Gordon Kelley A, Jones Ronald N
The JONES Group/JMI Laboratories, North Liberty, Iowa, USA.
Diagn Microbiol Infect Dis. 2003 Apr;45(4):295-301. doi: 10.1016/s0732-8893(02)00467-4.
Urinary tract infections (UTIs) remain a worldwide nosocomial infection problem. Geographic variations in pathogen occurrence and susceptibility profiles require monitoring to provide information to guide new (garenoxacin [BMS284756]) therapeutic options. Two thousand seven hundred-eighty UTI isolates from Europe (n = 783), Latin America (531), and North America (1,466) were tested and compared against 44 agents by reference methods in the SENTRY Antimicrobial Surveillance Program. The top seven pathogens accounted for 90% of all isolates and the rank order for all regions was: Escherichia coli (1,316; 47%), Enterococcus spp. (351; 13%), Klebsiella spp. (306; 11%), Pseudomonas aeruginosa (210; 8%), Proteus mirabilis (145; 5%), Enterobacter spp. (97; 4%), and Citrobacter spp. (78; 3%). The pathogen rank order was similar among regions except for the rarer occurrence of Enterococcus spp. (Rank #6, 4%) in Latin America. E. coli ampicillin resistance was highest in Europe and Latin America (51-55%). Ampicillin (37%), ciprofloxacin or garenoxacin (4%), and trimethoprim/sulfamethoxazole (23%) resistance remained lowest in North America. Nitrofurantoin susceptibility in E. coli was still at acceptable levels and ranged from 91 to 96% across regions. The regional ciprofloxacin-resistant rank order for P. aeruginosa by region was: Latin America (55%) > Europe (41%) > North America (29%). Vancomycin-resistant enterococci (VRE) were only detected in North America (7%). Garenoxacin possessed a 34 to 44% wider spectrum compared to ciprofloxacin against enterococci UTI isolates. Extended spectrum beta-lactamase rates for E. coli and Klebsiella spp. were 4 and 19%, respectively. These results emphasized the need to assess the often striking differences in pathogen occurrence and resistance rates among the commonly encountered UTI pathogens.
尿路感染（UTIs）仍然是一个全球性的医院感染问题。病原体出现情况和药敏谱的地理差异需要进行监测，以便提供信息来指导新的（加替沙星[BMS284756]）治疗选择。在SENTRY抗菌药物监测计划中，采用参考方法对来自欧洲（n = 783）、拉丁美洲（531）和北美洲（1466）的2780株UTI分离株进行了检测，并与44种药物进行了比较。前七种病原体占所有分离株的90%，所有地区的排序如下：大肠埃希菌（1316株；47%）、肠球菌属（351株；13%）、克雷伯菌属（306株；11%）、铜绿假单胞菌（210株；8%）、奇异变形杆菌（145株；5%）、肠杆菌属（97株；4%）和柠檬酸杆菌属（78株；3%）。除拉丁美洲肠球菌属出现频率较低（排名第6，4%）外，各地区病原体排序相似。欧洲和拉丁美洲大肠埃希菌对氨苄西林的耐药率最高（51 - 55%）。北美洲氨苄西林（37%）、环丙沙星或加替沙星（4%）以及甲氧苄啶/磺胺甲恶唑（23%）的耐药率仍然最低。大肠埃希菌对呋喃妥因的敏感性仍处于可接受水平，各地区范围为91%至96%。铜绿假单胞菌对环丙沙星的耐药率按地区排序为：拉丁美洲（55%）>欧洲（41%）>北美洲（29%）。耐万古霉素肠球菌（VRE）仅在北美洲检测到（7%）。与环丙沙星相比，加替沙星对肠球菌UTI分离株的抗菌谱宽34%至44%。大肠埃希菌和克雷伯菌属的超广谱β-内酰胺酶发生率分别为4%和19%。这些结果强调了评估常见UTI病原体在病原体出现情况和耐药率方面通常存在的显著差异的必要性。
