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Adane Bitew, 1 Nuhamen Zena, 2 Abera Abdeta31 Department of Medical Laboratory Sciences, Faculty of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia;2 Microbiology, Millennium School of Medicine, Hospital St Paul, Addis Ababa, Ethiopia Department;3 National Reference Laboratory for Clinical Bacteriology and Mycology, Ethiopian Institute of Public Health, Addis Ababa, Ethiopia Umbhali Ohambelanayo: Abera Abdeta, National Reference Laboratory for Clinical Bacteriology and Mycology, Ethiopian Institute of Public Health, PO Box: 1242, Addis Ababa, Ethiopia , +251911566420, i-imeyili [i-imeyili evikelwe] Isendlalelo: Ama-UTI yizifo ezivamile kwezezingane.Ulwazi lwezimbangela ezivamile zezifo zomgudu womchamo, amaphethini azo okuba sengozini yokulwa namagciwane, nezici ezihambisana nobungozi ezihambisana nezilungiselelo ezithile zinganikeza ubufakazi bokwelashwa okufanele kwamacala.Izinjongo : Lolu cwaningo luhlose ukunquma i-etiology evamile kanye nokusabalala kwe-uropathogens ehambisanayo kanye nezifo ze-urinary tract, kanye namaphrofayili okuthambekela kwe-antibiotic ye-isolate ye-bacterial isolate, kanye nokuhlonza izici eziyingozi ezihlobene nokutheleleka kwe-urinary tract ezigulini zezingane.Izinto kanye nezindlela: Ucwaningo yenziwa kusukela ngo-Okthoba 2019 kuya kuJulayi 2020 e-Millennium School of Medicine, esibhedlela i-St. izinqubo.Ukuhlolwa kwe-antibiotic susceptibility test of bacterial pathogens kusetshenziswa indlela ye-Kirby Bauer disc diffusion.Izibalo ezichazayo kanye nokuhlehliswa kwempahla kusetshenziswe ukulinganisa izilinganiso ezingavuthiwe ezinezikhathi zokuzethemba ezingama-95%.Imiphumela yenani le-P: Ukukhula okuphawulekayo kwebhaktheriya/fungal kwabonwa kumasampuli angu-65 nge ukwanda okungama-28.6%, lapho u-75.4% (49/65) kanye no-24.6% (16/65) kwakungamagciwane ebhaktheriya kanye nesikhunta, ngokulandelana.Cishe ama-79.6% e-bacterial etiologies kwakuyi-Escherichia coli kanye ne-Klebsiella pneumoniae (i-astampicillin ephezulu kakhulu ye-astampicillin. 100%), i-cefazolin (92.1%) kanye ne-trimethoprim-sulfamethoxazole (84.1%), ezivame ukusetshenziswa ngokomthetho e-Ethiopia.Ubude bokuhlala esibhedlela (P=0.01) kanye ne-catheterization (P=0.04) zazihlotshaniswa ngokwezibalo nesifo somzila womchamo. Iziphetho: Ucwaningo lwethu lubone ukwanda okuphezulu kwezifo zomchamo.I-Enterobacteriaceae iyimbangela ehamba phambili yokutheleleka kwe-urinary tract.Ubude bokuhlala esibhedlela kanye ne-catheterization kwakuhlotshaniswa kakhulu nokutheleleka kwe-urinary tract.Zombili amagciwane e-Gram-negative kanye ne-Gram-positive ayengazweli kakhulu i-ampicillin ne-trimethoprim-sulfamethoxazole.Amagama angukhiye: Amaphethini okungenwa yimithi elwa namagciwane, Izifo zezingane, izifo zomgudu womchamo, Ethiopia
Izifo ze-Urinary tract infections (UTIs) ezibangelwa amagciwane kanye nemvubelo ingenye yezifo ezivame kakhulu zomchamo ezinganeni.Emazweni asathuthuka, iyisifo sesithathu esivame kakhulu eqenjini lezingane ngemva kokuphefumula kanye nezifo zesisu.2 Izifo zamathumbu ezinganeni zihlotshaniswa nokugula kwesikhashana, okuhlanganisa imfiva, i-dysuria, ukuphuthuma, nobuhlungu obuphansi emuva.Kungase futhi kubangele ukulimala kwezinso zesikhathi eside, njengezibazi zezinso ezihlala njalo kanye nezinkinga zesikhathi eside, kuhlanganise nomfutho wegazi ophakeme kanye nokwehluleka kwezinso. 3 Wennerstrom et al15 bachaze izibazi zezinso cishe ku-15% wezingane ngemva kwe-UTI yokuqala, egcizelela ukubaluleka kokuxilongwa ngokushesha kanye nokwelashwa kusenesikhathi kwezifo zomgudu womchamo. Ngaphezu kwalokho, izindleko zokulawulwa komgudu womchamo ohlobene nokunakekelwa kwezempilo ziphezulu kakhulu.3, 4 Ucwaningo oluningi lwe-UTIs yezingane emazweni ahlukene asathuthuka lubonise ukuthi ukusabalala kwe-UTIs kuyahlukahluka kusuka ku-16% kuya ku-34%.5-9 Ngaphezu kwalokho, kuze kufike ku-8% wezingane ezineminyaka eyi-1 ukuya kweyi-11 zizothuthukisa okungenani i-UTI10 eyodwa, futhi kufika ku-30% wezinsana nezingane kwaziwa ukuthi zinezifo eziphindelelayo phakathi nezinyanga zokuqala ezingu-6-12 ngemva kwe-UTI yokuqala .11
Amagciwane e-Gram-negative kanye ne-Gram-positive, kanye nezinhlobo ezithile ze-Candida, angabangela izifo zomgudu womchamo.E.coli iyimbangela evame kakhulu yezifo zomgudu womchamo, okulandelwa yi-Klebsiella pneumoniae.12 Ucwaningo luye lwabonisa ukuthi izinhlobo ze-Candida, ikakhulukazi i-Candida albicans, zihlala ziyimbangela evame kakhulu ye-Candida UTIs ezinganeni.Iminyaka engu-13 ubudala, isimo sokusoka, kanye nama-catheter ahlala kuyingozi izici ze-UTIs ezinganeni.Abafana basengozini enkulu ngonyaka wokuqala wokuphila, ngemva kwalokho, ngenxa yokuhluka kwezitho zobulili, isigameko siphezulu kakhulu emantombazaneni, futhi izinsana zabesilisa ezingasokile zisengozini enkulu.1,33 Amaphethini okungenwa ngama-Antibiotic Ama-uropathogens ayahlukahluka ngokuhamba kwesikhathi, indawo yesiguli, izibalo zabantu kanye nezici zomtholampilo.
Izifo ezithathelwanayo ezifana ne-UTIs kucatshangwa ukuthi yimbangela yokufa kwe-26% emhlabeni jikelele, i-98% yazo ivela emazweni anemali ephansi. %,16.Ucwaningo lwasesibhedlela lwezingane zaseNingizimu Afrika lubonise ukuthi izifo zomgudu womchamo zibalelwa ku-11% izifo zokunakekelwa kwempilo.17 Olunye ucwaningo eKenya lwathola ukuthi izifo zomgudu womchamo zibalelwa ku-11.9% womthwalo we-febrile infections ezinganeni ezincane.18
Zimbalwa izifundo ezihlonze ama-UTI ezigulini zezingane e-Ethiopia: izifundo e-Hawassa Referral Hospital, eYekatit 12 Hospital, Felege-Hiwot Specialist Hospital kanye naseGondar University Hospital zibonise u-27.5%, 19 15.9%, 20 16.7%, 21 kanye 26.45% kanye 22, ngokulandelana. .Emazweni asathuthuka, okuhlanganisa ne-Ethiopia, ukuntuleka kwamasiko omchamo emazingeni ahlukahlukene okuthuthwa kwendle kusalokhu kungenakwenzeka ngoba kusebenzisa izinsiza.Ngakho-ke, i-pathogen spectrum ye-UTI kanye nephrofayili yayo yokuba sengozini yezidakamizwa e-Ethiopia akwaziwa.Kuze kube manje, lokhu ucwaningo oluhloselwe ukunquma ukusabalala kwezifo zomgudu womchamo, ukuhlaziya amagciwane amagciwane kanye nesikhunta ahlotshaniswa nama-UTIs, anqume amaphrofayili okuthambekela okulwa namagciwane okuhlukaniswa kwamagciwane, futhi ahlonze izici ezinkulu ezithintekayo ezihlobene ne-UTIs.
Kusukela ngo-Okthoba 2019 kuya kuJulayi 2020, ucwaningo olusekelwe esibhedlela lwenziwa eMnyangweni Wezifo Zezingane wase-St Paul's Hospital Millennium Medical College (SPHMMC), e-Addis Ababa, e-Ethiopia.
Phakathi nenkathi yocwaningo, zonke iziguli zezingane kanye neziguli zangaphandle zazibonwa kwezokwelapha zezingane.
Ngesikhathi socwaningo, zonke iziguli ezilalisiwe zezingane kanye neziguli zangaphandle ezinezimpawu nezimpawu ze-UTI zathamela indawo yocwaningo.
Usayizi wesampula wanqunywa kusetshenziswa ifomula yokubala usayizi wesampula yengxenye eyodwa enesikhawu sokuzethemba esingu-95%, umkhawulo wephutha ongu-5%, kanye nokuvama kwe-UTIs emsebenzini wangaphambili [15.9% noma P=0.159)] Merga Duffa et al20 e-Addis Ababa , njengoba kuboniswe ngezansi.
Z α/2 = 95% yenani elibalulekile lesikhawu sokuzithemba ekusakazeni okuvamile, elilingana no-1.96 (inani elingu-Z kokuthi α = 0.05);
D = umkhawulo wephutha, olingana no-5%, α = izinga lephutha abantu abazimisele ukulibekezelela;xhuma lokhu kufomula, n= (1.96)2 0.159 (1–0.159)/(0.05)2=206 futhi uthathe u-10% engaphendulwanga lapho n = 206+206/10 = 227.
Kusetshenziswe indlela ekahle yokusampula kulolu cwaningo. Qoqa idatha kuze kube yilapho usayizi wesampula oyifunayo ufinyelelwa.
Idatha yaqoqwa ngemva kokuthola imvume ebhaliwe enolwazi evela kubazali.Izici zenhlalo yabantu (iminyaka yobudala, ubulili, nendawo yokuhlala) nezici zobungozi ezihlobene (i-catheter, i-UTI yangaphambilini, isimo se-human immunodeficiency virus (HIV), ukusoka, nobude bokuhlala esibhedlela) yababambe iqhaza ocwaningweni baqoqwe ngabahlengikazi abaqeqeshiwe besebenzisa idatha eshiwo ngaphambilini.Uhlu lwemibuzo oluhlelekile lokuhlolwa.Izimpawu nezimpawu zesiguli kanye nesifo esiwumsuka zabhalwa udokotela wezingane okhona.
Ngaphambi kokuhlaziywa: izici ze-sociodemographic (iminyaka yobudala, ubulili, njll.) kanye nolwazi lwezokwelashwa nokwelashwa lwabahlanganyeli bocwaningo luqoqwe kuhlu lwemibuzo.
Ukuhlaziywa: Ukusebenza kwe-autoclave, incubator, ama-reagents, i-microscope, kanye nekhwalithi ye-microbiological ye-medium (ubunyumba bokusebenza okumaphakathi nokukhula komkhakha ngamunye) kwahlolwa ngokwezinqubo ezijwayelekile ngaphambi kokusetshenziswa.Ukuqoqwa nokuthuthwa kwamasampula omtholampilo kuyenziwa. ngemva kwezinqubo ze-aseptic.Ukufakwa kwamasampula omtholampilo kwenziwa ngaphansi kwekhabhinethi yesibili yokuphepha.
Ukuhlaziywa Kwangemuva: Lonke ulwazi olukhishiwe (njengemiphumela yaselabhorethri) luhlolelwa ukufaneleka, ukuphelela kanye nokuvumelana futhi kuqoshwa ngaphambi kokufaka amathuluzi ezibalo.Idatha ibuye igcinwe endaweni evikelekile.Izihlukanisi zamagciwane nemvubelo zagcinwa ngokuvumelana neNqubo Ejwayelekile Yokusebenza (Standard Operating Procedure). I-SOP) ye-St. Paul's Hospital Millennium Medical College (SPHMMC).
Yonke idatha yezinhlolovo yafakwa amakhodi, yafakwa kabili, futhi yahlaziywa kusetshenziswa inguqulo yesofthiwe ye-Statistical Package for the Social Sciences (SPSS) version 23.Sebenzisa izibalo ezichazayo nokuhlehla kwezinto ukuze ulinganisele izilinganiso ezinzima ezinezikhawu zokuzethemba ezingu-95% eziguquguqukayo ezihlukahlukene.P < 0.05 kubhekwe njengokubalulekile.
Amasampula omchamo aqoqwa esigulini ngasinye sezingane kusetshenziswa iziqukathi zomchamo oyinyumba.Abazali noma ababheki babahlanganyeli bocwaningo banikezwa iziqondiso ezifanele mayelana nendlela yokuqoqa amasampula omchamo athathwa ahlanzekile.Amasampula omchamo we-catheter kanye nomchamo we-suprapubic aqoqwa abahlengikazi nodokotela abaqeqeshiwe.Ngokushesha ngemva kokuqoqwa , amasampula ayiswa elabhorethri ye-microbiology ye-SPHMMC ukuze kuqhutshekwe nokucutshungulwa. Izingxenye zamasampula zajovwa epuletini le-agar le-MacConkey (i-Oxoid, i-Basingstoke ne-Hampshire, e-England) kanye ne-blood agar (i-Oxoid, i-Basingstoke ne-Hampshire, e-England) kwikhabhinethi yezokuphepha kusetshenziswa Iluphu yokulinganisa engu-1 μL.Amasampuli asele afakwe ku-agar yokufakwa kwenhliziyo yobuchopho ehlanganiswe ne-chloramphenicol (100 µgml-1) ne-gentamicin (50 µgml-1) (Oxoid, Basingstoke, neHampshire, England).
Wonke amapuleti afakwe i-incubated aerobically at 37°C amahora angu-18-48 futhi ahlolwe ukukhula kwebhaktheriya kanye/noma imvubelo.Izibalo zamakholoni zamagciwane noma imvubelo ekhiqiza umchamo ongu-≥105 cfu/mL ayebhekwa njengokukhula okuphawulekayo.Amasampula omchamo aveza izinhlobo ezintathu noma ngaphezulu azizange zicutshungulwe ukuze kuqhutshekwe nophenyo.
I-isolate ehlanzekile ye-bacterial pathogens ekuqaleni yayibonakala nge-colony morphology, i-Gram staining.Amagciwane a-Gram-positive aphinde abonakala esebenzisa i-catalase, i-bile aescin, i-pyrrolidinopeptidase (i-PRY) kanye ne-rabbit plasma.I-Gram-negative bacteria ngokusebenzisa ukuhlolwa kwe-biochemical okujwayelekile okufana (urease test, ukuhlolwa kwe-indole, ukuhlolwa kokusetshenziswa kwe-citrate, ukuhlolwa kwe-iron trisaccharide, ukuhlolwa kokukhiqizwa kwe-hydrogen sulfide (H2S), ukuhlolwa kwe-lysine iron agar, ukuhlolwa kwe-motility kanye nokuhlolwa kwe-oxidase) ezingeni lezinhlobo zezilwane).
Imvubelo itholwe kusetshenziswa izindlela zokuxilonga ezijwayelekile njengokugcotshwa kweGram, ukuhlolwa kweshubhu le-embryo, ukuvutshelwa kwe-carbohydrate kanye nezivivinyo zokulinganisa kusetshenziswa i-chromogenic medium (CHROMagar Candida medium, bioM'erieux, France) ngokwemiyalelo yomkhiqizi.
Ukuhlolwa kwe-antimicrobial susceptibility testing kwenziwa yi-Kirby Bauer disc diffusion ku-Mueller Hinton agar (Oxoid, Basingstoke, England) ngokuvumelana neziqondiso ze-Clinical Laboratory Standards Institute (CLSI)24. Ukumiswa kwamagciwane kwe-isolate ngayinye kwalungiselelwa ku-0.5 mL womhluzi wezakhi futhi kwalungiselelwa ukuguquguquka fanisa izinga le-0.5 McFarland ukuze uthole cishe amayunithi angu-1 × 106 e-coloni-forming (CFUs) ngemL ngayinye ye-biomass. Gcoba i-swab oyinyumba ekumisweni bese ukhipha okubalulekile ngokuyicindezela eceleni kweshubhu. indawo ephakathi yepuleti ye-agar ye-Mueller Hinton futhi isatshalaliswe ngokulinganayo phezu kwe-medium.Amadiski e-Antibiotic afakwa ku-Mueller Hinton agar enembewu ngayinye phakathi kwemizuzu eyi-15 yokujova futhi ifakwe ku-35-37 °C amahora angu-24. Sebenzisa i-caliper ukuze ulinganise ububanzi bendawo yokuvimbela.Ukuvinjelwa kwendawo yobubanzi kwahunyushwa njengokuzwela (S), okumaphakathi (I), noma ukumelana (R) ngokweziqondiso ze-Clinical and Laboratory Standards Institute (CLSI)24.Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922) kanye ne-Pseudomonas aeruginosa (ATCC 27853) zisetshenziswe njengezinhlobo zokulawula ikhwalithi ukuhlola ukusebenza kahle kwama-antibiotics.
Kumagciwane e-Gram-negative, sisebenzisa amapuleti e-antibiotic: i-amoxicillin/clavulanate (30 μg);i-ciprofloxacin (5 μg);i-nitrofurantoin (300 μg);i-ampicillin (10 μg);i-amikacin (30 μg);I-Meropenem (10 μg);I-Piperacillin-tazobactam (100/10 μg);I-Cefazolin (30 μg);I-Trimethoprim-sulfamethoxazole (1.25/23.75 μg).
Ama-antibacterial discs we-Gram-positive isolates ayeyi: penicillin (amayunithi angu-10);i-cefoxitin (30 μg);i-nitrofurantoin (300 μg);vancomycin (30 μg);i-trimethoprim-sulfamethoxazole (1.25/g) 23.75 μg);I-Ciprofloxacin (5 μg);I-Doxycycline (30 μg) Wonke ama-antimicrobial discs asetshenziswe ocwaningweni lwethu kwakuyimikhiqizo ye-Oxide, i-Basingstoke ne-Hampshire, e-England.
Njengoba kuboniswe kuThebula 1, lolu cwaningo lubhalise iziguli zezingane ezingama-227 (227) ezibonise noma ezazisolwa kakhulu ngokuba ne-UTI futhi zahlangabezana nemibandela yokukhetha.Abahlanganyeli bocwaningo besilisa (138; 60.8%) badlula ababambiqhaza bocwaningo besifazane (89; 39.2%), ngesilinganiso sowesifazane nowesilisa sika-1.6: 1. Inani lezifundo zocwaningo lalishintshashintsha phakathi kwamaqembu eminyaka yobudala, neqembu le-˂ 3 elineminyaka engu-3 ubudala lineziguli eziningi (119; 52.4%), lilandelwa yi-13-15- oneminyaka yobudala (37; 16.3%) kanye namaqembu eminyaka yobudala engu-3-6 (31; 13.7%), ngokulandelana.Izinhloso zocwaningo ikakhulukazi amadolobha, anesilinganiso sasemadolobheni nesemakhaya esingu-2.4:1 (Ithebula 1).
Ithebula 1 Izici zenhlalo yabantu zezifundo ezifundwayo kanye nemvamisa yamasampula ahle ngokwesiko (N= 227)
Ukukhula okuphawulekayo kwebhaktheriya/imvubelo kubonwe kumasampula omchamo angama-65 kwangu-227 (227) wokuvama kwawo wonke okungama-28.6% (65/227), lapho u-21.6% (49/227) bekuyizifo ezibangelwa amagciwane, kuyilapho u-7 % (16/227) kwakungama-pathogens esikhunta.Ukuvama kwe-UTI kwakuphakeme kakhulu eqenjini leminyaka eyi-13-15 ku-17/37 (46.0%) futhi eqenjini leminyaka eyi-10-12 bekuphansi kakhulu ku-2/21 (9.5%).Ithebula 2) .Abesifazane babenezinga eliphezulu le-UTIs, 30/89 (33.7%), uma kuqhathaniswa nabesilisa abangama-35/138 (25.4%).
Kuma-bacterial isolate angama-49, ama-79.6% (39/49) bekuyi-Enterobacteriaceae, lapho i-Escherichia coli bekuyibhaktheriya ejwayeleke kakhulu ebalelwa ku-42.9% (21/49) wengqikithi yamagciwane, ilandelwa yi-Klebsiella pneumoniae bacteria, ebalelwa ku-34.6% ( I-17/49) yama-bacterium isolates.Ama-isolates amane (8.2%) ayemelwe i-Acinetobacter, i-Gram-negative bacillus engavundi. I-60.0%) yayiyi-Enterococcus.Kuma-yeast isolates angu-16, angu-6 (37.5%) ayemelwe ama-C. albicans.Kuma-uropathogens atholwe ngumphakathi angu-26, ama-76.9% (20/26) kwakungu-Escherichia coli kanye ne-Klebsiella pneumoniae.Of the 20 -ama-uropathogens atholakele, i-15/20 yayiyi-bacterial pathogens.Kuma-uropathogens atholakala e-ICU angu-19, i-10/19 yayiyimvubelo.Kumasampuli angu-65 omchamo onempilo, ama-39 (60.0%) atholakala esibhedlela kanti angu-26 (40.0%) atholakala okuzuzwe umphakathi (Ithebula 3).
Ithebula lesi-3 Ukuhlaziywa kokuhlehliswa kokuhleleka kwezinto eziyingozi ezihlobene nokutheleleka komgudu womchamo ezigulini zezingane ezine-SPHMMC (n = 227)
Ezigulini zezingane ezingama-227, eziyi-129 zilaliswe esibhedlela isikhathi esingaphansi kwezinsuku ezi-3, kuthi ezingama-25 (19.4%) zingenawo amasiko, eziyi-120 zalaliswa emtholampilo weziguli ezingalaliswanga, ezingama-25 (20.8%) zazo zinempilo, kanti ezingama-63 zine umlando wokutheleleka komgudu womchamo.Phakathi kwabo, ama-23 (37.70%) ayenethemba ngesiko, ama-38 ayengama-catheter ahlala ngaphakathi, ama-20 (52.6%) ayevumelana nesiko, kanti angama-71 ayenethemba lokushisa komzimba> 37.5°C, okungama-21 (29.6%). zazilungile ngesiko (Ithebula 3).
Izibikezelo ze-UTI zahlaziywa ngokuphindwe kabili, futhi zazinamanani okuhlehla kokuhleleka kokuhlala izinyanga ezi-3-6 (COR 2.122; 95% CI: 3.31-3.43; P=0.002) kanye ne-catheterization (COR= 3.56; 95) %CI : 1.73–7.1;P = 0.001).Ukuhlaziywa kokuhlehla okuningi kwenziwa kuzibikezelo ezibalulekile ezi-bivariately ze-UTI ezinamavelu okuhlehlisa alandelayo: ubude bokuhlala izinyanga ezi-3-6 (AOR = 6.06, 95% CI: 1.99-18.4; P = 0.01) kanye ne-catheterization ( I-AOR = 0.28; 95% CI: 0.13–0.57, P = 0.04). Ubude bokuhlala esibhedlela izinyanga ezingu-3-6 bebuhlotshaniswa kakhulu ne-UTI (P = 0.01). Ukuhlotshaniswa kwe-UTI ne-catheterization nakho kwakubalulekile ngokwezibalo ( P=0.04).Nokho, indawo yokuhlala, ubulili, ubudala, umthombo wokungena, umlando wangaphambilini we-UTI, isimo se-HIV, izinga lokushisa lomzimba, kanye nezifo ezingelapheki akutholakalanga kuhlotshaniswa kakhulu ne-UTI (Ithebula 3).
Ithebula lesi-4 nelesi-5 lichaza amaphethini okungenwa ngama-antimicrobial ewonke amagciwane e-Gram-negative kanye ne-Gram-positive kuma-antibiotic ayisishiyagalolunye ahloliwe.I-Amikacin ne-meropenem kwakuyimithi ephumelela kakhulu ehlolwe ngokumelene nama-Gram-negative bacteria, amazinga okumelana nawo angu-4.6% no-9.1%, ngokulandelana.Phakathi kwayo yonke imithi ehloliwe, amagciwane e-Gram-negative ayengazweli kakhulu ku-ampicillin, i-cefazolin, ne-trimethoprim-sulfamethoxazole, namazinga okumelana no-100%, 92.1%, kanye nama-84.1%, ngokulandelana.E.coli, okuwuhlobo oluvame kakhulu olutholakele, lwalunokumelana okuphezulu ne-ampicillin (100%), i-cefazolin (90.5%), kanye ne-trimethoprim-sulfamethoxazole (80.0%).I-Klebsiella pneumoniae kwakuyibhaktheriya yesibili evame ukuhluka kakhulu, enezinga lokumelana elingu-94.1%. ku-cefazolin kanye no-88.2% kuya ku-trimethoprim/sulfamethoxazole Ithebula 4.Izinga eliphakeme kakhulu lokuphikiswa (100%) lamagciwane e-Gram-positive labonwa ku-trimethoprim/sulfamethoxazole, kodwa wonke ama-isolate amagciwane e-Gram-positive (100%) ayengenwa kalula i-oxacillin ( ithebula 5).
Izifo ze-Urinary tract infections (UTIs) zisengenye yezimbangela ezivame kakhulu zokugula ezenzweni zezingane.Ukuxilongwa kusenesikhathi kwe-UTI kubantwana kubalulekile ngoba kungaba inkomba yokungajwayelekile kwezinso ezifana nezibazi, umfutho wegazi ophezulu, nesifo sezinso esingena esigabeni sokugcina. Ucwaningo lwethu, ukusabalala kwezifo zomgudu womchamo kwakungama-28.6%, okungama-21.6% abangelwa amagciwane amagciwane kanye no-7% abangelwa amagciwane esikhunta.Ocwaningweni lwethu, izinga lokutheleleka emgudwini womchamo okubangelwa amagciwane laliphezulu kune-15.9% ukusabalala okubikiwe. e-Ethiopia nguMerga Duffa et al.Ngokufanayo, i-27.5% et al 19 Isigameko se-UTIs ngenxa yemvubelo e-Ethiopia, ikakhulukazi izingane, akwaziwa ngereferensi yethu.Lokhu kungenxa yokuthi izifo zesikhunta ngokuvamile zibhekwa njengezibalulekile kunezifo ezibangelwa amagciwane kanye negciwane e-Ethiopia.Ngakho-ke, ukwenzeka kwemvubelo -ukutheleleka kwe-urinary tract ezigulini zezingane ezibikwe kulolu cwaningo bekuyi-7%, eyokuqala ezweni.Ukusabalala kwe-UTIs okubangelwa imvubelo okubikwe ocwaningweni lwethu kuhambisana nokusabalala kwe-5.2% okubikwe ocwaningweni lwezingane nguSeihi et al.25 Nokho, i-Zarei ibike ukusabalala kwe-16.5% ne-19.0% - i-Mahmoudabad et al 26 kanye no-Alkilani et al 27 e-Iran nase-Egypt, ngokulandelana.Ukusabalala okuphezulu kulezi zifundo ezimbili akumangazi njengoba izifundo ezifakiwe zaziyiziguli ze-ICU. ngaphandle kokukhetha iminyaka yobudala.Umehluko wokusabalala kwe-UTI phakathi kwezifundo ungase ubangelwe umehluko ekuklanyweni kocwaningo, izici ze-sociodemographic zezifundo zocwaningo, kanye ne-commorbidities.
Ocwaningweni lwamanje, i-60% ye-UTIs yatholwa esibhedlela (iyunithi yokunakekelwa okujulile kanye newadi-etholwe) .Imiphumela efanayo (78.5%) yabonwa ngu-Aubron et al.28, nakuba ukusabalala kwe-UTIs emazweni asathuthuka kwahlukahluka ngocwaningo nangesifunda, kungekho mehluko wesifunda emagciwaneni amagciwane kanye nesikhunta abangela ama-UTI.Amagciwane avame ukutholakala emasikweni omchamo kwakuyi-Gram-negative bacilli, ikakhulukazi i-Escherichia coli, elandelwa yi-Klebsiella. I-pneumoniae.6,29,30 Ngokuvumelana nezifundo ezifanayo zangaphambili, i-29,30 ucwaningo lwethu luphinde lwabonisa ukuthi i-Escherichia coli yayiyi-bacteria evame kakhulu.Amabhaktheriya avamile ahlanganisa i-42.9% yengqikithi yama-bacterial isolate, elandelwa yi-Klebsiella pneumoniae, eyaba ngu-34.6% we-bacterial isolates.I-Escherichia coli kwakuyi-pathogen yebhaktheriya evame kakhulu emphakathini- kanye ne-UTI etholwe esibhedlela (57.1% kanye no-42.9%, ngokulandelana). Ucwaningo oluningi luye lwabonisa ukuthi i-Candida iyimbangela okungenani engu-10-15% etholakala esibhedlela. izifo ze-urinary tract ezilungiselelweni zesibhedlela, futhi i-candida ivame kakhulu ezindlini zokunakekelwa okuphuthumayo.31-33 Esifundweni sethu, i-Candida ibalwa ku-7% we-UTIs, i-94% yayo eyayitholwa yi-nosocomial, okuyi-62.5% yabonwa ezigulini ze-ICU. .I-Candida albicans yayiyimbangela eyinhloko ye-candidiasis, kanti u-81.1% we-Candida ahlukaniswa namasampula omchamo atholakala ewodini kanye namasampula omchamo atholwe e-ICU. iziguli ezingenaso amandla omzimba njengeziguli ze-ICU.
Kulolu cwaningo, abesifazane babengenwa kalula izifo zomgudu womchamo kunabesilisa, kanti iziguli ezineminyaka engu-12-15 ubudala zazisengozini kakhulu. Nokho, umehluko phakathi kwalezi zimo ezimbili awubalulekile ngokwezibalo. iminyaka yobudala ingachazwa iqembu leminyaka yobudala lapho iziguli zibuthwa khona.Ngokubheka amaphethini e-epidemiological e-UTIs aziwayo, izehlakalo zabesilisa nabesifazane ngokuvamile zibonakala zilingana ebuntwaneni, nokubusa kwabesilisa esikhathini sokuzalwa kanye nokusetshenziswa kakhulu kwabesifazane ebuntwaneni. kanye nangesikhathi sokuqeqeshwa kwezindlu zangasese.Phakathi kwezinye izici zengozi ezihlaziywe ngezibalo, ukuhlala esibhedlela kwezinsuku ezingu-3-30 kwakuhlotshaniswa nezibalo ze-UTI (P=0.01) .Ukuhlobana phakathi kobude bokuhlala esibhedlela kanye ne-UTI kwabonwa kwezinye izifundo.34,35 UTI in ucwaningo lwethu luphinde lwahlotshaniswa kakhulu ne-catheterization (P=0.04) .NgokukaGokula et al.35 kanye noSaint et al.36, ukufakwa kwe-catheter kwandise usongo lwe-UTIs ngo-3 kuya ku-10%, kuye ngobude be-catheterization.Izinkinga zokuvimbela inzalo ngesikhathi sokufakwa kwe-catheter, ukushintshwa kwe-catheter okungajwayelekile, nokunakekelwa okungalungile kwe-catheter kungase kubangele ukwanda kwezifo ezihlobene ne-catheter-umchamo.
Phakathi nenkathi yocwaningo, iziguli eziningi zezingane ezingaphansi kweminyaka emithathu ubudala zangeniswa esibhedlela ezinezimpawu zokutheleleka kwe-urinary tract kunamanye amaqembu eminyaka.Lokhu kungase kube ngenxa yokuthi le minyaka yobudala bokuqeqeshwa kwebhodwe, okuhambisana nezinye izifundo.37- 39
Kulolu cwaningo, amagciwane e-Gram-negative ayengazweli kakhulu ku-ampicillin kanye ne-trimethoprim-sulfamethoxazole, amazinga okumelana nawo angu-100% kanye nama-84.1%, ngokulandelana. I-Escherichia coli eyayilulama kakhulu ne-Klebsiella pneumoniae yayingazweli kakhulu ku-ampicillin (100%) futhi i-trimethoprim-sulfamethoxazole (81.0%).Ngokunjalo, izinga eliphezulu kakhulu lokungazweli (100%) kubhaktheriya e-Gram-positive labonwa ku-trimethoprim/sulfamethoxazole.I-Ampicillin ne-trimethoprim-sulfamethoxazole isetshenziswe kabanzi njengokwelashwa komugqa wokuqala okunamandla kwezifo zomgudu womchamo. kuzo zonke izikhungo zezempilo e-Ethiopia, njengoba kunconywe yi-Ministry of Health's Standard Treatment Guidelines (STG) .40-42 Amazinga okumelana nama-bacterium e-gram-negative kanye ne-gram-positive ku-ampicillin ne-trimethoprim-sulfamethoxazole kulolu cwaningo.Kuqhubeka ukusetshenziswa kwezidakamizwa umphakathi wandisa amathuba okukhethwa nokugcinwa kwezinhlobo eziphikisanayo kuleso silungiselelo.43-45 Ngakolunye uhlangothi, ucwaningo lwethu lubonise ukuthi i-amikacin ne-meropenem kwakuyizidakamizwa eziphumelela kakhulu ngokumelene nama-bacterium e-Gram-negative kanye ne-oxacillin yayiyisidakamizwa esiphumelela kakhulu ngokumelene ne-Gram. -amagciwane akhona.Imininingwane kulesi sihloko ithathwe ephepheni elingashicilelwe ngu-Nuhamen Zena, elilayishwe e-Addis Ababa University Institutional Repository.46
Ngenxa yezinkinga zensiza, asikwazanga ukwenza ukuhlolwa kokungenwa kwe-antifungal kumagciwane esikhunta akhonjwe kulolu cwaningo.
Ukusabalala kwe-UTIs sekukonke bekungama-28.6%, lapho u-75.4% (49/65) bekungama-UTI ahlobene namagciwane kanye nama-24.6% (19/65) ama-UTI abangelwa imvubelo.I-Enterobacteriaceae iyimbangela ehamba phambili yezifo zomgudu womchamo.Zombili i-C. ama-albicans kanye nama-non-albicans ama-C. albicans ahlotshaniswa ne-UTI eyenziwe imvubelo, ikakhulukazi ezigulini zase-ICU.Ubude bokuhlala esibhedlela kanye ne-catheterization yezinyanga ezi-3 kuya kwezingu-6 zazihlotshaniswa kakhulu ne-UTI.Zombili amagciwane e-gram-negative kanye ne-gram-positive aphakeme kakhulu. ukumelana ne-ampicillin kanye ne-trimethoprim-sulfamethoxazole okutuswe uMnyango Wezempilo ekwelapheni okunamandla kwe-UTIs. Omunye umsebenzi kufanele wenziwe kuma-UTIs ezinganeni, futhi i-ampicillin ne-trimethoprim-sulfamethoxazole kufanele ibhekwe kabusha njengemithi yokuzikhethela yokwelashwa okunamandla kwe-UTIs.
Ucwaningo lwenziwe ngokuhambisana neSimemezelo sase-Helsinki.Konke ukucatshangelwa kokuziphatha kanye nezibopho zasingathwa ngendlela efanele futhi ucwaningo lwenziwa ngokugunyazwa kwezimiso zokuziphatha kanye nemvume ye-SPHMMC evela eBhodini Lokubuyekeza Kwangaphakathi Lomnyango Wesayensi Yelabhorethri Yezokwelapha, I-Faculty of Health Sciences, Addis. Ababa University.Njengoba ucwaningo lwethu lwalubandakanya izingane (ezingaphansi kweminyaka engu-16 ubudala), azikwazanga ukunikeza imvume ebhalwe phansi yangempela.Ngakho-ke, ifomu lemvume kufanele ligcwaliswe umzali/umbheki.Ngamafuphi, inhloso yomsebenzi kanye ne izinzuzo zichazwa ngokucacile kumzali/umnakekeli ngamunye.Abazali/ababheki bayelulekwa ukuthi imininingwane yomuntu ngamunye izogcinwa iyimfihlo.Umzali/umbheki uyaziswa ukuthi ingane yakhe ayiphoqelekile ukuthi ibambe iqhaza ocwaningweni uma yenza kanjalo. ukungavumi ukubamba iqhaza ocwaningweni.Uma sebevumile ukubamba iqhaza ocwaningweni futhi bengenantshisekelo yokuqhubeka, bakhululekile ukuthi bahoxe ocwaningweni nganoma yisiphi isikhathi phakathi nocwaningo.
Sithanda ukubonga udokotela wezingane okhona endaweni yocwaningo ngokubukeza ngokucophelela iziguli ngokombono wokwethulwa komtholampilo.Siphinde sibonge kakhulu iziguli ezibambe iqhaza ocwaningweni.Sithanda futhi ukubonga uNuhamen Zena ngokusivumela ukuthi akhiphe idatha ebalulekile ocwaningweni lwakhe olungakashicilelwa, olulayishwe endaweni yokugcina impahla yase-Addis Ababa University.
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Isikhathi sokuthumela: Apr-14-2022