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[社区尿路感染的流行病学与病因学。主要病原体的抗菌药物敏感性及耐药的临床意义]

[Epidemiology and etiology of urinary tract infections in the community. Antimicrobial susceptibility of the main pathogens and clinical significance of resistance].

作者信息

Alós Juan Ignacio

机构信息

Servicio de Microbiología, Hospital de Móstoles, Madrid, España.

出版信息

Enferm Infecc Microbiol Clin. 2005 Dec;23 Suppl 4:3-8. doi: 10.1157/13091442.

Abstract

Urinary tract infections (UTI) are a frequent problem in primary care. They occur mainly in women without underlying diseases and with no functional or structural anomalies of the urinary tract; consequently most cases are considered uncomplicated UTI. Etiology is influenced by factors such as age, diabetes, spinal cord injury, urinary catheterization, and other factors. Escherichia coli causes 80-85% of acute episodes of uncomplicated cystitis. Staphylococcus saprophyticus, Proteus mirabilis, Streptococcus agalactiae and Klebsiella spp. are responsible for most of the remaining episodes. The spectrum of bacteria that causes complicated UTI is much broader. Rates of resistance have undergone considerable variations, and consequently the empirical treatment of UTI requires constant updating of the antibiotic sensitivity of the main uropathogens of the area, country or institution. To correctly interpret the global data on sensitivity, the type of UTI (uncomplicated versus complicated), sex, age and previous antibiotic therapy in each patient must be taken into account. Resistance in uncomplicated UTI has clinical significance (although less than in systemic infections such as bacteremia), which depends on whether the infection is cystitis or pyelonephritis.

摘要

尿路感染(UTI)是初级医疗保健中常见的问题。它们主要发生在没有基础疾病且尿路无功能或结构异常的女性身上;因此,大多数病例被认为是单纯性尿路感染。病因受年龄、糖尿病、脊髓损伤、导尿等因素影响。大肠杆菌导致80% - 85%的单纯性膀胱炎急性发作。腐生葡萄球菌、奇异变形杆菌、无乳链球菌和克雷伯菌属是其余大多数发作的病因。导致复杂性尿路感染的细菌谱要广泛得多。耐药率有很大变化,因此尿路感染的经验性治疗需要不断更新该地区、国家或机构主要尿路病原体的抗生素敏感性。为了正确解释全球敏感性数据,必须考虑每个患者的尿路感染类型(单纯性与复杂性)、性别、年龄和先前的抗生素治疗情况。单纯性尿路感染中的耐药性具有临床意义(尽管低于菌血症等全身性感染),这取决于感染是膀胱炎还是肾盂肾炎。

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