{"id":395,"date":"2022-01-16T15:13:55","date_gmt":"2022-01-16T12:13:55","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=395"},"modified":"2022-01-16T15:13:55","modified_gmt":"2022-01-16T12:13:55","slug":"yaslilarda-idrar-yolu-enfeksiyonlarinda-tanisal-sorunlar","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-idrar-yolu-enfeksiyonlarinda-tanisal-sorunlar\/","title":{"rendered":"Ya\u015fl\u0131larda \u0130drar Yolu Enfeksiyonlar\u0131nda Tan\u0131sal Sorunlar"},"content":{"rendered":"

Bu blog yaz\u0131ma 20 g\u00fcn \u00f6nce gece n\u00f6betimde acil servise ba\u015fvuran 65 ya\u015f \u00fczeri bir hastay\u0131 anlatarak ba\u015flamak istiyorum:<\/p>\n

\u2018Hasta 69 ya\u015f\u0131nda erkek, \u00f6yk\u00fcs\u00fcnde son 10 g\u00fcnd\u00fcr diz\u00fcri ve pollak\u00fcri \u015fikayetlerini tarif ediyor. Ate\u015f, kas\u0131k a\u011fr\u0131s\u0131, idrar sondas\u0131 \u00a0kullan\u0131m\u0131 \u00f6yk\u00fcs\u00fc yok. Bilinen hastal\u0131klar\u0131 aras\u0131nda diabetes mellitus (DM) ve bening prostat hipertrofisi var. \u00a0D\u00fczenli olarak sabah ve ak\u015fam ins\u00fclin kullan\u0131yor. Yap\u0131lan fizik muayenesi normal olan hastan\u0131n vital bulgular\u0131 ate\u015f: 36.5\u00b0C, NDS: 72\/dk, TA: 120\/80mmHg, SDS: 20\/dk. Laboratuvar bulgular\u0131; CRP: 122 mg\/L, L\u00f6kosit: 12.600 \/\u00b5L, n\u00f6trofil:10670 \/\u00b5L (%80), lenfosit:%7.6, trombosit: 344000\/\u00b5l, kan \u00fcre nitrojen: 15 mg\/dl, kreatinin: 0.94 mg\/dl olarak saptan\u0131yor. Tam idrar tetkiki sonucunda; l\u00f6kosit:1320\/hpf, eritrosit 12\/hpf, l\u00f6kosit k\u00fcmesi:10\/hpf, idrarda nitrit: negatif, l\u00f6kosit esteraz: pozitif oldu\u011fu g\u00f6r\u00fcl\u00fcyor. Takibinde hasta enfeksiyon hastal\u0131klar\u0131 servisine komplike \u00fcriner sistem enfeksiyonu tan\u0131s\u0131 ile yat\u0131r\u0131l\u0131yor.\u2019<\/p>\n

Bu hasta asl\u0131nda tipik semptomlarla acil servise ba\u015fvuruyor. Bizi zorlayan durumlar ise, \u00e7o\u011fu kez atipik semptomlarla ba\u015fvuru s\u0131ras\u0131nda ya\u015fad\u0131\u011f\u0131m\u0131z tan\u0131sal zorluklar olabiliyor. Buradan yola \u00e7\u0131karak bir literat\u00fcr taramas\u0131 ile g\u00fcncel bilgileri sizinle payla\u015fmak isterim.<\/p>\n

Ya\u015fl\u0131l\u0131k herhangi bir hastal\u0131\u011f\u0131n olmad\u0131\u011f\u0131 hem anatomik hem fiziksel de\u011fi\u015fikli\u011fi i\u00e7eren ola\u011fan, ka\u00e7\u0131n\u0131lmaz bir s\u00fcre\u00e7 olarak ifade edilebilir. Bu s\u00fcre\u00e7te enfeksiyonlara kar\u015f\u0131 savunmas\u0131zl\u0131k s\u00f6z konusudur (1).<\/p>\n

\u0130drar yolu enfeksiyonu (\u0130YE) ya\u015fl\u0131larda s\u0131k olarak g\u00f6r\u00fclen bir enfeksiyondur. \u0130drar yolu enfeksiyonunu kolayla\u015ft\u0131ran fakt\u00f6rler kad\u0131nlarda pelvik prolapsus, sistosel, rektosel, mesane divertik\u00fcl\u00fc, idrar ka\u00e7\u0131rma, inkontinans, perine hijyeninin tam yap\u0131lamamas\u0131, vajinal atrofi, \u00f6strojen yetersizli\u011fi iken, erkeklerde prostata ba\u011fl\u0131 hastal\u0131klard\u0131r. Ya\u015fl\u0131larda ise; mental durumda olan de\u011fi\u015fiklik, imm\u00fcnosupresyon, n\u00f6rolojik hastal\u0131klar, invaziv prosed\u00fcrler, darl\u0131klar ve anatomik de\u011fi\u015fiklikler, hareketsizlik, yetersiz s\u0131v\u0131 al\u0131m\u0131 DM\u2019a ek olarak ba\u015fl\u0131ca risk fakt\u00f6rleri olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r (2). Tekrarlayan \u0130YE a\u00e7\u0131s\u0131ndan \u2265 65 ya\u015f risk grubunu (erkek cinsiyet, evde bak\u0131m hastalar\u0131, 4 haftadan fazla foley sonda kullan\u0131m\u0131, spinal kord hasar\u0131 varl\u0131\u011f\u0131, mesane n\u00f6rojenik disfonksiyonu) olu\u015fturmaktad\u0131r (3). Bak\u0131mevi hastalar\u0131nda; demans, parkinson, inme gibi durumlardan kaynakl\u0131 olan idrar yapmada bozukluklar, yetersiz hijyen ve \u00fcriner kateter uygulanma ihtiyac\u0131 gibi risk fakt\u00f6rleri bulunmaktad\u0131r. Bak\u0131mevlerinde bildirilen enfeksiyonlar\u0131n yakla\u015f\u0131k %20\u2019lik b\u00f6l\u00fcm\u00fcn\u00fc \u0130YE olu\u015fturmaktad\u0131r (2) Ya\u015fl\u0131larda uygulanan invaziv prosed\u00fcrler, \u00e7oklu komorbiditelere sahip olmak, ya\u015fa ba\u011fl\u0131 immunitede de\u011fi\u015fiklikler, uzun ve k\u0131sa s\u00fcreli kateterizasyon uygulanmas\u0131 idrar yolu enfeksiyonuna yatk\u0131nl\u0131\u011f\u0131 ve hastaneye yatma riskini artt\u0131rmaktad\u0131r (4).<\/p>\n

Ya\u015fl\u0131larda semptomatik olan idrar yolu enfeksiyonunu,\u00a0 asemptomatik bakteri\u00fcri (ASB) \u2018den\u00a0 ay\u0131rt etmek bazen zor olabilmektedir. Bunun nedeni, bir \u00e7ok ya\u015fl\u0131da \u0130YE\u2019nun lokalize genito\u00fcriner semptomlarla kendini g\u00f6stermemesidir (Tablo-1ve 2) (5).<\/p>\n

Ya\u015fl\u0131l\u0131kta her iki cinsiyette \u0130YE s\u0131k g\u00f6r\u00fclmektedir (6). Ya\u015fl\u0131larda idrar yolu enfeksiyonunun<\/em> semptomatik olmas\u0131<\/em>lokalize \u00a0olan genito\u00fcriner semptomlar yan\u0131nda piy\u00fcri ile g\u00f6sterilen idrar yolu enflamasyonu, idrar k\u00fclt\u00fcr\u00fc ile tan\u0131mlanm\u0131\u015f idrar yolu patojenini i\u00e7erir. Bir \u00e7ok k\u0131lavuz ve \u00a0uzla\u015f\u0131ya ra\u011fmen, yine de ya\u015fl\u0131larda \u0130YE tan\u0131mlanmas\u0131nda net bir tan\u0131m bulunmamaktad\u0131r (7-9).<\/p>\n

Genel olarak tan\u0131mlamalar \u015fu \u015fekildedir; <\/em><\/p>\n

Asemptomatik Bakteri\u00fcri (ASB)<\/em>; \u00a0klinik semptomlar olmaks\u0131z\u0131n\u00a0 kad\u0131nlarda ard\u0131\u015f\u0131k iki erkeklerde ise bir \u00f6rnekte\u00a0 idrar k\u00fclt\u00fcr\u00fcnde 105 <\/sup>cfu\/mL \u00fcreme olmas\u0131 olarak tan\u0131mlan\u0131r (10). Burada \u00f6nemli nokta ya\u015fl\u0131larda \u0130YE\u2019nun ASB\u2019den ay\u0131rt edilmesidir. Zor olsa da \u00f6zellikle \u00f6nemlidir. \u00c7\u00fcnk\u00fc antibiyotik kullan\u0131m\u0131 semptomlar\u0131 olan \u0130YE tedavisi i\u00e7in gerekli iken, ASB i\u00e7in antibiyotik gerekli de\u011fildir. ASB\u00a0 hem erkeklerde hem de kad\u0131nlarda ya\u015fla birlikte \u00f6nemli \u00f6l\u00e7\u00fcde artmaktad\u0131r. 60 ya\u015f \u00fczeri kad\u0131nlarda insidans\u00a0 %6-10 iken,\u00a0 65 ya\u015f \u00fczeri erkeklerde\u00a0 %5\u2019dir (5). Rodhe ve ark.\u2019n\u0131n yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada, \u2265 80 ya\u015f ASB insidans\u0131 kad\u0131nlarda \u00a0%20 ve erkeklerde %10 olarak bulunmu\u015ftur (11). \u00dcriner kateter s\u00fcresi\u00a0 bakteri\u00fcri geli\u015fiminde \u00f6nemli bir risk fakt\u00f6r\u00fcd\u00fcr. S\u0131k olarak E. coli, Klebsiella spp. Proteus mirabilis, Enterobacter spp., Pseudomonas spp., ve Staphylococus saprophyticus bakterileri etken olarak g\u00f6r\u00fclmektedir. ASB \u2018nin y\u00f6netiminde; gebe ve \u00fcrolojik giri\u015fim planlanan hastalar d\u0131\u015f\u0131nda\u00a0 tarama yap\u0131lmas\u0131na gerek duyulmamaktad\u0131r (12). Zeng ve ark.\u2019n\u0131n \u00a0yapt\u0131klar\u0131 bir \u00e7al\u0131\u015fmada, \u00a0semptomatik \u0130YE tan\u0131s\u0131n\u0131n ay\u0131r\u0131m\u0131n\u0131n zor olabilece\u011fi,\u00a0 ASB i\u00e7in rutin\u00a0 tarama ve tedavi \u00f6nerilmesine gerek olmad\u0131\u011f\u0131, antibiyotik kullan\u0131m\u0131n\u0131n ise \u00a0k\u00fclt\u00fcr ve duyarl\u0131l\u0131k sonucuna g\u00f6re yap\u0131lmas\u0131 gerekti\u011fi belirtilmi\u015ftir (13). Kebabc\u0131 yapt\u0131\u011f\u0131 ara\u015ft\u0131rmas\u0131nda; deliryum, inkontinans, immobilizasyon, depresyon, d\u00fc\u015fme, k\u0131r\u0131lgan ya\u015fl\u0131 tan\u0131mlamalar\u0131n\u0131 i\u00e7eren \u2018geriatrik sendrom\u1fef<\/em> durumunda l\u00f6k\u00f6sitoz ve CRP art\u0131\u015f\u0131n\u0131n \u0130YE\u2019da ya\u015fl\u0131 hastalarda g\u00f6r\u00fclece\u011fini vurgulam\u0131\u015ft\u0131r (14).<\/p>\n

Semptomatik \u0130YE;<\/em> \u00fcriner sistem boyunca herhangi bir lokalizasyonda (sistit, piyelonefrit, prostatit) olan enfeksiyon olarak tan\u0131mlanmaktad\u0131r. Tan\u0131 y\u00f6n\u00fcnden zorluklar ya\u015fanmas\u0131 s\u00f6z konusu olabilmektedir. Ya\u015fl\u0131 hastalar bazen atipik semptomlar bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131, deliryum, i\u015ftahs\u0131zl\u0131k, ajitasyon, idrar ka\u00e7\u0131rma ile ba\u015fvurdu\u011funda,\u00a0 \u015fiddetli \u0130YE tan\u0131s\u0131 alabilmektedir (15). Sondas\u0131 olmayan ya\u015fl\u0131 bir hastada, tek ba\u015f\u0131na diz\u00fcri veya ate\u015f ( > 37.9\u00b0 C) olmas\u0131 ek olarak; yeni olan yada artan inkontinans, suprapubik hassasiyet, hemat\u00fcri, kostavertebral a\u00e7\u0131 hassasiyeti, s\u0131k idrara \u00e7\u0131kma veya idrara s\u0131k\u0131\u015fma hissi gibi bulgulardan birinin varl\u0131\u011f\u0131 bakteri\u00fcrisi olan hastaya antibiyotik ba\u015flanmas\u0131n\u0131 gerektirmektedir (12, 15). Ya\u015fl\u0131 hastalarda antibiyotik se\u00e7iminde bili\u015fsel i\u015flev \u00fczerine olan etkiler, yan etkiler, altta yatan komorbiditenin (DM) varl\u0131\u011f\u0131 ve hastal\u0131\u011f\u0131n var olan derecesine dikkat edilmelidir (13). \u00dclkemizde ya\u015fl\u0131 hastalarda \u0130YE nedeni ile ba\u015flanan antibiyotiklerde b\u00fcy\u00fck oranda diren\u00e7 olmas\u0131 dikkat \u00e7ekmektedir. \u00a0Ayd\u0131n ve ark.\u2019n\u0131n yapt\u0131\u011f\u0131 bir \u00e7al\u0131\u015fmada E. coli su\u015flar\u0131nda Karbapenem direncini %38 olarak verirken, bu oran Avrupa \u00fclkelerinde %2\u2019dir (16). Tedavi algoritmas\u0131nda \u00a0hafif ate\u015f ve \u00a0l\u00f6kositozu olan, klini\u011finde bulant\u0131-kusmas\u0131 olmayan hastalara oral Nitrofurantoin (kronik b\u00f6brek yetmezli\u011fi durumunda kontrendikedir), Fosfomisin ve Trimetoprim \/Sulfametaksazol verilmesi \u00f6neriler aras\u0131nda yer almaktad\u0131r (17).<\/p>\n

Sistit; <\/em>idrara s\u0131k \u00e7\u0131kma, idrar yaparken a\u011fr\u0131 olmas\u0131 ve idrara s\u0131k\u0131\u015f\u0131k olma hissinin ile karekterize klinik bir tablodur. Suprapubik a\u011fr\u0131 her zaman klinik tabloya e\u015flik etmeyebilir. Ya\u015fl\u0131 hastalar\u0131n bazen sadece n\u00f6rolojik de\u011fi\u015fiklikler ile hastaneye ba\u015fvurabilece\u011fi unutulmamal\u0131d\u0131r. Tan\u0131n\u0131n do\u011frulanmas\u0131nda,\u00a0 idrar mikroskopisi yer almaktad\u0131r. Sonucunda\u00a0 l\u00f6kosit, nitrit ve bakteri varl\u0131\u011f\u0131nda bir sonraki a\u015fama idrar k\u00fclt\u00fcr\u00fcn\u00fcn\u00a0 g\u00f6nderilmesidir (18). Ya\u015fl\u0131 hastalarda sistit tedavisinde Kinolonlar\u0131n kullan\u0131m\u0131 \u00f6neriler aras\u0131nda de\u011fildir. K\u00fclt\u00fcr sonucuna g\u00f6re uygun tedavinin 7-10 g\u00fcn s\u00fcre ile verilmesi planlanmal\u0131d\u0131r (17).<\/p>\n

Akut pyelonefrit;<\/em> klinik bulgu ate\u015f, \u00fc\u015f\u00fcme, titreme, bulant\u0131-kusma ve kostavertebral a\u00e7\u0131 hassasiyetinin olmas\u0131d\u0131r. Ya\u015fl\u0131larda %30 gibi bir oranda klinik tabloya ate\u015f e\u015flik etmeyebilir. Atipik klinik bulgular\u0131n varl\u0131\u011f\u0131n\u0131n olabilece\u011fi unutulmamal\u0131d\u0131r (19, 20). \u0130drar k\u00fclt\u00fcr\u00fc alt\u0131n standart olmakla beraber, sonucun \u00e7\u0131kmas\u0131 zaman almaktad\u0131r. Erken tan\u0131 y\u00f6ntemi olarak, idrar \u00f6rne\u011finin gram boyamas\u0131 yap\u0131labilir. Ya\u015fl\u0131larda komplike pyelonefrit d\u00fc\u015f\u00fcn\u00fclen olgularda ay\u0131r\u0131c\u0131 tan\u0131da yard\u0131mc\u0131 olarak g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri d\u00fc\u015f\u00fcn\u00fclebilir (21). Sepsisin e\u015flik etti\u011fi ve klini\u011fin k\u00f6t\u00fc gitti\u011fi ya\u015fl\u0131 hastalarda hastaneye yat\u0131\u015f verilerek, parenteral antibiyotik tedavisi yap\u0131lmal\u0131d\u0131r. Ampirik tedavide geni\u015f spekturumlu antibiyotikler tercih edilmelidir (17).<\/p>\n

Sonu\u00e7 olarak, ya\u015fl\u0131 hastalarda hemodinami daha kolay bozulabilmektedir. Tan\u0131 konuldu\u011fu andan itibaren tedavi mutlaka verilmelidir. Atipik bulgularla kar\u015f\u0131la\u015f\u0131labilece\u011fi ve mortalitede art\u0131\u015f\u0131n s\u00f6z konusu olabilece\u011fi unutulmamal\u0131d\u0131r.<\/p>\n

 <\/p>\n

Tablo-1:<\/strong> Toplumda ya\u015fl\u0131larda idrar yolu enfeksiyonuna yakla\u015f\u0131m (5).<\/p>\n

\"\"<\/p>\n

Tablo-2:<\/strong> Bak\u0131mevinde ya\u015fl\u0131larda (\u00fcriner kateteri olmayan) idrar yolu enfeksiyonuna yakla\u015f\u0131m (5).<\/p>\n

\"\"<\/p>\n

Kaynaklar<\/strong><\/p>\n

    \n
  1. Y\u0131lmazer A. Ya\u015fl\u0131larda g\u00fcncel sa\u011fl\u0131k sorunlar\u0131. \u0130\u00e7inde: D\u00fcnyada ve T\u00fcrkiye\u2019de Ya\u015fl\u0131larda Demografik De\u011fi\u015fimler. (Edit\u00f6r: M. Alt\u0131ndi\u015f). \u0130stanbul T\u0131p Kitapevi, \u0130stanbul,T\u00fcrkiye1.2013.bask\u0131, pp.1-10.<\/li>\n
  2. Demiray Dindar KE, Alkan S, \u00d6nder T, \u00d6nt\u00fcrk H, \u00d6nder A. Ya\u015fl\u0131l\u0131kta K\u0131r\u0131lganl\u0131k ve \u00dcriner Sistem Enfeksiyonlar\u0131. Black Sea Journal of Health Science.2022;5(1):143-148<\/li>\n
  3. Alkan-\u00c7eviker S, G\u00fcnal \u00d6, K\u0131l\u0131\u00e7 SS. Investigation of risk factors in recurrent urinary tract infections in adults. Klimik Derg.2019; 32(3): 303-309.<\/li>\n
  4. Mahesh E, Medha Y, Indumathi VA, Kumar PS, Khan MW, Punith K. Community acquired urinary tract infection in the elderly. BJMP. 2011;4(1):6\u20139).<\/li>\n
  5. Rowe TA, Juthani-Mehta M. Diagnosis and management of urinary tract infection in older adults. Infect Dis Clin North Am. 2014; 28(1):75-89.<\/li>\n
  6. Tartar AS, Balin SO. Geriatric urinary tract infections: The value of laboratory parameters in estimating the need for bacteremia and Intensive Care Unit. Pak J Med Sci.2019; 35(1): 215\u2013219.<\/li>\n
  7. Juthani-Mehta M., Drickamer M.A., Towle V., et. al.: Nursing home practitioner survey of diagnostic criteria for urinary tract infections. J\u00a0Am Geriatr Soc. 2005; 53: pp. 1986-1990.<\/li>\n
  8. Stone N.D., Ashraf M.S., Calder J., et. al.: Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012; 33: pp. 965-977.<\/li>\n
  9. Loeb M., Bentley D.W., Bradley S., et. al.: Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001; 22: pp. 120-124.<\/li>\n
  10. Nicolle L.E., Bradley S., Colgan R., et. al.: Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40: pp. 643-654.<\/li>\n
  11. Rodhe N., Lofgren S., Matussek A., et. al.: Asymptomatic bacteriuria in the elderly: high prevalence and high turnover of strains. Scand J Infect Dis 2008; 40: pp. 804-810.<\/li>\n
  12. URL 4. https:\/\/www.cdc.gov\/nhsn\/pdfs\/ltc\/ltcf-uti-protocolcurrent.pdf (eri\u015fim tarihi: 25 Haziran 2021).<\/li>\n
  13. Zeng G, Zhu W, Lam W, Bayramgil A. Treatment of urinary tract infections in the old and fragile. World J Uro. 2020;38(11):2709-2720.<\/li>\n
  14. Kebabc\u0131 N. Enfeksiyon hastal\u0131klar\u0131 klini\u011finde yatan geriatrik hastalar\u0131n irdelenmesi. Yay\u0131nlanmam\u0131\u015f uzmanl\u0131k tezi. Uluda\u011f \u00dcniversitesi T\u0131p Fak\u00fcltesi. 2015.Bursa, Turkey.<\/li>\n
  15. Matthews SJ, Lancaster JW. Urinary tract infections in the elderly population. The American J Geriat Pharmacotherapy. 2011; 9(5): 286-309.<\/li>\n
  16. Ayd\u0131n M, Azak E, Bilgin H, Menekse S, Asan A, Mert H. Changes in antimicrobial resistance and outcomes of health care-associated infections. European J Clin Microbiol Infect Diseas. 2021;40: 1737-1742.<\/li>\n
  17. Heppner PE, Schnepper L, Langer K, Fritzlar S, Deppa B. Evidence of antimicrobial stewardship in the treatment of uncomplicated urinary tract \u0131nfection. J Nurse Pract.2020;16(9):e153-e157.<\/li>\n
  18. Homma Y, Akiyama Y, Tomoe H, Furuta A, Ueda T, Maeda D. Clinical guidelines for interstitial cystitis\/bladder pain syndrome. Int J Urol. 2020; 27(7): 578-589.<\/li>\n
  19. Alpay Y, Aykin N, Korkmaz P, Gulduren HM, Caglan F. C. Urinary tract infections in the geriatric patients. Pakistan J Med Sci. 2018;34(1): 67.<\/li>\n
  20. Laborde C, Bador J, Hacquin A, Barben J, Putot S, Manckoundia P, Putot A. 2021. Atypical presentation of bacteremic urinary tract \u0131nfection in older patients: frequency and prognostic \u0131mpact. Diagnostics. 2021;11(3): 523.<\/li>\n
  21. Wagenlehner FM, Johansen TEB, Cai T, Koves B, Kranz J, Pilatz A, Tandogdu Z. Epidemiology, definition and treatment of complicated urinary tract infections. Nature Reviews Urol. 2020;17(10): 586-600.<\/li>\n<\/ol>\n

     <\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Bu blog yaz\u0131ma 20 g\u00fcn \u00f6nce gece n\u00f6betimde acil servise ba\u015fvuran 65 ya\u015f \u00fczeri bir hastay\u0131 anlatarak ba\u015flamak istiyorum: \u2018Hasta 69 ya\u015f\u0131nda…<\/p>\n","protected":false},"author":1185,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-395","post","type-post","status-publish","format-standard","hentry","category-genel"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/395","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=395"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/395\/revisions"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=395"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=395"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=395"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}