Lau Sheung-Mei, Peng Ming-Yieh, Chang Feng-Yee
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
J Microbiol Immunol Infect. 2004 Jun;37(3):185-91.
This study examined the distribution of organisms and their antimicrobial resistance in patients admitted due to acute bacteremic and non-bacteremic community-acquired urinary tract infection (UTI). During a period of 1 year and 1 month, a total of 201 patients and 253 bacterial isolates were studied. Fever higher than 38.5 degrees C was significantly more common in the bacteremic group than the non-bacteremic group (68% vs 48%; p<0.05). Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis were the most common organisms isolated. E. coli was the leading pathogen and it was significantly more predominant in bacteremic UTI than non-bacteremic UTI (73% vs 49%; p<0.01). Bacteria other than E. coli (i.e., K. pneumoniae, P. aeruginosa, Proteus spp., Morganella morganii, Enterobacter cloacae, Citrobacter spp., Acinetobacter baumannii, Serratia marcescens, and Providencia spp.) were more common in non-bacteremic UTI than bacteremic UTI (44% vs 22%; p<0.01). E. coli isolated from both bacteremic and non-bacteremic patients had a high rate of resistance to ampicillin (80%), cephalothin (59%), gentamicin (29%), piperacillin (61%), trimethoprim-sulfamethoxazole (56%), amoxicillin-clavulanic acid (34%), and ticarcillin-clavulanic acid (36%). Isolates of P. aeruginosa, K. pneumoniae, and Proteus spp. from the non-bacteremic group showed a higher proportion of resistance to extended-spectrum cephalosporins, aminoglycosides (netilmicin and amikacin) and ciprofloxacin. The emergence of a high rate of resistance to commonly used antimicrobials (ampicillin, cephalothin, gentamicin, trimethoprim-sulfamethoxazole, piperacillin, amoxicillin-clavulanic acid and ticarcillin-clavulanic acid) may have an impact on the antibiotic treatment of patients admitted due to acute community-acquired bacteremic or non-bacteremic UTI in Taiwan. Further studies are needed to clarify the impact of antimicrobial resistance on the outcome in these conditions.
本研究调查了因急性菌血症性和非菌血症性社区获得性尿路感染（UTI）入院患者的微生物分布及其抗菌药物耐药性。在1年零1个月的时间里，共研究了201例患者和253株细菌分离株。菌血症组发热高于38.5℃的情况显著多于非菌血症组（68%对48%；p<0.05）。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和奇异变形杆菌是最常分离出的微生物。大肠埃希菌是主要病原体，在菌血症性UTI中比非菌血症性UTI中更占主导地位（73%对49%；p<0.01）。除大肠埃希菌外的其他细菌（即肺炎克雷伯菌、铜绿假单胞菌、变形杆菌属、摩根摩根菌、阴沟肠杆菌、柠檬酸杆菌属、鲍曼不动杆菌、黏质沙雷菌和普罗威登斯菌属）在非菌血症性UTI中比菌血症性UTI中更常见（44%对22%；p<0.01）。从菌血症性和非菌血症性患者中分离出的大肠埃希菌对氨苄西林（80%）、头孢噻吩（59%）、庆大霉素（29%）、哌拉西林（61%）、甲氧苄啶-磺胺甲恶唑（56%）、阿莫西林-克拉维酸（34%）和替卡西林-克拉维酸（36%）的耐药率较高。非菌血症组中分离出的铜绿假单胞菌、肺炎克雷伯菌和变形杆菌属菌株对广谱头孢菌素、氨基糖苷类（奈替米星和阿米卡星）和环丙沙星的耐药比例更高。对常用抗菌药物（氨苄西林、头孢噻吩、庆大霉素、甲氧苄啶-磺胺甲恶唑、哌拉西林、阿莫西林-克拉维酸和替卡西林-克拉维酸）出现的高耐药率可能会对台湾因急性社区获得性菌血症性或非菌血症性UTI入院患者的抗生素治疗产生影响。需要进一步研究以阐明抗菌药物耐药性对这些情况下治疗结果的影响。
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