Use of CRP/Albumin Ratio (CAR) in the Early Diagnosis of Extended-Spectrum Beta-Lactamase (ESBL)-Related Upper Urinary Tract Infection in Children and Antibiotic Resistance of Isolated Uropathogens

Aylin Gençler; Salim Yakut; Fadile Yıldız Zeyrek

Makale detayları

Use of CRP/Albumin Ratio (CAR) in the Early Diagnosis of Extended-Spectrum Beta-Lactamase (ESBL)-Related Upper Urinary Tract Infection in Children and Antibiotic Resistance of Isolated Uropathogens

Yazarlar:

Aylin Gençler | Salim Yakut | Fadile Yıldız Zeyrek

Yayıncı:

Harran University

Ana Başlıklar:

Çocuk Nefrolojisi | Tıbbi Mikrobiyoloji (Diğer)

Dergi:

Harran Üniversitesi Tıp Fakültesi Dergisi Vol.21 Issue 2, pp.314-320

Belge Tipi:

Makale

Yayın Tarihi:

8/2024

Belge Dili:

Türkçe

Document ID (Org No.):

2001323564

pISSN:

1304-9623

Anahtar kelimeler:

Özet:

 Background: Urinary tract infections UTIs are the second most common infections among children. Early initiation of treatment is crucial to prevent complications. In recent years, the increasing production of extended-spectrum beta-lactamases ESBL in gram-negative bacteria has made it challenging to treat infections caused by these pathogens in children. The C-reactive protein to albumin ratio CAR has emerged as an important marker for inflammation in recent years. The aim of our study is to investigate the predictive value of CAR in the early identification of ESBL-positive upper urinary tract infections UUTI in children and to determine the antibiotic resistance profiles of isolated uropathogens. Materials and Methods: This study was conducted by reviewing the medical records of 194 children diagnosed with UUTI and treated either as outpatients or inpatients. Based on urine culture results, patients were divided into two groups: ESBL-positive UUTI and ESBL-negative UUTI. Laboratory tests obtained within the first 6 hours after UUTI diagnosis, before the initiation of antibiotic therapy, as well as demographic data, were retrieved from hospital records and compared between the two groups. The microorganisms isolated in urine cultures and their antimicro-bial susceptibility results were recorded. Results: Of the patients, 98 50,5 were female and 96 49,4 were male, with a median age of 12 4,92-36 months. Among the isolated pathogens, 126 64,9 were ESBL-negative, while 68 35,1 were ESBL-positive. CRP and CAR levels were significantly higher in the ESBL-positive UUTI group p0.001. A ROC analysis was performed to assess the ability of laboratory parameters to predict ESBL-positive UUTI. For CRP, values of 2,270 and above predicted ESBL positivity with 54,41 sensitivity and 61,11 specificity p0.001; AUC: 0.660 0,584-0,737. For CAR, values of 0,698 and above predicted ESBL-positive UUTI with 58,82 sensitivity and 59,52 specificity p0.001; AUC: 0,650 0,573-0,727. Escherichia coli 39,2 was the most frequently isolated microorganism in all patients, followed by Klebsiella pneumoniae 28,9, Enterococ-cus spp. 14,4, and Proteus mirabilis 9,3. Among ESBL-positive UUTI patients, the most commonly isolated microorganisms were E. coli and K. pneumoniae. Ampicillin resistance in ESBL-positive E. coli was 89,3, and the highest resistance among cephalosporins was observed against ceftriaxone 89,7. Amikacin resistance in ESBL-positive E. coli was 7,7, while no resistance was observed in ESBL-positive UUTI K. pneumo-niae. Meropenem resistance was found in 5,6 and ertapenem resistance in 6,7 of K. pneumoniae isolates, while in E. coli, meropenem resistance was 13,6 and ertapenem resistance was 9,1. Conclusions: CAR is independently associated with ESBL-positive UUTI. Our study demonstrated that CAR may be useful in predicting ESBL-positive UUTI. Given the high resistance observed to cephalosporins, it is recommended that patients with significantly elevated CAR levels receive empirical treatment with carbapenems, amikacin, nitrofurantoin, or fosfomycin, whether treated as outpatients or inpatients.

 Background: Urinary tract infections UTIs are the second most common infections among children. Early initiation of treatment is crucial to prevent complications. In recent years, the increasing production of extended-spectrum beta-lactamases ESBL in gram-negative bacteria has made it challenging to treat infections caused by these pathogens in children. The C-reactive protein to albumin ratio CAR has emerged as an important marker for inflammation in recent years. The aim of our study is to investigate the predictive value of CAR in the early identification of ESBL-positive upper urinary tract infections UUTI in children and to determine the antibiotic resistance profiles of isolated uropathogens. Materials and Methods: This study was conducted by reviewing the medical records of 194 children diagnosed with UUTI and treated either as outpatients or inpatients. Based on urine culture results, patients were divided into two groups: ESBL-positive UUTI and ESBL-negative UUTI. Laboratory tests obtained within the first 6 hours after UUTI diagnosis, before the initiation of antibiotic therapy, as well as demographic data, were retrieved from hospital records and compared between the two groups. The microorganisms isolated in urine cultures and their antimicro-bial susceptibility results were recorded. Results: Of the patients, 98 50,5 were female and 96 49,4 were male, with a median age of 12 4,92-36 months. Among the isolated pathogens, 126 64,9 were ESBL-negative, while 68 35,1 were ESBL-positive. CRP and CAR levels were significantly higher in the ESBL-positive UUTI group p0.001. A ROC analysis was performed to assess the ability of laboratory parameters to predict ESBL-positive UUTI. For CRP, values of 2,270 and above predicted ESBL positivity with 54,41 sensitivity and 61,11 specificity p0.001; AUC: 0.660 0,584-0,737. For CAR, values of 0,698 and above predicted ESBL-positive UUTI with 58,82 sensitivity and 59,52 specificity p0.001; AUC: 0,650 0,573-0,727. Escherichia coli 39,2 was the most frequently isolated microorganism in all patients, followed by Klebsiella pneumoniae 28,9, Enterococ-cus spp. 14,4, and Proteus mirabilis 9,3. Among ESBL-positive UUTI patients, the most commonly isolated microorganisms were E. coli and K. pneumoniae. Ampicillin resistance in ESBL-positive E. coli was 89,3, and the highest resistance among cephalosporins was observed against ceftriaxone 89,7. Amikacin resistance in ESBL-positive E. coli was 7,7, while no resistance was observed in ESBL-positive UUTI K. pneumo-niae. Meropenem resistance was found in 5,6 and ertapenem resistance in 6,7 of K. pneumoniae isolates, while in E. coli, meropenem resistance was 13,6 and ertapenem resistance was 9,1. Conclusions: CAR is independently associated with ESBL-positive UUTI. Our study demonstrated that CAR may be useful in predicting ESBL-positive UUTI. Given the high resistance observed to cephalosporins, it is recommended that patients with significantly elevated CAR levels receive empirical treatment with carbapenems, amikacin, nitrofurantoin, or fosfomycin, whether treated as outpatients or inpatients.

 Background: Urinary tract infections UTIs are the second most common infections among children. Early initiation of treatment is crucial to prevent complications. In recent years, the increasing production of extended-spectrum beta-lactamases ESBL in gram-negative bacteria has made it challenging to treat infections caused by these pathogens in children. The C-reactive protein to albumin ratio CAR has emerged as an important marker for inflammation in recent years. The aim of our study is to investigate the predictive value of CAR in the early identification of ESBL-positive upper urinary tract infections UUTI in children and to determine the antibiotic resistance profiles of isolated uropathogens. Materials and Methods: This study was conducted by reviewing the medical records of 194 children diagnosed with UUTI and treated either as outpatients or inpatients. Based on urine culture results, patients were divided into two groups: ESBL-positive UUTI and ESBL-negative UUTI. Laboratory tests obtained within the first 6 hours after UUTI diagnosis, before the initiation of antibiotic therapy, as well as demographic data, were retrieved from hospital records and compared between the two groups. The microorganisms isolated in urine cultures and their antimicro-bial susceptibility results were recorded. Results: Of the patients, 98 50,5 were female and 96 49,4 were male, with a median age of 12 4,92-36 months. Among the isolated pathogens, 126 64,9 were ESBL-negative, while 68 35,1 were ESBL-positive. CRP and CAR levels were significantly higher in the ESBL-positive UUTI group p0.001. A ROC analysis was performed to assess the ability of laboratory parameters to predict ESBL-positive UUTI. For CRP, values of 2,270 and above predicted ESBL positivity with 54,41 sensitivity and 61,11 specificity p0.001; AUC: 0.660 0,584-0,737. For CAR, values of 0,698 and above predicted ESBL-positive UUTI with 58,82 sensitivity and 59,52 specificity p0.001; AUC: 0,650 0,573-0,727. Escherichia coli 39,2 was the most frequently isolated microorganism in all patients, followed by Klebsiella pneumoniae 28,9, Enterococ-cus spp. 14,4, and Proteus mirabilis 9,3. Among ESBL-positive UUTI patients, the most commonly isolated microorganisms were E. coli and K. pneumoniae. Ampicillin resistance in ESBL-positive E. coli was 89,3, and the highest resistance among cephalosporins was observed against ceftriaxone 89,7. Amikacin resistance in ESBL-positive E. coli was 7,7, while no resistance was observed in ESBL-positive UUTI K. pneumo-niae. Meropenem resistance was found in 5,6 and ertapenem resistance in 6,7 of K. pneumoniae isolates, while in E. coli, meropenem resistance was 13,6 and ertapenem resistance was 9,1. Conclusions: CAR is independently associated with ESBL-positive UUTI. Our study demonstrated that CAR may be useful in predicting ESBL-positive UUTI. Given the high resistance observed to cephalosporins, it is recommended that patients with significantly elevated CAR levels receive empirical treatment with carbapenems, amikacin, nitrofurantoin, or fosfomycin, whether treated as outpatients or inpatients.

 Amaç: Çocuklarda üriner sistem enfeksiyonları ÜSE sık görülen enfeksiyonlar arsında ikinci sırada yer almaktadır. Komplikasyonların gelişimini önlemek için tedaviye erken başlamak oldukça önemlidir. Son yıllarda gram negatif bakterilerde genişlemiş spektrumlu beta laktamaz GSBL üretiminin artmasından dolayı çocuklarda bu etkenlere bağlı gelişen enfeksiyonların tedavisini zorlaştırmaktadır. C-reaktif protein CRP ile albümin oranı CAO, son yıllarda enflamasyonun belirlenmesinde kullanılan önemli göstergelerden biridir. Çalışmamızın amacı CAO kullanarak GSBL pozitif üst ÜSEnun Ü-ÜSE erken dönemde tahmin edilmesini araştırmak ve üreyen üropatojenler ile antibiyotik dirençlerini belirlemektir. Materyal ve metod: Bu çalışma, Ü-ÜSE tanısı konarak ayaktan veya hastaneye yatırılarak tedavi edilen 194 çocuğun hasta dosyalarının incelenme-siyle gerçekleştirildi. Hastalar, idrar kültürü sonuçlarına göre GSBL pozitif Ü-ÜSE ve GSBL negatif Ü-ÜSE olmak üzere iki gruba ayrıldı. Ü-ÜSE tanısı konulduktan sonraki ilk 6 saat içinde ve antibiyotik tedavisi başlanılmadan önce alınan laboratuvar tetkikleri ve hastaların demografik verileri hastane kayıtlarından alınarak her iki grup arasında karşılaştırma yapıldı. İdrar kültürlerinde üreyen mikroorganizmalar ve antimikrobiyal duyarlılık sonuçları kaydedildi. Bulgular: Hastaların 98 50.5i kız, 96 49.4sı erkek idi. Yaş ortalaması 12 4,92-36 ay olarak tespit edildi. İzole edilen etkenlerin 126 64,9sı GSBL negatif iken 68 35,1i GSBL pozitif idi. CRP ve CAO, GSBL pozitif Ü-ÜSE grubunda anlamlı olarak daha yüksekti p0.001. Laboratuvar paramtrelerinin GSBL pozitif Ü-ÜSEnu öngörmesi için ROC analizi yapıldı. CRP parametresi için 2,270 ve daha büyük değerlerin GSBL pozitifliğini 54,41 duyarlılık ve 61,11 özgüllük ile p0,001; AUC: 0,660 0,584-0,737; CAO parametresi için 0,698 ve daha büyük değerlerin GSBL pozitif Ü-ÜSEnu 58,82 duyarlılık ve 59,52 özgüllük ile p0,001; AUC:0,650 0,573-0,727 öngördüğü belirlenmiştir. Tüm hastalarda E.coli 39,2 en sık üreyen mikroorganizma iken, K.pneumoniae 28,9, Enterococcus spp 14,4, Proteus mirabilis  9,3 diğer sık saptanan mikroorganizmalar oldu. GSBL pozitif Ü-ÜSE hastalarının idrar kültüründe üreyen en sık mikroorganizmalar ise sırasıyla E.coli ve K.pneumoniae idi. Ampisilin direnci GSBL pozitif E.colide 89,3 idi. Sefalosporin grubu ajanlardan en yüksek oranda seftriaksona karşı direnç 89,7 saptandı. Amikasin direnci GSBL pozitif E.colide 7,7 oranında gözlenirken, GSBL pozitif Ü-ÜSE K.pneumoniaeda direnç gözlenmedi. K.pneumoniaeda meropenem direnci 5,6, ertapenem direnci 6,7 oranında görülürken, E.colide meropenem direnci 13,6, ertapenem direnci ise 9,1 oranında görüldü. Sonuç: CAO, Ü-ÜSEda GSBL pozitif Ü-ÜSE ile bağımsız bir ilişkiye sahiptir. Çalışmamızda, CAOnun GSBL pozitif Ü-ÜSEyi tahmin etmek için yararlı olabileceği gösterildi. Sefalosporinlere yüksek oranda direnç görülürken CAO belirgin yüksek olan Ü-ÜSEli hastaların ayaktan yada yatarak ampirik tedavisinde karbapenem, amikasin, nitrofurantoin ve fosfomisin kullanılması önerilebilir.

Makale detayları

Use of CRP/Albumin Ratio (CAR) in the Early Diagnosis of Extended-Spectrum Beta-Lactamase (ESBL)-Related Upper Urinary Tract Infection in Children and Antibiotic Resistance of Isolated Uropathogens

Yazarlar:

Aylin Gençler | Salim Yakut | Fadile Yıldız Zeyrek

Yayıncı:

Harran University

Ana Başlıklar:

Çocuk Nefrolojisi | Tıbbi Mikrobiyoloji (Diğer)

Dergi:

Harran Üniversitesi Tıp Fakültesi Dergisi Vol.21 Issue 2, pp.314-320

Belge Tipi:

Makale

Yayın Tarihi:

8/2024

Belge Dili:

Türkçe

Document ID (Org No.):

2001323564

pISSN:

1304-9623

GSBL

Üriner Sistem Enfeksiyonu

Çocuk

Antimikrobiyal Direnç

C-Reaktif Protein Albümin Oranı (CAO)

Sayı

Makale detayları

Use of CRP/Albumin Ratio (CAR) in the Early Diagnosis of Extended-Spectrum Beta-Lactamase (ESBL)-Related Upper Urinary Tract Infection in Children and Antibiotic Resistance of Isolated Uropathogens

Yazarlar: Aylin Gençler | Salim Yakut | Fadile Yıldız Zeyrek

Yayıncı: Harran University

Ana Başlıklar: Çocuk Nefrolojisi | Tıbbi Mikrobiyoloji (Diğer)

Dergi: Harran Üniversitesi Tıp Fakültesi Dergisi Vol.21 Issue 2, pp.314-320

Belge Tipi: Makale

Yayın Tarihi: 8/2024

Belge Dili: Türkçe

Document ID (Org No.): 2001323564

pISSN: 1304-9623

GSBL

Üriner Sistem Enfeksiyonu

Çocuk

Antimikrobiyal Direnç

C-Reaktif Protein Albümin Oranı (CAO)

Sayı

Yazarlar:

Aylin Gençler | Salim Yakut | Fadile Yıldız Zeyrek

Yayıncı:

Harran University

Ana Başlıklar:

Çocuk Nefrolojisi | Tıbbi Mikrobiyoloji (Diğer)

Dergi:

Harran Üniversitesi Tıp Fakültesi Dergisi Vol.21 Issue 2, pp.314-320

Belge Tipi:

Makale

Yayın Tarihi:

8/2024

Belge Dili:

Türkçe

Document ID (Org No.):

2001323564

pISSN:

1304-9623