Patrón de resistencia/sensibilidad bacteriana en lactantes menores de 2 años con diagnóstico de infección de vías urinarias en una IPS Materno-Infantil de Barranquilla en el periodo 2022 -2024
Fecha
2025
Autores
Cabarcas Sierra, Ana Rita
Ricardo Aaron, Jenny Magdalena
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Editor
Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: La Infección de las Vías Urinarias (IVU) se considera generalmente como la presencia de microorganismos patógenos en el tracto urinario que puede acompañarse o no de síntomas. En la edad pediátrica, la IVU es la tercera causa de las patologías infecciosas más frecuentes, precedida de las infecciones respiratorias y gastrointestinales. Entre el 8 al 12% y 3 al 5% de niñas y niños para cada uno, presentarán por lo menos un episodio de IVU, antes de cumplir 10 años. La resistencia antimicrobiana en infecciones del tracto urinario en la población pediátrica es de suma importancia, debido a un aumento de su recurrencia en los últimos años, sumado a esto se presenta como una de las principales complicaciones asociadas a gran morbilidad y puede conllevar a mortalidad, si no es tratada oportunamente.Existen múltiples factores asociados al éxito o fracaso de un tratamiento, como lo son los determinantes de la salud, descritos por la Organización Mundial de la Salud como "las circunstancias en que las personas nacen crecen, trabajan, viven y envejecen, incluido el conjunto más amplio de fuerzas y sistemas que influyen sobre las condiciones de la vida cotidiana". Durante el abordaje de estos pacientes juega un papel importante la historia clínica, la cual nos permitirá evaluar sus antecedentes, factores de riesgo y condiciones psicosociales que puedan contribuir al curso de la patología; cabe resaltar que es imprescindible conocer la epidemiología local que nos orientaría a una sospecha en cuanto a la probable etiología y microorganismos causales del episodio de IVU antes de obtener el resultado del urocultivo, lo cual resulta relevante al momento de iniciar la antibioticoterapia empírica para cada paciente en particular. El presente proyecto, se realizó partiendo de la necesidad de estudiar los patrones de resistencia y sensibilidad bacteriana en los pacientes menores de 2 años con diagnóstico de IVU hospitalizados en una IPS del Atlántico, al igual que establecer estrategias de prevención por parte del personal asistencial y administrativo de la institución. Ante la poca disponibilidad de estudios de alcance regional sobre los patrones de resistencia más frecuentes y su asociación con los determinantes de la salud. Objetivos: Caracterizar el perfil de resistencia y sensibilidad bacteriana en lactantes menores de 2 años con diagnóstico de infección de vías urinarias en una IPS materno-infantil de Barranquilla en el periodo 2022 - 2024. Materiales y métodos: Estudio descriptivo retrospectivo de corte transversal. La población estudiada estuvo compuesta por lactantes menores de 2 años con diagnóstico de infección de vías urinarias en una Institución Prestadora de Servicios de Salud (IPS) materno-infantil de Barranquilla en el periodo 2022 -2024. Se incluyeron en el estudio pacientes lactantes entre 28 días y 24 meses de vida con resultados de urocultivos positivos tomados con adecuada técnica de recolección, fueron excluidos pacientes recién nacidos, en edad preescolar, escolar y adolescencia, pacientes con datos incompletos en la historia clínica y aquellos con comorbilidades y/o malformaciones congénitas o dispositivos invasivos. Se realizó muestreo no probabilístico por conveniencia, el tamaño de la muestra se calculó utilizando la aplicación Epi – Info 7.4 se estima que para un modelo de regresión con un nivel de significancia del 0.05, poder del 80%, tamaño del efecto f de Cohen de 0.39. Realizándose ajuste de pérdida esperada del 20% se aplicó la fórmula 1/(1-r), resultando en un total de 212 pacientes. Resultados: El sexo femenino evidenció la frecuencia más alta con un 61.8%, el 50.5% de los pacientes estaban entre 1 y 12 meses (lactantes menores) y el 49.5% entre los 12 a 24 meses (lactantes mayores), el 56.2% de los lactantes con IVU se encontraban clasificados como adecuados nutricionalmente. E. coli fue el agente etiológico aislado con mayor frecuencia con el 82.6%, seguido del Proteus mirabilis 9.9%, la Klebsiella 4.3% y otros gérmenes (Pseudomona aeruginosa, Enterobacter) el 3.2%. Se describen los perfiles de sensibilidad y resistencias de los tres gérmenes aislados con mayor frecuencia, así entonces, para la Escherichia coli la mayor sensibilidad se observó para el Imipenem y Meropenem con un 100%, Nitrofurantoina, Cefuroxima, Cefepima y Amikacina 98.3%, Aztreonam, Ceftazidima y Ceftriaxona 97.1%. Conclusiones: Las características sociodemográficas de la población pediátrica que ingresaron al servicio de hospitalización en una IPS materno-infantil de la ciudad de Barranquilla por infección de vías urinarias (IVU), no difiere de lo observado en estudios nacionales e internacionales. La Escherichia coli fue el microorganismo que se aisló con mayor frecuencia y la mayor sensibilidad de este se presentó para Imipenem y Meropenem. La infección de vías urinarias mostró una mayor frecuencia en el sexo femenino, mientras que la distribución según los grupos etarios no presentó diferencias significativas.
Introduction: Urinary Tract Infection (UTI) is generally considered to be the presence of pathogenic microorganisms in the urinary tract that may or may not be accompanied by symptoms.In children, UTI is the third most common cause of infectious diseases, preceded by respiratory and gastrointestinal infections. Between 8% and 12% and 3% and 5% of girls and boys each will experience at least one episode of UTI before reaching the age of 10. Antimicrobial resistance in urinary tract infections in the pediatric population is of utmost importance due to an increase in its recurrence in recent years. In addition, it is one of the main complications associated with high morbidity and can lead to mortality if not treated promptly. There are multiple factors associated with the success or failure of a treatment, such as the determinants of health, described by the World Health Organization as "the circumstances in which people are born, grow, work, live and age, including the broader set of forces and systems that influence the conditions of everyday life". During the approach to these patients, the clinical history plays an important role, which will allow us to evaluate their history, risk factors and psychosocial conditions that may contribute to the course of the pathology; It should be noted that it is essential to know the local epidemiology that would guide us to a suspicion regarding the probable etiology and microorganisms causing the UTI episode before obtaining the result of the urine culture, which is relevant when starting empirical antibiotic therapy for each particular patient. The present project was carried out based on the need to study the patterns of bacterial resistance and sensitivity in patients under 2 years of age with a diagnosis of UTI hospitalized in an IPS in Atlántico, as well as to establish prevention strategies by the healthcare and administrative staff of the institution. Given the limited availability of regional studies on the most frequent resistance patterns and their association with health determinants. Goals: To characterize the bacterial resistance and sensitivity profile in infants under 2 years of age diagnosed with urinary tract infection in a maternal-child IPS in Barranquilla in the period 2022 - 2024. Materials and methods: Retrospective cross-sectional descriptive study. The population studied was composedby infants under 2 years of age diagnosed with urinary tract infection in a maternal-child Health Services Provider Institution (IPS) in Barranquilla in the period 2022 -2024. The study included infant patients between 28 days and 24 months of age with positive urine culture results taken with adequate collection technique. Newborn patients, preschool, school-age and adolescent patients, patients with incomplete data in the medical history and those with comorbidities were excluded.Icongenital malformations or invasive devices. Non-probabilistic convenience sampling was performed, the sample sizeIt was calculated using the Epi – Info 7.4 application, it is estimated that for a regression model with a significance level of 0.05, power of 80%, effect size Cohen’s f of 0.39. Performing an expected loss adjustment of 20%, the formula 1/(1-r) was applied, resulting in a total of 212 patients. Results: The female sex showed the highest frequency with 61.8%,50.5% of patients were between 1 and 12 months (younger infants) and 49.5% between 12 and 24 months (older infants). 56.2% of infants with UTI were classified as nutritionally adequate. E. coli was the most frequently isolated etiologic agent with 82.6%, followed by Proteus mirabilis 9.9%, Klebsiella 4.3% and other germs (Pseudomona aeruginosa, Enterobacter) 3.2%.The sensitivity and resistance profiles of the three most frequently isolated germs are described, thus, for Escherichia coli the highest sensitivity was observed for Imipenem and Meropenem with 100%, Nitrofurantoin, Cefuroxime, Cefepime and Amikacin 98.3%, Aztreonam, Ceftazidime and Ceftriaxone 97.1%. Conclusions: Sociodemographic characteristics of the pediatric population admitted to the hospitalization servicein a maternal-child IPS in the city of Barranquilladue to urinary tract infection (UTI), does not differ from what was observed in national and international studies. TheEscherichia coliIt was the microorganism that was isolated most frequently and the greatest sensitivity of this occurred forImipenem and Meropenem. Urinary tract infection was more frequent in females, while the distribution according to age groups did not show significant differences.
Introduction: Urinary Tract Infection (UTI) is generally considered to be the presence of pathogenic microorganisms in the urinary tract that may or may not be accompanied by symptoms.In children, UTI is the third most common cause of infectious diseases, preceded by respiratory and gastrointestinal infections. Between 8% and 12% and 3% and 5% of girls and boys each will experience at least one episode of UTI before reaching the age of 10. Antimicrobial resistance in urinary tract infections in the pediatric population is of utmost importance due to an increase in its recurrence in recent years. In addition, it is one of the main complications associated with high morbidity and can lead to mortality if not treated promptly. There are multiple factors associated with the success or failure of a treatment, such as the determinants of health, described by the World Health Organization as "the circumstances in which people are born, grow, work, live and age, including the broader set of forces and systems that influence the conditions of everyday life". During the approach to these patients, the clinical history plays an important role, which will allow us to evaluate their history, risk factors and psychosocial conditions that may contribute to the course of the pathology; It should be noted that it is essential to know the local epidemiology that would guide us to a suspicion regarding the probable etiology and microorganisms causing the UTI episode before obtaining the result of the urine culture, which is relevant when starting empirical antibiotic therapy for each particular patient. The present project was carried out based on the need to study the patterns of bacterial resistance and sensitivity in patients under 2 years of age with a diagnosis of UTI hospitalized in an IPS in Atlántico, as well as to establish prevention strategies by the healthcare and administrative staff of the institution. Given the limited availability of regional studies on the most frequent resistance patterns and their association with health determinants. Goals: To characterize the bacterial resistance and sensitivity profile in infants under 2 years of age diagnosed with urinary tract infection in a maternal-child IPS in Barranquilla in the period 2022 - 2024. Materials and methods: Retrospective cross-sectional descriptive study. The population studied was composedby infants under 2 years of age diagnosed with urinary tract infection in a maternal-child Health Services Provider Institution (IPS) in Barranquilla in the period 2022 -2024. The study included infant patients between 28 days and 24 months of age with positive urine culture results taken with adequate collection technique. Newborn patients, preschool, school-age and adolescent patients, patients with incomplete data in the medical history and those with comorbidities were excluded.Icongenital malformations or invasive devices. Non-probabilistic convenience sampling was performed, the sample sizeIt was calculated using the Epi – Info 7.4 application, it is estimated that for a regression model with a significance level of 0.05, power of 80%, effect size Cohen’s f of 0.39. Performing an expected loss adjustment of 20%, the formula 1/(1-r) was applied, resulting in a total of 212 patients. Results: The female sex showed the highest frequency with 61.8%,50.5% of patients were between 1 and 12 months (younger infants) and 49.5% between 12 and 24 months (older infants). 56.2% of infants with UTI were classified as nutritionally adequate. E. coli was the most frequently isolated etiologic agent with 82.6%, followed by Proteus mirabilis 9.9%, Klebsiella 4.3% and other germs (Pseudomona aeruginosa, Enterobacter) 3.2%.The sensitivity and resistance profiles of the three most frequently isolated germs are described, thus, for Escherichia coli the highest sensitivity was observed for Imipenem and Meropenem with 100%, Nitrofurantoin, Cefuroxime, Cefepime and Amikacin 98.3%, Aztreonam, Ceftazidime and Ceftriaxone 97.1%. Conclusions: Sociodemographic characteristics of the pediatric population admitted to the hospitalization servicein a maternal-child IPS in the city of Barranquilladue to urinary tract infection (UTI), does not differ from what was observed in national and international studies. TheEscherichia coliIt was the microorganism that was isolated most frequently and the greatest sensitivity of this occurred forImipenem and Meropenem. Urinary tract infection was more frequent in females, while the distribution according to age groups did not show significant differences.
Descripción
Palabras clave
Sensibilidad, Resistencia, Infección vías urinarias