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Adane Bitew, 1 Nuhamen Zena, 2 Abera Abdeta31 Dipatimenti ya Medical Laboratory Sciences, Faculty of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia;2 Microbiology, Millennium School of Medicine, Chipatala cha St Paul, Addis Ababa, Dipatimenti ya Ethiopia;3 National Reference Laboratory for Clinical Bacteriology and Mycology, Ethiopian Institute of Public Health, Addis Ababa, Ethiopia Wolemba Wofanana: Abera Abdeta, National Reference Laboratory for Clinical Bacteriology and Mycology, Ethiopian Institute of Public Health, PO Box: 1242, Addis Ababa, Ethiopia , +251911566420, imelo [email protected] Background: UTIs ndi matenda ofala kwambiri pa matenda a ana.Kudziwa zomwe zimayambitsa matenda a mkodzo, machitidwe awo a antimicrobial susceptibility, ndi zoopsa zomwe zimagwirizana nazo muzochitika zinazake zingapereke umboni wa chithandizo choyenera cha milandu.Zolinga : Kafukufukuyu anali ndi cholinga chofuna kudziwa chomwe chimayambitsa matenda komanso kufalikira kwa ma uropathogens okhudzana ndi matenda a mkodzo, komanso ma antibiotic susceptibility profiles of bacterial isolates, komanso kudziwa zomwe zimayambitsa matenda a mkodzo mwa odwala. Zida ndi njira: Phunziro adachitidwa kuyambira Okutobala 2019 mpaka Julayi 2020 ku Millennium School of Medicine, Chipatala cha St. njira.Kuyesa kwa maantibayotiki okhudzana ndi tizilombo toyambitsa matenda pogwiritsa ntchito njira ya Kirby Bauer disc diffusion.Ziwerengero zofotokozera ndi kusintha kwa kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka anthu. kuchuluka kwa 28.6%, pomwe 75.4% (49/65) ndi 24.6% (16/65) anali tizilombo toyambitsa matenda ndi mafangasi, motsatana.Pafupifupi 79.6% ya mabakiteriya etiologies anali Escherichia coli ndi Klebsiella pneumoniae (apamwamba kwambiri aastampicillin). 100%), cefazolin (92.1%) ndi trimethoprim-sulfamethoxazole (84.1%), zomwe zimagwiritsidwa ntchito mozama ku Ethiopia.Kutalika kwa chipatala (P = 0.01) ndi catheterization (P = 0.04) zinali zogwirizana ndi matenda a mkodzo. Kutsiliza: Kafukufuku wathu adawona kufalikira kwakukulu kwa matenda a mkodzo.Enterobacteriaceae ndizomwe zimayambitsa matenda a mkodzo.Kutalika kwa chipatala ndi catheterization kunali kogwirizana kwambiri ndi matenda a mkodzo. ampicillin ndi trimethoprim-sulfamethoxazole.Mawu ofunika: Ma antibayotiki amatengeka mosavuta, Matenda a ana, matenda a mkodzo, Ethiopia
Matenda a mkodzo (UTIs) oyambitsidwa ndi mabakiteriya ndi yisiti ndi amodzi mwa matenda omwe amapezeka kwambiri mwa ana.M'mayiko omwe akutukuka kumene, ndi matenda achitatu omwe amapezeka kwambiri m'zaka za ana pambuyo pa kupuma ndi m'mimba.2 Matenda a m'mimba mwa ana. zimagwirizanitsidwa ndi matenda afupipafupi, kuphatikizapo kutentha thupi, dysuria, kufulumira, ndi kupweteka kwa msana.Zingayambitsenso kuwonongeka kwa impso kwa nthawi yaitali, monga kuwonongeka kwa impso kosatha ndi mavuto a nthawi yaitali, kuphatikizapo kuthamanga kwa magazi ndi kulephera kwa impso. 3 Wennerstrom et al15 adalongosola kuwonongeka kwa aimpso pafupifupi 15% ya ana pambuyo pa UTI yoyamba, kutsindika kufunika kozindikira matenda a mkodzo mwamsanga ndi kuchiza matenda a mkodzo. 4 Kafukufuku wochuluka wa UTI wa ana m'mayiko osiyanasiyana omwe akutukuka kumene wasonyeza kuti kufalikira kwa UTIs kumasiyana 16% mpaka 34%.5-9 Komanso, mpaka 8% ya ana a zaka za mwezi umodzi mpaka zaka 11 adzakhala ndi UTI10 imodzi, ndipo mpaka 30% ya makanda ndi ana amadziwika kuti ali ndi matenda obwerezabwereza m'miyezi 6-12 yoyambirira pambuyo pa UTI woyambirira .11
Mabakiteriya a gram-negative ndi gram-positive, komanso mitundu ina ya Candida, amatha kuyambitsa matenda a mkodzo.E.coli ndizomwe zimayambitsa matenda a mkodzo, zotsatiridwa ndi Klebsiella pneumoniae.12 Kafukufuku wasonyeza kuti mitundu ya Candida, makamaka Candida albicans, imakhalabe yomwe imayambitsa matenda a Candida UTIs mwa ana. zifukwa za UTIs mwa ana. Anyamata ali pachiopsezo kwambiri m'chaka choyamba cha moyo, pambuyo pake, chifukwa cha kusiyana kwa ziwalo zogonana, zochitika zimakhala zazikulu kwambiri mwa atsikana, ndipo makanda osadulidwa aamuna ali pachiopsezo chachikulu.1,33 Ma antibiotic susceptibility Matenda a uropathogens amasiyanasiyana pakapita nthawi, malo odwala, chiwerengero cha anthu, ndi zizindikiro zachipatala.
Matenda opatsirana monga UTIs amaganiziridwa kuti ndi omwe amachititsa 26% ya imfa zapadziko lonse, 98% zomwe zimachitika m'mayiko osauka.14 Kafukufuku wa odwala ana ku Nepal ndi India adanena kuti kufalikira kwa UTIs kwa 57% 15 ndi 48 %,16.Kafukufuku wa m’chipatala wa ana a ku South Africa anasonyeza kuti matenda a mkodzo amatenga 11 peresenti ya matenda a chisamaliro chaumoyo.17 Kafukufuku wina ku Kenya anapeza kuti matenda a mkodzo amakhala pafupifupi 11.9% ya kulemedwa kwa matenda a febrile kwa ana aang'ono.18
Kafukufuku wochepa wapeza UTIs mwa odwala ana ku Ethiopia: maphunziro ku Hawassa Referral Hospital, Yekatit 12 Hospital, Felege-Hiwot Specialist Hospital ndi Gondar University Hospital anasonyeza 27.5%, 19 15.9%, 20 16.7%, 21 ndi 26.45% ndi 22, motero M'mayiko omwe akutukuka kumene, kuphatikizapo Ethiopia, kusowa kwa chikhalidwe cha mkodzo pamagulu osiyanasiyana a ukhondo kumakhalabe kosatheka chifukwa ndizovuta kwambiri. Kafukufuku wopangidwa ndi cholinga chofuna kudziwa kuchuluka kwa matenda a mkodzo, kusanthula tizilombo toyambitsa matenda ndi mafangasi okhudzana ndi UTIs, kudziwa mbiri ya antimicrobial susceptibility profils of bacterial isolates, ndikuzindikira zinthu zazikulu zomwe zimakhudzidwa ndi UTIs.
Kuyambira Okutobala 2019 mpaka Julayi 2020, kafukufuku wokhudzana ndi chipatala adachitika ku Dipatimenti ya Paediatrics ku St Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.
Pa nthawi yophunzira, odwala onse omwe ali ndi ana ndi odwala kunja adawonedwa ndi ana.
Panthawi yophunzira, odwala onse omwe ali ndi ana komanso odwala omwe ali ndi zizindikiro za UTI adapezeka pamalo ophunzirira.
Kukula kwachitsanzo kunatsimikiziridwa pogwiritsa ntchito chiŵerengero chimodzi cha kukula kwachitsanzo chokhala ndi nthawi yodalirika ya 95%, 5% malire a zolakwika, ndi kufalikira kwa UTIs mu ntchito yoyamba [15.9% kapena P = 0.159)] Merga Duffa et al20 ku Addis Ababa , monga momwe zilili pansipa.
Z α/2 = 95% nthawi yachidaliro yofunika kwambiri yogawa bwino, yofanana ndi 1.96 (Z mtengo pa α = 0.05);
D = malire a zolakwika, ofanana ndi 5%, α = ndi mlingo wa zolakwika zomwe anthu akulolera kulekerera;ikani izi mu fomula, n= (1.96)2 0.159 (1–0.159)/(0.05)2=206 ndipo lingalirani 10% osayankhidwa pomwe n = 206+206/10 = 227.
Njira yabwino yotengera zitsanzo idagwiritsidwa ntchito mu kafukufukuyu. Sungani deta mpaka kukula kwachitsanzo komwe mukufuna kukwaniritsidwa.
Deta inasonkhanitsidwa pambuyo polandira chilolezo chodziwitsidwa kuchokera kwa makolo.Makhalidwe a chikhalidwe cha anthu (zaka, jenda, ndi malo okhala) ndi zifukwa zomwe zimayenderana ndi chiopsezo (catheter, UTI wam'mbuyo, chikhalidwe cha kachilombo ka HIV (HIV), mdulidwe, ndi nthawi yokhala m'chipatala) mwa omwe adachita nawo kafukufuku adasonkhanitsidwa ndi anamwino oyenerera pogwiritsa ntchito deta yomwe idatchulidwiratu.Mafunso okonzedwa a mayeso.Zizindikiro ndi zizindikiro za wodwalayo ndi matenda oyambitsa matendawa adalembedwa ndi dokotala wa ana.
Musanaunike: mawonekedwe a chikhalidwe cha anthu (zaka, jenda, ndi zina zotero) ndi chidziwitso chachipatala ndi chithandizo cha omwe adatenga nawo phunziroli adasonkhanitsidwa kuchokera m'mafunso.
Kusanthula: Ntchito ya autoclave, chofungatira, reagents, maikulosikopu, ndi microbiological khalidwe la sing'anga (sterility wa sing'anga ndi kukula ntchito ya sing'anga iliyonse) anayesedwa malinga ndi muyezo ndondomeko asanayambe ntchito.Kusonkhanitsa ndi kunyamula zitsanzo zachipatala zimachitika. pambuyo aseptic procedures.The inoculation wa zitsanzo zachipatala anachitidwa pansi yachiwiri chitetezo nduna.
Pambuyo Pofufuza: Zonse zomwe zatulutsidwa (monga zotsatira za laboratory) zimafufuzidwa kuti ziyeneretsedwe, kukwanira ndi kusasinthasintha ndi kulembedwa musanalowemo zida zowerengera.Data imasungidwanso pamalo otetezeka.Zigawo za mabakiteriya ndi yisiti zinasungidwa molingana ndi Ndondomeko Yoyendetsera Ntchito (Standard Operating Procedure). SOP) ya St. Paul's Hospital Millennium Medical College (SPHMMC).
Deta yonse ya kafukufukuyo inalembedwa, kulowetsedwa kawiri, ndikuwunikidwa pogwiritsa ntchito pulogalamu ya Statistical Package for the Social Sciences (SPSS) version 23.Gwiritsani ntchito ziwerengero zofotokozera ndi kubwereranso kwazinthu kuti muyerekezere ziwerengero zovuta ndi 95% nthawi yodalirika pamitundu yosiyanasiyana.P <0.05 amaonedwa kuti ndi ofunika.
Zitsanzo za mkodzo zinasonkhanitsidwa kuchokera kwa wodwala aliyense wa ana pogwiritsa ntchito ziwiya za mkodzo wosabala.Makolo kapena oyang'anira omwe adachita nawo phunziroli anapatsidwa malangizo oyenerera a momwe angasonkhanitsire zitsanzo za mkodzo wapakatikati.Zitsanzo za catheter ndi suprapubic mkodzo zinasonkhanitsidwa ndi anamwino ophunzitsidwa bwino ndi madokotala. Zitsanzo zinatengedwa ku labotale ya Microbiology ya SPHMMC kuti ipitirire kukonzanso.Nthawi zina za zitsanzozo zinathiridwa pa mbale za MacConkey agar (Oxoid, Basingstoke ndi Hampshire, England) ndi blood agar (Oxoid, Basingstoke ndi Hampshire, England) media mu kabati yachitetezo pogwiritsa ntchito 1 μL calibration loop.Zitsanzo zotsalazo zinakutidwa pa ubongo kulowetsedwa kwa agar kuwonjezeredwa ndi chloramphenicol (100 µgml-1) ndi gentamicin (50 µgml-1) (Oxoid, Basingstoke, ndi Hampshire, England).
Ma mbale onse opangidwa ndi incubated anali aerobically pa 37 ° C kwa maola 18-48 ndikuyang'ana kukula kwa bakiteriya ndi / kapena yisiti. Kuwerengera kwa mabakiteriya kapena yisiti kumatulutsa ≥105 cfu / mL mkodzo kunkaonedwa kuti ndi kukula kwakukulu. sanaganizidwe kuti afufuzenso.
Zodzipatula zoyera za tizilombo toyambitsa matenda poyamba zinkadziwika ndi colony morphology, Gram staining. kuyesa kwa indole, kuyesa kugwiritsa ntchito citrate, kuyesa kwachitsulo cha trisaccharide, kuyesa kwa hydrogen sulfide (H2S), kuyesa kwa lysine iron agar, kuyesa kwa motility ndi kuyesa kwa oxidase) mpaka pamlingo wamitundu).
Yisiti adadziwika pogwiritsa ntchito njira zanthawi zonse zodziwira matenda monga Gram staining, embryo tube assay, fermentation ya carbohydrate ndi ma assimilation assay pogwiritsa ntchito chromogenic medium (CHROMagar Candida medium, bioM'erieux, France) malinga ndi malangizo a wopanga.
Kuyeza kwa antimicrobial susceptibility test kunachitidwa ndi Kirby Bauer disc diffusion pa Mueller Hinton agar (Oxoid, Basingstoke, England) malinga ndi malangizo a Clinical Laboratory Standards Institute (CLSI)24. Kuyimitsidwa kwa mabakiteriya amtundu uliwonse kunakonzedwa mu 0.5 mL ya msuzi wopatsa thanzi ndikusinthidwa kuti zisawonongeke. fananizani ndi muyezo wa 0.5 McFarland kuti mupeze pafupifupi 1 × 106 koloni-forming units (CFUs) pa mL imodzi ya biomass. Iviikani swab wosabala mu kuyimitsidwa ndikuchotsa zinthu zochulukirapo pokanikizira kumbali ya chubu. Pakatikati pa mbale ya agar ya Mueller Hinton ndi kugawidwa mofanana pamwamba pa sing'anga.Ma antibiotic disks anaikidwa pa Mueller Hinton agar yomwe imayikidwa pamtundu uliwonse mkati mwa mphindi 15 pambuyo pa katemera ndi incubated pa 35-37 °C kwa maola 24. Gwiritsani ntchito caliper kuyeza Diameter of the zone of inhibition.Diameter-area inhibition inatanthauzidwa ngati tcheru (S), intermediate (I), kapena resistant (R) malinga ndi malangizo a Clinical and Laboratory Standards Institute (CLSI)24.Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922) ndi Pseudomonas aeruginosa (ATCC 27853) adagwiritsidwa ntchito ngati zovuta zowongolera kuti awone momwe maantibayotiki amathandizira.
Kwa mabakiteriya a Gram-negative, timagwiritsa ntchito mbale zowononga: 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).
Ma antibacterial discs a gram-positive isolate anali: penicillin (mayunitsi 10);cefoxitin (30 μg);nitrofurantoin (300 μg);vancomycin (30 μg);trimethoprim-sulfamethoxazole (1.25 / g) 23.75 μg);Ciprofloxacin (5 μg);Doxycycline (30 μg) Ma disks onse oletsa tizilombo toyambitsa matenda omwe amagwiritsidwa ntchito mu phunziro lathu anali mankhwala a Oxide, Basingstoke ndi Hampshire, England.
Monga momwe tawonetsera mu Table 1, phunziroli linalembetsa odwala a 227 (227) omwe adawonetsa kapena akuwakayikira kwambiri kuti ali ndi UTI ndipo adakwaniritsa zofunikira zosankhidwa.Ophunzira aamuna (138; 60.8%) adaposa omwe adaphunzira nawo akazi (89; 39.2%), ndi chiwerengero cha akazi ndi amuna cha 1.6: 1. Chiwerengero cha maphunziro chinali chosiyana pakati pa magulu azaka, ndi ˂ 3 wazaka zakubadwa ali ndi odwala ambiri (119; 52.4%), akutsatiridwa ndi 13-15- wazaka (37; 16.3%) ndi magulu azaka zapakati pa 3-6 (31; 13.7%), motero.Zofufuzazo ndizo makamaka mizinda, yomwe ili ndi chiŵerengero cha 2.4: 1 (Table 1).
Gulu 1 Makhalidwe a chikhalidwe cha anthu omwe amaphunzira komanso kuchuluka kwa zitsanzo zabwino za chikhalidwe (N= 227)
Kukula kwakukulu kwa bakiteriya/ yisiti kunawonedwa mu zitsanzo za mkodzo 65 mwa 227 (227) za kufalikira kwa 28.6% (65/227), pomwe 21.6% (49/227) anali tizilombo toyambitsa matenda, pomwe 7% (16/227) anali tizilombo toyambitsa matenda.Kuchuluka kwa UTI kunali kokulirapo mu gulu la zaka 13-15 pa 17/37 (46.0%) ndipo m’zaka zapakati pa 10-12 kunali kochepa kwambiri pa 2/21 (9.5%).Table 2) .Amayi anali ndi chiwerengero chachikulu cha UTI, 30/89 (33.7%), poyerekeza ndi 35/138 (25.4%) amuna.
Mwa mabakiteriya odzipatula 49, 79.6% (39/49) anali Enterobacteriaceae, omwe Escherichia coli anali mabakiteriya ambiri omwe amawerengera 42.9% (21/49) ya mabakiteriya odzipatula, kutsatiridwa ndi mabakiteriya a Klebsiella pneumoniae, omwe amawerengera 34.6% ( 17/49) ya mabakiteriya odzipatula anayi (8.2%) odzipatula anaimiridwa ndi Acinetobacter, bacillus yopanda fermenting ya Gram-negative. 60.0%) anali Enterococcus. Mwa 16 yisiti yodzipatula, 6 (37.5%) ankayimiridwa ndi C. albicans. Mwa 26 opezeka ndi anthu a uropathogens, 76.9% (20/26) anali Escherichia coli ndi Klebsiella pneumoniae.Of the 20 -anapeza uropathogens, 15/20 anali tizilombo toyambitsa matenda. Mwa 19 ICU-acquired uropathogens, 10/19 anali yisiti. Pa 65 chikhalidwe-positive mkodzo zitsanzo, 39 (60.0%) anapezeka chipatala ndipo 26 (40.0%) anali zopezedwa ndi anthu ammudzi (Table 3).
Table 3 Kusanthula kwazinthu zowopsa zokhudzana ndi matenda a mkodzo mwa odwala omwe ali ndi SPHMMC (n = 227)
Mwa odwala 227 a ana, 129 adagonekedwa m'chipatala kwa masiku osakwana 3, pomwe 25 (19.4%) anali ndi chikhalidwe, 120 adalandiridwa kuchipatala chakunja, omwe 25 (20.8%) anali ndi chikhalidwe, ndipo 63 anali ndi mbiri ya matenda a mkodzo.Mwa iwo, 23 (37.70%) anali abwino pachikhalidwe, 38 anali a catheter okhalamo, 20 (52.6%) anali abwino pachikhalidwe, ndipo 71 anali abwino kutentha kwa thupi> 37.5 ° C, omwe 21 (29.6%) zinali zabwino kwa chikhalidwe (Table 3).
Zolosera za UTI zidawunikidwa mosiyanasiyana, ndipo anali ndi mayendedwe obwerera kwa nthawi yayitali miyezi 3-6 (COR 2.122; 95% CI: 3.31-3.43; P=0.002) ndi catheterization (COR= 3.56; 95) %CI : 1.73–7.1;P = 0.001) .Kusanthula kambiri kobwerezabwereza kunachitidwa pa zolosera zofunikira kwambiri za UTI ndi mfundo zotsatirazi zokhazikika: kutalika kwa miyezi 3-6 (AOR = 6.06, 95% CI: 1.99-18.4; P = 0.01) ndi catheterization ( AOR = 0.28; 95% CI: 0.13-0.57, P = 0.04) . Kutalika kwa chipatala kwa miyezi 3-6 kunali kogwirizana kwambiri ndi UTI (P = 0.01) .Kugwirizana kwa UTI ndi catheterization kunalinso kofunika kwambiri ( P = 0.04) .Komabe, kukhala, kugonana, zaka, gwero lovomerezeka, mbiri yakale ya UTI, kachilombo ka HIV, kutentha kwa thupi, ndi matenda aakulu sizinapezeke kuti zikugwirizana kwambiri ndi UTI (Table 3).
Matebulo 4 ndi 5 akufotokoza momwe mabakiteriya a gram-negative ndi gram-positive amachitira ndi maantibayotiki asanu ndi anayi omwe anayesedwa. motsatana.Pakati pa mankhwala onse amene anayesedwa, mabakiteriya a Gram-negative anali osamva kwambiri ampicillin, cefazolin, ndi trimethoprim-sulfamethoxazole, okhala ndi kukana kwa 100%, 92.1%, ndi 84.1%, motsatira.E.coli, mitundu yodziwika bwino yochira, inali ndi mphamvu yolimbana ndi ampicillin (100%), cefazolin (90.5%), ndi trimethoprim-sulfamethoxazole (80.0%). ku cefazolin ndi 88.2% mpaka trimethoprim/sulfamethoxazole Table 4. Kuchuluka kwamphamvu kwambiri (100%) kwa mabakiteriya a Gram-positive kunawonedwa mu trimethoprim/sulfamethoxazole, koma zopatula zonse za mabakiteriya a gram-positive (100%) anali kutenga oxacillin ( tebulo 5).
Urinary tract infections (UTIs) imakhalabe imodzi mwazinthu zomwe zimayambitsa kudwala kwa ana. Kuzindikira koyambirira kwa UTI mwa ana ndikofunikira chifukwa kumatha kukhala chizindikiro cha vuto la impso monga zipsera, kuthamanga kwa magazi, komanso matenda a aimpso. Kafukufuku wathu, kuchuluka kwa matenda a mkodzo kunali 28.6%, komwe 21.6% idayambitsidwa ndi tizilombo toyambitsa matenda ndi 7% ndi tizilombo toyambitsa matenda. ku Ethiopia ndi Merga Duffa et al.Mofananamo, 27.5% et al 19 Zochitika za UTIs chifukwa cha yisiti ku Ethiopia, makamaka ana, sizidziwika kuti titchule.Izi ndichifukwa chakuti matenda a fungal nthawi zambiri amaonedwa kuti ndi osafunika kwambiri kuposa matenda a bakiteriya ndi mavairasi ku Ethiopia.Choncho, chiwerengero cha yisiti -kuyambitsa matenda a mkodzo kwa odwala a ana omwe adanenedwa mu phunziroli anali 7%, yoyamba m'dziko. al.25 Komabe, Zarei adanena za kuchuluka kwa 16.5% ndi 19.0% - Mahmoudabad et al 26 ndi Alkilani et al 27 ku Iran ndi Egypt, motero. popanda kukonda zaka.Kusiyana kwa kufalikira kwa UTIs pakati pa maphunziro kungayambitsidwe ndi kusiyana kwa mapangidwe a maphunziro, makhalidwe a chikhalidwe cha anthu a maphunziro, ndi comorbidities.
Pakafukufuku wamakono, 60% ya UTIs adalandira chipatala (malo osamalira odwala kwambiri ndi ward-acquired) Zotsatira zofanana (78.5%) zinawonedwa ndi Aubron et al.28, ngakhale kuti kufalikira kwa UTIs m'mayiko omwe akutukuka kumene kumasiyana malinga ndi kafukufuku komanso dera, popanda kusiyana kwa chigawo cha tizilombo toyambitsa matenda ndi fungal zomwe zimayambitsa UTIs. pneumoniae.6,29,30 Mogwirizana ndi maphunziro oyambirira omwewo, 29,30 kafukufuku wathu adawonetsanso kuti Escherichia coli anali mabakiteriya omwe amapezeka kwambiri. of bacterial isolates.Escherichia coli anali tizilombo tomwe timayambitsa mabakiteriya ambiri m'madera ndi ma UTI omwe amapezeka m'chipatala (57.1% ndi 42.9%, motero).Kafukufuku wambiri wasonyeza kuti Candida ndi chifukwa cha osachepera 10-15% ya chipatala-opezeka. matenda a mkodzo m'makonzedwe a chipatala, ndipo candida imapezeka makamaka m'magulu osamalira odwala kwambiri.31-33 Mu phunziro lathu, Candida anali ndi 7% ya UTIs, 94% yomwe inali nosocomial-acquired, yomwe 62.5% inawonedwa mu ICU odwala. .Candida albicans chinali chomwe chimayambitsa matenda a candidiasis, ndipo 81.1% ya Candida adapatulidwa kuchokera ku ward-acquired mkodzo chikhalidwe-positive ndi ICU-anapeza zitsanzo zabwino mkodzo mkodzo. odwala immunocompromised monga odwala ICU.
Mu phunziro ili, amayi anali otengeka kwambiri kuposa amuna ku matenda a mkodzo, ndipo odwala azaka zapakati pa 12-15 anali okhudzidwa kwambiri. Zaka zimatha kufotokozedwa ndi gulu lazaka zoyambirira zomwe odwala adalembedwamo.Kutengera momwe matenda a UTIs amadziwika, zochitika za amuna ndi akazi nthawi zambiri zimawoneka ngati zofanana paubwana, ndi amuna omwe ali ndi mphamvu pa nthawi ya ukhanda komanso amayi omwe ali ndi vuto laubwana. komanso panthawi ya maphunziro a chimbudzi.Pakati pazifukwa zina zowonongeka, chipatala cha masiku 3-30 chinali chogwirizana ndi UTI (P = 0.01) .Kugwirizana pakati pa kutalika kwa chipatala ndi UTI kunawonedwa mu maphunziro ena.34,35 UTI mu phunziro lathu linagwirizananso kwambiri ndi catheterization (P = 0.04) . Malinga ndi Gokula et al.35 ndi Saint et al.36, catheterization inachulukitsa chiopsezo cha UTI ndi 3 mpaka 10%, malingana ndi kutalika kwa catheterization.Nkhani zopewera sterility panthawi yoika catheter, kulowetsedwa kwa catheter kawirikawiri, komanso kusamalidwa bwino kwa catheter kungayambitse kuwonjezeka kwa matenda a mkodzo okhudzana ndi catheter.
Panthawi yophunzira, odwala ambiri omwe ali ndi zaka zosachepera zitatu adaloledwa kuchipatala ndi zizindikiro za matenda a mkodzo kusiyana ndi magulu ena azaka.Izi zikhoza kukhala chifukwa chakuti m'badwo uno ndi zaka za maphunziro a potty, zomwe zimagwirizana ndi maphunziro ena.37- 39
Mu kafukufukuyu, mabakiteriya a Gram-negative anali osamva kwambiri ampicillin ndi trimethoprim-sulfamethoxazole, omwe anali osamva 100% ndi 84.1%, motsatana. Trimethoprim-sulfamethoxazole (81.0%).Momwemonso, chiwerengero chapamwamba kwambiri cha kukana (100%) mu mabakiteriya a Gram-positive adawonedwa mu trimethoprim/sulfamethoxazole.Ampicillin ndi trimethoprim-sulfamethoxazole akhala akugwiritsidwa ntchito kwambiri monga chithandizo choyamba cha empiric cha matenda a mkodzo. m'zipatala zonse ku Ethiopia, malinga ndi momwe Ministry of Health's Standard Treatment Guidelines (STG) yayamikiridwa ndi Ministry of Health's Standard Treatment Guidelines (STG).40-42 Kukana kwa mabakiteriya a gram-negative ndi gram-positive ku ampicillin ndi trimethoprim-sulfamethoxazole mu kafukufukuyu. anthu ammudzi amawonjezera mwayi wosankha ndi kusamalira mitundu yosagonjetsedwa mu chikhalidwe chimenecho.43-45 Komano, kafukufuku wathu anasonyeza kuti amikacin ndi meropenem anali mankhwala othandiza kwambiri polimbana ndi mabakiteriya a Gram-negative ndi oxacillin anali mankhwala othandiza kwambiri polimbana ndi Gram. -mabakiteriya abwino.Zomwe zili m'nkhaniyi zatengedwa kuchokera ku pepala losasindikizidwa ndi Nuhamen Zena, lomwe layikidwa ku Addis Ababa University Institutional Repository.46
Chifukwa cha zovuta zazinthu, sitinathe kuyesa kutengera kwa tizilombo toyambitsa matenda a fungal omwe tapezeka mu kafukufukuyu.
Kuchuluka kwa UTIs kunali 28.6%, pomwe 75.4% (49/65) anali ma UTI okhudzana ndi mabakiteriya ndipo 24.6% (19/65) anali UTI woyambitsa yisiti.Enterobacteriaceae ndi omwe amayambitsa matenda a mkodzo. ma albicans ndi osakhala albicans C. albicans akhala akugwirizana ndi ma UTI opangidwa ndi yisiti, makamaka odwala ICU. Kutalika kwa chipatala ndi catheterization ya miyezi 3 mpaka 6 kumagwirizana kwambiri ndi UTI. kugonjetsedwa ndi ampicillin ndi trimethoprim-sulfamethoxazole akulimbikitsidwa ndi Unduna wa Zaumoyo kuti athetse matenda a UTIs. Ntchito yowonjezera iyenera kuchitidwa pa UTIs mwa ana, ndipo ampicillin ndi trimethoprim-sulfamethoxazole ayenera kuganiziridwanso ngati mankhwala osankhidwa pa empiric mankhwala a UTIs.
Kafukufukuyu anachitidwa motsatira Declaration of Helsinki.Zolinga zonse zamakhalidwe abwino ndi maudindo zinayankhidwa bwino ndipo kafukufukuyu anachitidwa ndi chilolezo cha makhalidwe abwino ndi chilolezo cha SPHMMC kuchokera ku Internal Review Board ya Dipatimenti ya Medical Laboratory Sciences, Faculty of Health Sciences, Addis. Ababa University.Popeza kafukufuku wathu anakhudza ana (osakwana zaka 16), sanathe kupereka chilolezo cholembedwa chowona.Choncho, fomu yololeza iyenera kudzazidwa ndi kholo/wowayang'anira.Mwachidule, cholinga cha ntchitoyi ndi mapindu amafotokozedwa momveka bwino kwa kholo/omuyang'anira aliyense.Makolo/olera akulangizidwa kuti zambiri za mwana aliyense zizisungidwa mwachinsinsi.Makolo/woyang'anira amadziwitsidwa kuti mwana wake sakuyenera kutenga nawo gawo pa kafukufukuyu ngati atero. osavomera kutenga nawo gawo mu kafukufukuyu.Akavomera kutenga nawo gawo mu kafukufukuyu ndipo sakufuna kupitiriza, ali ndi ufulu wotuluka mu kafukufukuyu nthawi ina iliyonse mu kafukufukuyu.
Tikufuna kuthokoza dokotala wa ana omwe amapezeka pa malo ophunzirira kuti awonetsetse mozama za odwala kuchokera ku zochitika zachipatala.Tikuthokozanso kwambiri odwala omwe adachita nawo phunziroli.Tikufunanso kuthokoza Nuhamen Zena potilola Chotsani deta yofunikira kuchokera ku kafukufuku wake wosasindikizidwa, womwe wakwezedwa kumalo osungiramo mabuku a yunivesite ya Addis Ababa.
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Nthawi yotumiza: Apr-14-2022