Farrell D J, Morrissey I, De Rubeis D, Robbins M, Felmingham D
GR Micro Limited, London, UK.
J Infect. 2003 Feb;46(2):94-100. doi: 10.1053/jinf.2002.1091.
To determine the prevalence of resistance amongst urinary tract pathogens against antimicrobials used to treat urinary tract infections (UTIs) in the UK to provide data to help direct empirical therapy.
During 1999-2000, a total of 1291 bacterial isolates causing UTI were collected from 8 centres in the UK. Isolates were cultured from patients with (1). community-acquired UTI in those less than 65 years old (397), (2). hospital-acquired UTI other than those admitted with pyelonephritis (394), (3). pyelonephritis (108) and (4). community-acquired UTI in those greater than 65 years old (392). After re-identification, MICs for a range of antimicrobials were determined and interpreted using NCCLS procedures and interpretive guidelines.
Escherichia coli was the predominant pathogen in all categories but the total percentage for each category varied (56.3-77.3%). The next three pathogens of importance were Enterococcus faecalis, Klebsiella pneumoniae and Proteus mirabilis which varied in prevalence slightly from category to category. The activity of amoxycillin against E. coli (51.3% susceptible) was greatly reduced as a result of beta-lactamase production and only partially restored by the addition of clavulanic acid (78.8% susceptible). Cefuroxime was very active against E. coli using parenteral form breakpoints (97.1% susceptible) but less so using oral form breakpoints (68.6% susceptible). Cefuroxime was inactive against Enterococcus spp. and Pseudomonas spp. Nitrofurantoin was very active against isolates of E. coli (96.3% susceptible) and E. faecalis but not against K. pneumoniae, P. mirabilis or Pseudomonas aeruginosa. Overall susceptibility to trimethoprim ranged from 58.1% to 84.5% for the most prevalent pathogens. Ciprofloxacin was highly active against the UTI pathogens examined in this study with susceptibilities of between 88.6% and 97.7% for the most prevalent pathogens (E. coli, n=864, 97.7% susceptible) and was the only oral agent tested with activity against Pseudomonas spp.
These data provide much needed information on the prevalence of antimicrobial resistance amongst pathogens currently causing UTI in the UK.
确定英国引起尿路感染（UTIs）的尿路病原体对用于治疗UTIs的抗菌药物的耐药率，以提供有助于指导经验性治疗的数据。
在1999 - 2000年期间，从英国8个中心共收集了1291株引起UTI的细菌分离株。分离株来自以下患者：（1）年龄小于65岁的社区获得性UTI患者（397例）；（2）除肾盂肾炎入院患者外的医院获得性UTI患者（394例）；（3）肾盂肾炎患者（108例）；（4）年龄大于65岁的社区获得性UTI患者（392例）。重新鉴定后，使用美国国家临床实验室标准化委员会（NCCLS）的程序和解释性指南测定并解释了一系列抗菌药物的最低抑菌浓度（MICs）。
大肠埃希菌是所有类别中的主要病原体，但各类别中的总体百分比有所不同（56.3 - 77.3%）。接下来三种重要的病原体是粪肠球菌、肺炎克雷伯菌和奇异变形杆菌，其患病率在不同类别中略有差异。由于β-内酰胺酶的产生，阿莫西林对大肠埃希菌的活性（51.3%敏感）大大降低，加入克拉维酸后仅部分恢复（78.8%敏感）。头孢呋辛采用胃肠外给药的折点时对大肠埃希菌非常有效（97.1%敏感），但采用口服给药的折点时效果较差（68.6%敏感）。头孢呋辛对肠球菌属和假单胞菌属无活性。呋喃妥因对大肠埃希菌分离株（96.3%敏感）和粪肠球菌非常有效，但对肺炎克雷伯菌、奇异变形杆菌或铜绿假单胞菌无效。对于最常见的病原体，对甲氧苄啶的总体敏感性范围为58.1%至84.5%。环丙沙星对本研究中检测的UTI病原体具有高度活性，对最常见的病原体（大肠埃希菌，n = 864，97.7%敏感）的敏感性在88.6%至97.7%之间，并且是唯一测试的对假单胞菌属有活性的口服药物。
这些数据提供了关于英国目前引起UTI的病原体中抗菌药物耐药率的急需信息。
