Liu Y C, Huang W K, Huang T S, Kunin C M
Sections of Infectious Diseases and Microbiology, Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
J Clin Epidemiol. 1999 Jun;52(6):539-45. doi: 10.1016/s0895-4356(99)00027-x.
Antibiotic resistance is the inevitable consequence of the selective pressure of antimicrobial drug use and the adaptive plasticity of the microorganisms. Excessive and irrational use of antimicrobial drugs is a problem in all countries. It is particularly troublesome in developing countries where there is a heavy burden of infectious diseases. This study was designed to determine whether detection of antimicrobial activity in the urine might be a useful tool for epidemiologic studies of the interaction between antibiotic use and resistance in developing countries. A laboratory marker is necessary because the history of antimicrobial drug use may be unreliable. Serial specimens or spontaneously voided urine were obtained from healthy volunteers given a single oral dose of commonly used antimicrobial drugs. Urine was also obtained from hospitalized patients the morning after the last dose of an antimicrobial drug and from untreated controls. Assays were performed with standard American Type Culture Collection (Rockville, MD) stains of Bacillus stearothermophilus, Escherichia coli, and Streptococcus pyogenes. Antimicrobial activity could not be detected in pretreatment urine. After a single oral dose, the beta lactam antibiotics and erythromycin could be detected for about 12 to 24 hours, whereas clindamycin, tetracycline, trimethoprim/sulfamethoxazole, and ciprofloxacin could be detected for 48 or more hours. In hospitalized patients, receiving multiple drugs, the following were the sensitivity and specificity for detection of antimicrobial activity: for B. stearothermophilus, 100.0% and 85.9%, respectively; for S. pyogenes, 94.9% and 94.9%, respectively; and for E. coli, 71.8% and 98.7%, respectively. The combination of E. coli and Streptococcus pyogenes exhibited a sensitivity of 97.4% and specificity of 94.9%. Detection of antimicrobial activity in urine is a promising method to determine antimicrobial drug use in epidemiologic studies, particularly in populations in which drug use history is unreliable.
抗生素耐药性是抗菌药物使用的选择压力与微生物适应性可塑性共同作用的必然结果。抗菌药物的过度和不合理使用在所有国家都是一个问题。在传染病负担沉重的发展中国家，这一问题尤为棘手。本研究旨在确定检测尿液中的抗菌活性是否可能成为发展中国家抗生素使用与耐药性相互作用的流行病学研究的有用工具。由于抗菌药物使用史可能不可靠，因此需要一个实验室标志物。从单次口服常用抗菌药物的健康志愿者中获取系列标本或自然排尿的尿液。还从住院患者在最后一剂抗菌药物服用后的次日早晨以及未接受治疗的对照者中获取尿液。使用美国典型培养物保藏中心（马里兰州罗克维尔）的嗜热脂肪芽孢杆菌、大肠埃希菌和化脓性链球菌的标准菌株进行检测。在预处理尿液中未检测到抗菌活性。单次口服给药后，β-内酰胺类抗生素和红霉素可检测到约12至24小时，而克林霉素、四环素、甲氧苄啶/磺胺甲恶唑和环丙沙星可检测到48小时或更长时间。在接受多种药物治疗的住院患者中，检测抗菌活性的敏感性和特异性如下：对于嗜热脂肪芽孢杆菌，分别为100.0%和85.9%；对于化脓性链球菌，分别为94.9%和94.9%；对于大肠埃希菌，分别为71.8%和98.7%。大肠埃希菌和化脓性链球菌的组合显示敏感性为97.4%，特异性为94.9%。检测尿液中的抗菌活性是在流行病学研究中确定抗菌药物使用情况的一种有前景的方法，特别是在药物使用史不可靠的人群中。
