Zhanel George G, Hisanaga Tamiko L, Laing Nancy M, DeCorby Melanie R, Nichol Kim A, Palatnik Lorraine P, Johnson Jack, Noreddin Ayman, Harding Godfrey K M, Nicolle Lindsay E, Hoban Daryl J
Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Antimicrob Agents. 2005 Nov;26(5):380-8. doi: 10.1016/j.ijantimicag.2005.08.003.
The goal of the North American Urinary Tract Infection Collaborative Alliance (NAUTICA) study was to determine antibiotic susceptibility to commonly used agents for urinary tract infections against outpatient urinary isolates obtained in various geographic regions in the USA and Canada. Forty-one medical centres (30 from the USA and 11 from Canada) participated, with each centre submitting up to 50 consecutive outpatient midstream urine isolates. Isolates were identified to species level by the standard protocol of each laboratory. Susceptibility testing was determined using the National Committee for Clinical Laboratory Standards (NCCLS) microdilution method. Resistance breakpoints used were those published by the NCCLS, including: ampicillin (resistant > or = 32 microg/mL), sulphamethoxazole/trimethoprim (SMX/TMP) (resistant > or = 4 microg/mL), nitrofurantoin (resistant > or = 128 microg/mL), ciprofloxacin (resistant > or = 4 microg/mL) and levofloxacin (resistant > or = 8 microg/mL). Of the 1990 isolates collected, 75.1% (1494) were collected from the USA and 24.9% (496) were collected from Canada. The mean age of the patients was 48.3 years (range 1 month to 99 years), and 79.5% and 20.5% of isolates were obtained from women and men, respectively. The most common organisms were Escherichia coli (57.5%), Klebsiella pneumoniae (12.4%), Enterococcus spp. (6.6%), Proteus mirabilis (5.4%), Pseudomonas aeruginosa (2.9%), Citrobacter spp. (2.7%), Staphylococcus aureus (2.2%), Enterobacter cloacae (1.9%), coagulase-negative staphylococci (1.3%), Staphylococcus saprophyticus (1.2%), Klebsiella spp. (1.2%), Enterobacter aerogenes (1.1%) and Streptococcus agalactiae (1.0%). Among all 1990 isolates, 45.9% were resistant to ampicillin, 20.4% to SMX/TMP, 14.3% to nitrofurantoin, 9.7% to ciprofloxacin and 8.1% to levofloxacin. Fluoroquinolone resistance was highest in patients > or = 65 years of age. For the 1142 E. coli isolates, resistance rates were: ampicillin 37.7%, SMX/TMP 21.3%, ciprofloxacin 5.5%, levofloxacin 5.1% and nitrofurantoin 1.1%. For all 1990 isolates and for the 1142 E. coli only, resistance rates were significantly higher in US compared with Canadian medical centres. This study reports higher rates of antibiotic resistance in US versus Canadian outpatient urinary isolates and demonstrates the continuing evolution of resistance to antimicrobial agents.
北美尿路感染协作联盟（NAUTICA）研究的目的是确定在美国和加拿大不同地理区域获取的门诊泌尿系统分离菌株对常用尿路感染药物的抗生素敏感性。41个医疗中心（美国30个，加拿大11个）参与了研究，每个中心提交了多达50份连续的门诊中段尿分离菌株。各实验室按照标准方案将分离菌株鉴定到种水平。药敏试验采用美国国家临床实验室标准委员会（NCCLS）的微量稀释法。使用的耐药断点是NCCLS公布的，包括：氨苄西林（耐药≥32μg/mL）、磺胺甲恶唑/甲氧苄啶（SMX/TMP）（耐药≥4μg/mL）、呋喃妥因（耐药≥128μg/mL）、环丙沙星（耐药≥4μg/mL）和左氧氟沙星（耐药≥8μg/mL）。在收集的1990份分离菌株中，75.1%（1494份）来自美国，24.9%（496份）来自加拿大。患者的平均年龄为48.3岁（范围1个月至9９岁），分离菌株分别有79.5%和20.5%来自女性和男性。最常见的微生物是大肠埃希菌（57.5%）、肺炎克雷伯菌（12.4%）、肠球菌属（6.6%）、奇异变形杆菌（5.4%）、铜绿假单胞菌（2.9%）柠檬杆菌属（2.7%）、金黄色葡萄球菌（2.2%）、阴沟肠杆菌（1.9%）、凝固酶阴性葡萄球菌（1.3%）、腐生葡萄球菌（1.2%）、克雷伯菌属（1.2%）、产气肠杆菌（1.1%）和无乳链球菌（1.0%）。在所有１９９０份分离菌株中，45.9%对氨苄西林耐药，20.4%对SMX/TMP耐药，14.3%对呋喃妥因耐药，9.7%对环丙沙星耐药，8.1%对左氧氟沙星耐药。氟喹诺酮耐药在年龄≥65岁的患者中最高。对于1142份大肠埃希菌分离菌株，耐药率分别为：氨苄西林37.7%、SMX/TMP 21.3%、环丙沙星5.5%、左氧氟沙星5.1%和呋喃妥因1.1%。仅对于所有1990份分离菌株和1142份大肠埃希菌，美国医疗中心的耐药率显著高于加拿大医疗中心。本研究报告了美国门诊泌尿系统分离菌株中抗生素耐药率高于加拿大，并证明了对抗菌药物耐药性的持续演变。
