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    ANTIMICROBIAL SUSCEPTIBILITY OF ENTEROBAKTERIACEA SPECIES CAUSING COMMUNITY ACQUIRED URINARY TRACT INFECTION: A RETROSPECTIVE STUDY
    (Aves, 2007) Eroglu, Muzaffer; Kocoglu, Esra; Karabay, Oguz; Semercioz, Atilla
    Introduction: The rates of antibiotic resistance in common pathogenic bacteria have been increasing due to high and unnecessary antibiotic use. It can vary according to geographical and regional location. But little is known about the epidemiology of community-acquired antibiotic resistant enterobacteriacea spices in our region. The aim of this study is to assess the antimicrobial susceptibility of enterobacteriacea spices causing community-acquired urinary tract infection in our region. Materials and Methods: Medical records of AIBU microbiology laboratory from August 2004 to August 2006 were retrospectively reviewed to identify all adult patients with community acquired urinary tract infection (UTI). Patients, who had more than three episodes of UTI in the last year, hospitalization in the last month, pregnancy and those with upper UTI were excluded. Susceptibility testing for urinary tract isolates was performed if there were >= 100,000 colonies per milliliter. The resistance rates of ampicilline, ciprofloxacine, gentamisin, amikacin, nitrofurantoin and SXT were investigated by Kirby-Bauer disk diffusion technique. Antibacterial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute criteria's (CLSI). Results: During the study period, 3575 urine samples were analyzed and the mean age was 47.2 years (range: 17-74). The overall female to male ratio was 4.8. A total of 305 patients were excluded due to contamination and 697 (21.3%) bacterial isolates were examined in the study. E. coli was the most causative agent (87.1%) and it was followed by Klebsiella pneumonia with a percentage of 9.6%. Highest and lowest antibiotic resistance to Escherichia coli was ampicillin (41%) and nitrofurantoin (0.05%), respectively. Conclusion: Resistance rates of SXT and kinolons are increasing in every day due to high and widespread antibiotic usage. In our region nitrofurantoin and amikacin may be better empiric choices in patients with community-acquired UTI, because their resistance rates are only 0.05% and 3.5%, respectively. Although nitrofurantoin has maintained excellent activity against almost all E. coli strains causing UTI, it is not active against some strains of Enterobacter, Klebsiella and most strains of Proteus species. Urine culture and antimicrobial susceptibility should be essential in the treatment of UTI. Antibiotic resistance rates are changing in every region. Physicians must be educated continuously about the antibiotic resistance and they should know the local antibiotic resistance rates in order to prescribe appropriate antibiotics. Local infection control guidelines must be prepared in every year.
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    ENTEROVESICAL FISTULA SECONDARY TO CROHN'S DISEASE MIMICKING BLADDER TUMOR
    (Aves, 2006) Kandirali, Engin; Sengul, Neriman; Akkoc, Ali; Turkeli, Vildan; Semercioz, Atilla; Metin, Ahmet
    Introduction: Although most fistulas in Crohn's disease are perianal or enterocutaneous, a small portion involves the bladder and urinary system. We describe enterovesical fistulas in a patient with Crohn's disease that presented exclusively as urinary symptoms mimicking bladder tumor. A 55 years-old man presented with lower urinary tract symptoms to our clinic. Ulrasonographic examination showed a normal upper urinary tract and 4 cm papillary bladder tumor. TUR-T was performed and an enterovesical fistula was noticed during operation. Patient underwent abdominal exploration and partial resection of the ileum, ileostomy, and primary bladder repair was performed. Urologic manifestations must be recognized of fistulizing Crohn's disease and urologist should be aware that Crohn's disease may involve the bladder as inflammatory tumor.