Prevalence of Urinary Tract Infection among Children of Primary Schools in Nablus
Date
2009
Authors
Rayah Mohammed Hussein Sawalha
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Urinary Tract Infection (UTI) is a serious bacterial infection causing illness in infants and children. UTI is defined by a combination of clinical features and the presence of bacteria in urine، or it is the presence of more than 100،000 cfu/ml after doing urine culture، regardless to symptoms. Clinical symptoms of UTI usually include frequency، dysuria، abdominal pain، back pain، fever، and urgency.
Diagnosis of UTI relies on both urinalysis and urine culture. Most of UTI cases are caused by gram negative bacteria such as Escherichia coli . UTI must be recognized and treated rapidly with an appropriate antibiotic to minimize any morbidity،mortality، and renal damage from acute UTI. Management of UTI in children faces the problem of the emergence of resistant of uropathogens to commonly used antibiotics for the treatment of UTI. Antibiotics are not recommended for initial empirical therapy، when their resistance rate ?10- 20%. This cross sectional study was conducted to measure the prevalence of UTI among children in primary schools in Nablus district، West Bank،Palestine، to identify microorganisms responsible for UTI، to explore sensitivity patterns of identified microorganisms to certain antibiotics used in the treatment of UTI، and to study the relation between some demographic variables and UTI. This study was conducted in the period between February and May 2009، included 1462 children in the age group from 6-12 years. This study utilized two main instruments، questionnaire and urine testing (urinalysis and urine culture). The response rate in this study was 95.35% (1394/1462)، from which 58 cases were excluded for taking antibiotics at the time of doing the test. Calculations were done on the remaining 1338 children (719 girls and 619 boys). Prevalence of UTI was calculated to be 4% (54/1338)، 7.5% among girls (54/719) and 0% among boys (0/619).Gram negative bacteria were responsible for 59.25% of UTIs in comparison to gram positive bacteria which were 40.7%.Escherichia coli was the most predominant uropathogen with 51.8% (28/54) followed by Staphylococcus aurous 29.6% (16/54). All antibiotics used in this study had a resistance rate over 20%. UTI was statistically associated with the following variables; gender (p=0.0001)، fever (p=0.012)، burning sensation while urination (p=0.0001)، nocturnal enuresis (p=0.035)، and hygienic use of toilets (p=0.046).
Pupils must be allowed to go to toilets up on their request during their stay at school and they must be educated on how to use the toilets by themselves in a safe and hygienic way، Urine culture is an important diagnostic tool to confirm UTI. Rules must be put on the consumption of antibiotics to limit their abuse and misuse، Physicians are asked to go back to traditional antibiotics like Trimethoprime/Sulphamethoxazole، a cheap antibiotic that showed a low resistance rate in this study over commonly used antibiotics such as Cephalosporin’s which are more expensive.
ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻫﻲ ﻋﺩﻭﻯ ﺒﻜﺘﻴﺭﻴﺔ ﺨﻁﻴﺭﺓ ﺘﺴﺒﺏ ﺍﻟﻤﺭﺽ ﻋﻨﺩ ﺍﻟﺭﻀﻊ ﻭﺍﻷﻁﻔﺎل. ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻴﺘﻡ ﺘﻌﺭﻴﻔﻬﺎ ﻤﻥ ﺨﻼل ﻤﺯﻴﺞ ﻤﻥ ﺍﻟﻤﻅﺎﻫﺭ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻭﺠﻭﺩ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﻓـﻲ ﺍﻟﺒﻭل ، ﺃﻭ ﻫﻲ ﻭﺠﻭﺩ ﺃﻜﺜﺭ ﻤﻥ cfu/ml 100،000 ﺒﻌﺩ ﺍﻟﻘﻴﺎﻡ ﺒﺯﺭﺍﻋﺔ ﺍﻟﺒﻭل ﻭﺒﻐﺽ ﺍﻟﻨﻅﺭ ﻋﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﺔ ﺍﻟﺘﻲ ﻋﺎﺩﺓ ﻤﺎ ﺘﺸﻤل ﺍﺭﺘﺩﺍﺩ ﻓﻲ ﺍﻟﺒﻭل، ﻋﺴﺭ ﺍﻟﺒﻭل ،ﺃﻟﻡ ﻓﻲ ﺍﻟﺒﻁﻥ ،ﺃﻟﻡ ﻓـﻲ ﺍﻟﻅﻬﺭ ، ﻭﺤﻤﻰ. تﺸﺨﻴﺹ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺘﺤﻠﻴل ﺍﻟﺒﻭل ﻭ ﺯﺭﺍﻋﺘﻪ ﻋﻠـﻰ ﺤـﺩ ﺴﻭﺍﺀ. ﻤﻌﻅﻡ ﺤﺎﻻﺕ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﺘﺴﺒﺒﻬﺎ ﺍﻟﺠﺭﺍﺜﻴﻡ ﺴﻠﺒﻴﺔ ﺍﻟﻐـﺭﺍﻡ ﻤﺜـل Escherichia coli.ﻴﺠﺏ ﺘﺸﺨﻴﺹ ﻭ ﻤﻌﺎﻟﺠﺔ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﺒﺎﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﻤﻨﺎﺴـﺒﺔ ﻟﺘﻘﻠﻴـل ﺃﻱ ﺍﻋﺘﻼل ﺃﻭ ﻭﻓﺎﻩ ﺃﻭ ﺘﻠﻑ ﻓﻲ ﺃﻟﻜﻠﻰ ﻨﺎﺘﺠﺔ ﻋﻨﻬﺎ. ﺃﻟﺴﻴﻁﺭﺓ ﻋﻠﻰ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﺘﻭﺍﺠﻪ ﻤﺸﻜﻠﺔ ﻅﻬﻭﺭ ﻤﻘﺎﻭﻤﺔ ﻟﻠﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﻤﻥ ﻗﺒل ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺍﻟﻤﺴـﺒﺒﺔ ﻻﻟﺘﻬﺎﺒـﺎﺕ ﺍﻟﻤﺴـﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ ﻭﺍﻟﺘﻲ ﻋﺎﺩﺓ ﻤﺎ ﻴﺸﻴﻊ ﺍﺴﺘﺨﺩﺍﻤﻬﺎ ﻟﻌﻼﺝ ﺍﻟﺘﻬﺎﺒﺎﺕ ﺃﻟﻤﺴﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ.ﻭ ﻟﻜﻥ ﻻ ﻴﻨﺼﺢ ﺒﺎﺴـﺘﺨﺩﺍﻡ ﺃﻟﻤﻀﺎﺩﺍﺕ ﺃﻟﺤﻴﻭﻴﺔ ﻜﻌﻼﺝ ﺃﻭﻟﻲ، ﻋﻨﺩﻤﺎ ﻴﻜﻭﻥ ﻤﻌﺩل ﻤﻘﺎﻭﻤﺘﻬﻡ ﺃﻜﺜﺭ ﻤﻥ 20-10 %. ﻫﺫﻩ ﺩﺭﺍﺴـﺔ ﻤﻘﻁﻌﻴﺔ ﺃﺠﺭﻴﺕ ﻟﻘﻴﺎﺱ ﻤﺩﻯ ﺍﻨﺘﺸﺎﺭ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﺒﻴﻥ ﺍﻷﻁﻔﺎل ﻓﻲ ﺍﻟﻤﺩﺍﺭﺱ ﺍﻻﺒﺘﺩﺍﺌﻴﺔ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﻨﺎﺒﻠﺱ، ﺍﻟﻀﻔﺔ ﺍﻟﻐﺭﺒﻴﺔ، ﻓﻠﺴﻁﻴﻥ، ﻟﺘﺤﺩﻴﺩ ﺍﻟﻜﺎﺌﻨﺎﺕ ﺍﻟﺩﻗﻴﻘﺔ ﺍﻟﻤﺴﺅﻭﻟﺔ ﻋﻥ ﻋﺩﻭﻯ ﺍﻟﻤﺴـﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻻﺴﺘﻜﺸﺎﻑ ﺃﻨﻤﺎﻁ ﺍﻟﺤﺴﺎﺴﻴﺔ ﻤﻥ ﺍﻟﻜﺎﺌﻨﺎﺕ ﺍﻟﺩﻗﻴﻘﺔ ﺍﻟﺘﻲ ﺘﻡ ﺘﺤﺩﻴﺩﻫﺎ ﻟﺒﻌﺽ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﻌﻼﺝ ﻤﻥ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ، ﻭﺩﺭﺍﺴﺔ ﺍﻟﻌﻼﻗـﺔ ﺒـﻴﻥ ﺒﻌـﺽ ﺍﻟﻤﺘﻐﻴـﺭﺍﺕ ﺍﻟﺩﻴﻤﻐﺭﺍﻓﻴﺔ ﻭﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ. ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺃﺠﺭﻴﺕ ﻓﻲ ﺍﻟﻔﺘﺭﺓ ﺒﻴﻥ ﺸـﺒﺎﻁ ﻭﺃﻴـﺎﺭ 2009،ﻭﺸﻤﻠﺕ 1462 ﻁﻔل ﻓﻲ ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺭﻴﺔ ﻤﻥ 12-6 ﺴﻨﺔ. ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺘﺴﺘﺨﺩﻡ ﺃﺩﺍﺘﻴﻥ ﺭﺌﻴﺴـﻴﺘﻴﻥ، ﺍﻻﺴﺘﺒﻴﺎﻥ ﻭﺍﺨﺘﺒﺎﺭ ﺍﻟﺒﻭل (ﺘﺤﻠﻴل ﺍﻟﺒﻭل ﻭ ﺯﺭﺍﻋﺔ ﺍﻟﺒﻭل). ﻤﻌﺩل ﺍﻻﺴﺘﺠﺎﺒﺔ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴـﺔ ﻫـﻭ 58 ،(1462/1394) ٪ 95.35 ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺘﻡ ﺍﺴﺘﺒﻌﺎﺩﻫﺎ ﻷﺨﺫ ﺃﻷﻁﻔﺎل ﻤﻀﺎﺩﺍﺕ ﺤﻴﻭﻴﺔ ﻓـﻲ ﻭﻗﺕ ﺍﻻﺨﺘﺒﺎﺭ. ﺃﻟﺤﺴﺎﺒﺎﺕ ﺃﺠﺭﻴﺕ ﻋﻠﻰ 1338 ﻁﻔﻼ (719 ﺍﻟﺒﻨﺎﺕ ﻭﺍﻟﺒﻨﻴﻥ 619 ﺘـﻡ ﺤﺴـﺎﺏ ﺍﻨﺘﺸﺎﺭ ﺍﻟﺘﻬﺎﺒﺎﺕ ﺃﻟﻤﺴﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ 7.5 ،(1338/54) ٪4٪ ﺒﻴﻥ ﺍﻟﻔﺘﻴﺎﺕ (719/54) ﻭ 0٪ ﺒـﻴﻥ ﺍﻟﺫﻜﻭﺭ (619 / 0). ﺍﻟﺠﺭﺍﺜﻴﻡ ﺴﻠﺒﻴﺔ ﺍﻟﻐﺭﺍﻡ ﻜﺎﻨﺕ ﻤﺴﺅﻭﻟﺔ ﻋﻥ 59.3 ٪ ﻤﻥ ﺍﻟﻤﺴـﺎﻟﻙ ﺍﻟﺒﻭﻟﻴـﺔ ﻤﻘﺎﺭﻨﺔ ﻤﻊ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺇﻴﺠﺎﺒﻴﺔ ﺃﻟﻐﺭﺍﻡ 40.7٪ ﻭﻜﺎﻨـﺕEscherichia Coli ﺃﻟﺒﻜﺘﻴﺭﻴـﺎ ﺍﻟﻐﺎﻟﺒـﺔ ﺍﻟﻤﻀـﺎﺩﺍﺕ ﺠﻤﻴﻊ .(54/16) ٪29.6 Staphylococcus aureus ﺘﻠﻴﻬﺎ (54/28) ٪51.8 ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻜﺎﻥ ﻟﻬﺎ ﻤﻌﺩل ﻤﻘﺎﻭﻤﺔ ﺃﻜﺜﺭ ﻤﻥ 20٪. ﺍﻟﺘﻬﺎﺒـﺎﺕ ﺃﻟﻤﺴـﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ ﻜﺎﻨﺕ ﻤﺭﺘﺒﻁﺔ ﺇﺤﺼﺎﺌﻴﺎ ﻤـﻊ ﺍﻟﻤﺘﻐﻴـﺭﺍﺕ ﺍﻟﺘﺎﻟﻴـﺔ ؛ ﺍﻟﺠـﻨﺱ (p=0.0001) ، ﻭﺍﻟﺤﻤـﻰ، (p=0.035) ﺍﻟﻠﻴﻠـﻲ ﺍﻟﺒﻭل ﺴﻠﺱ ،(p=0.0001) ﺍﻟﺘﺒﻭل ﺤﻴﻥ ﺒﺤﺭﻗﺎﻥ ﺇﺤﺴﺎﺱ ،(p=0.012) ﻭﺍﺴﺘﻌﻤﺎل ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﻁﺭﻴﻘﺔ ﺼﺤﻴﺔ (p=0.046). ﻴﺠﺏ ﺃﻥ ﻴﺴـﻤﺢ ﻟﻠﺘﻼﻤﻴـﺫ ﺒﺎﻟـﺫﻫﺎﺏ ﺇﻟـﻰ ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﻨﺎﺀ ﻋﻠﻰ ﻁﻠﺒﻬﻡ ، ﺃﺜﻨﺎﺀ ﻭﺠﻭﺩﻫﻡ ﻓﻲ ﺍﻟﻤﺩﺭﺴﺔ ، ﻭﻴﺠـﺏ ﺘﻌﻠـﻴﻤﻬﻡ ﻜﻴﻔﻴـﺔ ﺍﺴـﺘﺨﺩﺍﻡ ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﺄﻨﻔﺴﻬﻡ ﺒﻁﺭﻴﻘﺔ ﺁﻤﻨﺔ ﻭﺼﺤﻴﺔ ، ﻭﺯﺭﺍﻋﺔ ﺍﻟﺒﻭل ﺃﺩﺍﺓ ﻫﺎﻤﺔ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﻬﺎﺒـﺎﺕ ﺃﻟﻤﺴـﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ ، ﻴﺠﺏ ﻭﻀﻊ ﻗﻴﻭﺩ ﻋﻠﻰ ﺍﺴﺘﻬﻼﻙ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﻟﻠﺤﺩ ﻤﻥ ﺴﻭﺀ ﻭﻜﺜﺭﺓ ﺍﺴﺘﺨﺩﺍﻤﻬﺎ.ﻭﻗﺩ ﺃﻅﻬﺭﺕ ﺍﻟﻨﺘﺎﺌﺞ ﻤﻘﺎﻭﻤﺔ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﻋﻠﻰ ﺍﺨﺘﻼﻑ ﺃﻨﻭﺍﻋﻬﺎ ﻟﻬﺫﻩ ﺍﻟﻤﻀﺎﺩﺍﺕ، ﻭﻋﻠﻴﻪ ﻭﻤـﻥ ﻀﻤﻥ ﻤﺎ ﻴﻤﻜﻥ ﻓﻌﻠﻪ ﻭﻀﻊ ﺴﻴﺎﺴﺎﺕ ﺘﺘﻌﻠﻕ ﺒﻀﺒﻁ ﻭﺼﻔﺎﺕ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ، ﺤﻴـﺙ ﺃﻥ ﻨﺴـﺒﺔ ﺍﻟﻤﻘﺎﻭﻤﺔ ﻟﺠﻤﻴﻊ ﺍﻟﻤﻀﺎﺩﺍﺕ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻜﺎﻨﺕ ﺘﺯﻴﺩ ﻋﻥ 20%.
ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻫﻲ ﻋﺩﻭﻯ ﺒﻜﺘﻴﺭﻴﺔ ﺨﻁﻴﺭﺓ ﺘﺴﺒﺏ ﺍﻟﻤﺭﺽ ﻋﻨﺩ ﺍﻟﺭﻀﻊ ﻭﺍﻷﻁﻔﺎل. ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻴﺘﻡ ﺘﻌﺭﻴﻔﻬﺎ ﻤﻥ ﺨﻼل ﻤﺯﻴﺞ ﻤﻥ ﺍﻟﻤﻅﺎﻫﺭ ﺍﻟﺴﺭﻴﺭﻴﺔ ﻭﻭﺠﻭﺩ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﻓـﻲ ﺍﻟﺒﻭل ، ﺃﻭ ﻫﻲ ﻭﺠﻭﺩ ﺃﻜﺜﺭ ﻤﻥ cfu/ml 100،000 ﺒﻌﺩ ﺍﻟﻘﻴﺎﻡ ﺒﺯﺭﺍﻋﺔ ﺍﻟﺒﻭل ﻭﺒﻐﺽ ﺍﻟﻨﻅﺭ ﻋﻥ ﺍﻷﻋﺭﺍﺽ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﺔ ﺍﻟﺘﻲ ﻋﺎﺩﺓ ﻤﺎ ﺘﺸﻤل ﺍﺭﺘﺩﺍﺩ ﻓﻲ ﺍﻟﺒﻭل، ﻋﺴﺭ ﺍﻟﺒﻭل ،ﺃﻟﻡ ﻓﻲ ﺍﻟﺒﻁﻥ ،ﺃﻟﻡ ﻓـﻲ ﺍﻟﻅﻬﺭ ، ﻭﺤﻤﻰ. تﺸﺨﻴﺹ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻴﻌﺘﻤﺩ ﻋﻠﻰ ﺘﺤﻠﻴل ﺍﻟﺒﻭل ﻭ ﺯﺭﺍﻋﺘﻪ ﻋﻠـﻰ ﺤـﺩ ﺴﻭﺍﺀ. ﻤﻌﻅﻡ ﺤﺎﻻﺕ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﺘﺴﺒﺒﻬﺎ ﺍﻟﺠﺭﺍﺜﻴﻡ ﺴﻠﺒﻴﺔ ﺍﻟﻐـﺭﺍﻡ ﻤﺜـل Escherichia coli.ﻴﺠﺏ ﺘﺸﺨﻴﺹ ﻭ ﻤﻌﺎﻟﺠﺔ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﺒﺎﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﻤﻨﺎﺴـﺒﺔ ﻟﺘﻘﻠﻴـل ﺃﻱ ﺍﻋﺘﻼل ﺃﻭ ﻭﻓﺎﻩ ﺃﻭ ﺘﻠﻑ ﻓﻲ ﺃﻟﻜﻠﻰ ﻨﺎﺘﺠﺔ ﻋﻨﻬﺎ. ﺃﻟﺴﻴﻁﺭﺓ ﻋﻠﻰ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻋﻨﺩ ﺍﻷﻁﻔﺎل ﺘﻭﺍﺠﻪ ﻤﺸﻜﻠﺔ ﻅﻬﻭﺭ ﻤﻘﺎﻭﻤﺔ ﻟﻠﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﻤﻥ ﻗﺒل ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺍﻟﻤﺴـﺒﺒﺔ ﻻﻟﺘﻬﺎﺒـﺎﺕ ﺍﻟﻤﺴـﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ ﻭﺍﻟﺘﻲ ﻋﺎﺩﺓ ﻤﺎ ﻴﺸﻴﻊ ﺍﺴﺘﺨﺩﺍﻤﻬﺎ ﻟﻌﻼﺝ ﺍﻟﺘﻬﺎﺒﺎﺕ ﺃﻟﻤﺴﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ.ﻭ ﻟﻜﻥ ﻻ ﻴﻨﺼﺢ ﺒﺎﺴـﺘﺨﺩﺍﻡ ﺃﻟﻤﻀﺎﺩﺍﺕ ﺃﻟﺤﻴﻭﻴﺔ ﻜﻌﻼﺝ ﺃﻭﻟﻲ، ﻋﻨﺩﻤﺎ ﻴﻜﻭﻥ ﻤﻌﺩل ﻤﻘﺎﻭﻤﺘﻬﻡ ﺃﻜﺜﺭ ﻤﻥ 20-10 %. ﻫﺫﻩ ﺩﺭﺍﺴـﺔ ﻤﻘﻁﻌﻴﺔ ﺃﺠﺭﻴﺕ ﻟﻘﻴﺎﺱ ﻤﺩﻯ ﺍﻨﺘﺸﺎﺭ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﺒﻴﻥ ﺍﻷﻁﻔﺎل ﻓﻲ ﺍﻟﻤﺩﺍﺭﺱ ﺍﻻﺒﺘﺩﺍﺌﻴﺔ ﻓﻲ ﻤﺤﺎﻓﻅﺔ ﻨﺎﺒﻠﺱ، ﺍﻟﻀﻔﺔ ﺍﻟﻐﺭﺒﻴﺔ، ﻓﻠﺴﻁﻴﻥ، ﻟﺘﺤﺩﻴﺩ ﺍﻟﻜﺎﺌﻨﺎﺕ ﺍﻟﺩﻗﻴﻘﺔ ﺍﻟﻤﺴﺅﻭﻟﺔ ﻋﻥ ﻋﺩﻭﻯ ﺍﻟﻤﺴـﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ﻻﺴﺘﻜﺸﺎﻑ ﺃﻨﻤﺎﻁ ﺍﻟﺤﺴﺎﺴﻴﺔ ﻤﻥ ﺍﻟﻜﺎﺌﻨﺎﺕ ﺍﻟﺩﻗﻴﻘﺔ ﺍﻟﺘﻲ ﺘﻡ ﺘﺤﺩﻴﺩﻫﺎ ﻟﺒﻌﺽ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﺍﻟﻌﻼﺝ ﻤﻥ ﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ ، ﻭﺩﺭﺍﺴﺔ ﺍﻟﻌﻼﻗـﺔ ﺒـﻴﻥ ﺒﻌـﺽ ﺍﻟﻤﺘﻐﻴـﺭﺍﺕ ﺍﻟﺩﻴﻤﻐﺭﺍﻓﻴﺔ ﻭﻋﺩﻭﻯ ﺍﻟﻤﺴﺎﻟﻙ ﺍﻟﺒﻭﻟﻴﺔ. ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺃﺠﺭﻴﺕ ﻓﻲ ﺍﻟﻔﺘﺭﺓ ﺒﻴﻥ ﺸـﺒﺎﻁ ﻭﺃﻴـﺎﺭ 2009،ﻭﺸﻤﻠﺕ 1462 ﻁﻔل ﻓﻲ ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺭﻴﺔ ﻤﻥ 12-6 ﺴﻨﺔ. ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﺘﺴﺘﺨﺩﻡ ﺃﺩﺍﺘﻴﻥ ﺭﺌﻴﺴـﻴﺘﻴﻥ، ﺍﻻﺴﺘﺒﻴﺎﻥ ﻭﺍﺨﺘﺒﺎﺭ ﺍﻟﺒﻭل (ﺘﺤﻠﻴل ﺍﻟﺒﻭل ﻭ ﺯﺭﺍﻋﺔ ﺍﻟﺒﻭل). ﻤﻌﺩل ﺍﻻﺴﺘﺠﺎﺒﺔ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴـﺔ ﻫـﻭ 58 ،(1462/1394) ٪ 95.35 ﻤﻥ ﺍﻟﺤﺎﻻﺕ ﺘﻡ ﺍﺴﺘﺒﻌﺎﺩﻫﺎ ﻷﺨﺫ ﺃﻷﻁﻔﺎل ﻤﻀﺎﺩﺍﺕ ﺤﻴﻭﻴﺔ ﻓـﻲ ﻭﻗﺕ ﺍﻻﺨﺘﺒﺎﺭ. ﺃﻟﺤﺴﺎﺒﺎﺕ ﺃﺠﺭﻴﺕ ﻋﻠﻰ 1338 ﻁﻔﻼ (719 ﺍﻟﺒﻨﺎﺕ ﻭﺍﻟﺒﻨﻴﻥ 619 ﺘـﻡ ﺤﺴـﺎﺏ ﺍﻨﺘﺸﺎﺭ ﺍﻟﺘﻬﺎﺒﺎﺕ ﺃﻟﻤﺴﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ 7.5 ،(1338/54) ٪4٪ ﺒﻴﻥ ﺍﻟﻔﺘﻴﺎﺕ (719/54) ﻭ 0٪ ﺒـﻴﻥ ﺍﻟﺫﻜﻭﺭ (619 / 0). ﺍﻟﺠﺭﺍﺜﻴﻡ ﺴﻠﺒﻴﺔ ﺍﻟﻐﺭﺍﻡ ﻜﺎﻨﺕ ﻤﺴﺅﻭﻟﺔ ﻋﻥ 59.3 ٪ ﻤﻥ ﺍﻟﻤﺴـﺎﻟﻙ ﺍﻟﺒﻭﻟﻴـﺔ ﻤﻘﺎﺭﻨﺔ ﻤﻊ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺇﻴﺠﺎﺒﻴﺔ ﺃﻟﻐﺭﺍﻡ 40.7٪ ﻭﻜﺎﻨـﺕEscherichia Coli ﺃﻟﺒﻜﺘﻴﺭﻴـﺎ ﺍﻟﻐﺎﻟﺒـﺔ ﺍﻟﻤﻀـﺎﺩﺍﺕ ﺠﻤﻴﻊ .(54/16) ٪29.6 Staphylococcus aureus ﺘﻠﻴﻬﺎ (54/28) ٪51.8 ﺍﻟﺤﻴﻭﻴﺔ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻜﺎﻥ ﻟﻬﺎ ﻤﻌﺩل ﻤﻘﺎﻭﻤﺔ ﺃﻜﺜﺭ ﻤﻥ 20٪. ﺍﻟﺘﻬﺎﺒـﺎﺕ ﺃﻟﻤﺴـﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ ﻜﺎﻨﺕ ﻤﺭﺘﺒﻁﺔ ﺇﺤﺼﺎﺌﻴﺎ ﻤـﻊ ﺍﻟﻤﺘﻐﻴـﺭﺍﺕ ﺍﻟﺘﺎﻟﻴـﺔ ؛ ﺍﻟﺠـﻨﺱ (p=0.0001) ، ﻭﺍﻟﺤﻤـﻰ، (p=0.035) ﺍﻟﻠﻴﻠـﻲ ﺍﻟﺒﻭل ﺴﻠﺱ ،(p=0.0001) ﺍﻟﺘﺒﻭل ﺤﻴﻥ ﺒﺤﺭﻗﺎﻥ ﺇﺤﺴﺎﺱ ،(p=0.012) ﻭﺍﺴﺘﻌﻤﺎل ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﻁﺭﻴﻘﺔ ﺼﺤﻴﺔ (p=0.046). ﻴﺠﺏ ﺃﻥ ﻴﺴـﻤﺢ ﻟﻠﺘﻼﻤﻴـﺫ ﺒﺎﻟـﺫﻫﺎﺏ ﺇﻟـﻰ ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﻨﺎﺀ ﻋﻠﻰ ﻁﻠﺒﻬﻡ ، ﺃﺜﻨﺎﺀ ﻭﺠﻭﺩﻫﻡ ﻓﻲ ﺍﻟﻤﺩﺭﺴﺔ ، ﻭﻴﺠـﺏ ﺘﻌﻠـﻴﻤﻬﻡ ﻜﻴﻔﻴـﺔ ﺍﺴـﺘﺨﺩﺍﻡ ﺍﻟﻤﺭﺍﺤﻴﺽ ﺒﺄﻨﻔﺴﻬﻡ ﺒﻁﺭﻴﻘﺔ ﺁﻤﻨﺔ ﻭﺼﺤﻴﺔ ، ﻭﺯﺭﺍﻋﺔ ﺍﻟﺒﻭل ﺃﺩﺍﺓ ﻫﺎﻤﺔ ﻟﺘﺄﻜﻴﺩ ﺍﻟﺘﻬﺎﺒـﺎﺕ ﺃﻟﻤﺴـﺎﻟﻙ ﺃﻟﺒﻭﻟﻴﺔ ، ﻴﺠﺏ ﻭﻀﻊ ﻗﻴﻭﺩ ﻋﻠﻰ ﺍﺴﺘﻬﻼﻙ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ ﻟﻠﺤﺩ ﻤﻥ ﺴﻭﺀ ﻭﻜﺜﺭﺓ ﺍﺴﺘﺨﺩﺍﻤﻬﺎ.ﻭﻗﺩ ﺃﻅﻬﺭﺕ ﺍﻟﻨﺘﺎﺌﺞ ﻤﻘﺎﻭﻤﺔ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﻋﻠﻰ ﺍﺨﺘﻼﻑ ﺃﻨﻭﺍﻋﻬﺎ ﻟﻬﺫﻩ ﺍﻟﻤﻀﺎﺩﺍﺕ، ﻭﻋﻠﻴﻪ ﻭﻤـﻥ ﻀﻤﻥ ﻤﺎ ﻴﻤﻜﻥ ﻓﻌﻠﻪ ﻭﻀﻊ ﺴﻴﺎﺴﺎﺕ ﺘﺘﻌﻠﻕ ﺒﻀﺒﻁ ﻭﺼﻔﺎﺕ ﺍﻟﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻭﻴﺔ، ﺤﻴـﺙ ﺃﻥ ﻨﺴـﺒﺔ ﺍﻟﻤﻘﺎﻭﻤﺔ ﻟﺠﻤﻴﻊ ﺍﻟﻤﻀﺎﺩﺍﺕ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻜﺎﻨﺕ ﺘﺯﻴﺩ ﻋﻥ 20%.