hauv txoj kev kawm yog tias nws ua. tsis pom zoo los koom rau hauv txoj kev tshawb no.Thaum lawv tau pom zoo los koom nrog hauv txoj kev kawm thiab tsis txaus siab mus txuas ntxiv, lawv muaj kev ywj pheej thim tawm ntawm txoj kev kawm txhua lub sijhawm thaum kawm.
Peb xav ua tsaug rau tus kws kho mob uas tuaj koom ntawm qhov chaw kawm rau kev tshuaj xyuas cov neeg mob nruj heev los ntawm kev nthuav qhia kev tshuaj ntsuam xyuas.Peb kuj ua tsaug ntau rau cov neeg mob uas tau koom nrog txoj kev tshawb no.Peb kuj xav ua tsaug rau Nuhamen Zena uas tau tso cai rau peb. rho tawm cov ntaub ntawv tseem ceeb los ntawm nws qhov kev tshawb fawb tsis tau tshaj tawm, uas tau muab tso rau hauv Addis Ababa University repository.
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