Bouza E, San Juan R, Muñoz P, Voss A, Kluytmans J
Servicio de Microbiología Clínica y Enfermedades Infecciosas_VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Clin Microbiol Infect. 2001 Oct;7(10):523-31. doi: 10.1046/j.1198-743x.2001.00326.x.
To obtain information on the microbiology workload, etiology and antimicrobial susceptibility of urinary tract infection (UTI) pathogens isolated in European hospitals.
We collected data available in the microbiology units of a large sample of European hospitals regarding the laboratory workload, diagnostic criteria, and etiology and antimicrobial resistance of the urinary isolates collected on one day (the study day).
Data were received from a total of 228 hospitals from 29 European countries. The average rate of urine samples cultured per 1000 admissions in 1999 was 324. The criteria to consider a positive urine culture as significant were quite variable; > or =10(4) colony-forming units (CFU)/mL for bacteria or > or =10(3) CFU/mL in the case of yeasts were the most used cut-off points. On the study day, a total of 607 micro-organisms from 522 patients with nosocomial UTI were isolated. The six most commonly isolated micro-organisms were, in decreasing order: Escherichia coli (35.6%), Enterococci (15.8%), Candida (9.4%), Klebsiella (8.3%), Proteus (7.9%) and Pseudomonas aeruginosa (6.9%). Pseudomonas was isolated more frequently in non-EU countries. The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin.
Nosocomial UTI accounts for an important proportion of the workload in microbiology laboratories. A consensus on the practice and interpretation of urine cultures in Europe is needed. The levels and patterns of resistance of UTI pathogens must be a serious cause for concern and a clear reason for stricter guidelines and regulations in antimicrobial policy.
获取欧洲医院分离出的尿路感染（UTI）病原体的微生物学工作量、病因及抗菌药物敏感性信息。
我们收集了来自大量欧洲医院微生物科室的可用数据，内容涉及实验室工作量、诊断标准以及在某一天（研究日）收集的尿液分离株的病因和抗菌药物耐药性。
共收到来自29个欧洲国家228家医院的数据。1999年每1000例入院患者中尿液培养的平均比率为324。将阳性尿液培养视为有意义的标准差异很大；细菌≥10⁴菌落形成单位（CFU）/mL或酵母≥10³CFU/mL是最常用的截断点。在研究日，共从522例医院获得性UTI患者中分离出607株微生物。六种最常分离出的微生物按降序排列为：大肠埃希菌（35.6%）、肠球菌（15.8%）、念珠菌（9.4%）、克雷伯菌（8.3%）、变形杆菌（7.9%）和铜绿假单胞菌（6.9%）。铜绿假单胞菌在非欧盟国家分离得更频繁。研究数据显示UTI病原体的抗菌药物耐药率很高，尤其是在非欧盟国家，那里铜绿假单胞菌对庆大霉素的氨基糖苷类耐药率高达72%，对妥布霉素为69.2%，对阿米卡星为40%。
医院获得性UTI在微生物实验室工作量中占重要比例。欧洲需要就尿液培养的操作和解读达成共识。UTI病原体的耐药水平和模式必须引起严重关注，这也是制定更严格抗菌政策指南和规定的明确理由。
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