基层医疗中抗生素耐药性感染的症状持续时间更长，且会增加工作量：大肠杆菌尿路感染患者的结局
Antibiotic-resistant infections in primary care are symptomatic for longer and increase workload: outcomes for patients with E. coli UTIs.
作者信息
Butler Christopher C, Hillier Sharon, Roberts Zoë, Dunstan Frank, Howard Anthony, Palmer Stephen
机构信息
Department of Epidemiology, Statistics and Public Health, Centre for Health Sciences Research, Cardiff University, Heath Park, Cardiff.
出版信息
Br J Gen Pract. 2006 Sep;56(530):686-92.
BACKGROUND
Antimicrobial resistance is considered to be one of the major threats to public health. However, the practical implications for patients and workload in primary care are largely unknown.
AIM
To determine outcomes for patients managed in primary care with an antibiotic resistant compared to an antibiotic sensitive Escherichia coli (E. coli) urinary tract infection (UTI).
DESIGN
Nested case control study with prospective measurement of outcomes.
SETTING
Ten general practices in South Wales.
METHOD
Patients consulting with symptoms suggestive of UTI identified through systematic sampling, and with a laboratory proven E. coli infection, were followed up by interview 1 month after their consultations and by searching of their medical records.
RESULTS
Nine hundred and thirty-two patients were interviewed and had their medical records reviewed. The risk of patients reporting 'feeling poorly', 'frequency or pain on urinating' and being 'out of action' for more than 5 days after consulting was significantly increased for patients with resistant compared to sensitive infections. After adjusting for risk factors, there was an increased risk of 'frequency or pain on urinating' and 'being out of action' for those infected with a resistant E. coli. The median number of maximum reported days with at least one symptom was 12 days for patients with E. coli infections resistant to trimethoprim, 7 days for infections resistant to ampicillin, 7 days for infections resistant to any antibiotic, and 5 days for infections sensitive to all tested antibiotics. Even if treated with an appropriate antibiotic, infections caused by a resistant strain were symptomatic for longer. For those infected with an organism resistant to at least one antibiotic, the odds ratio (OR) for re-visiting their GP within the next 30 days for the UTI was 1.47 (95% confidence interval [CI] = 1.10 to 1.95). The OR was 1.49 (95% CI = 1.11 to 2.00) for ampicillin resistance and 2.48 (95% CI = 1.70 to 3.59) for trimethoprim resistance.
CONCLUSIONS
Resistant E. coli UTIs are symptomatic for longer and cause increased work load in general practice.
背景
抗生素耐药性被认为是对公众健康的主要威胁之一。然而，其对初级医疗中患者的实际影响以及工作量在很大程度上尚不清楚。
目的
确定在初级医疗中治疗的耐抗生素与敏感大肠杆菌（E. coli）引起的尿路感染（UTI）患者的治疗结果。
设计
嵌套病例对照研究，对结果进行前瞻性测量。
地点
南威尔士的十家全科诊所。
方法
通过系统抽样确定有UTI症状并经实验室证实为大肠杆菌感染的患者，在其就诊后1个月通过访谈及查阅病历进行随访。
结果
932名患者接受了访谈并查阅了病历。与敏感感染患者相比，耐抗生素感染患者在就诊后报告“感觉不适”“排尿频率或疼痛”以及“无法正常活动”超过5天的风险显著增加。在对风险因素进行调整后，感染耐抗生素大肠杆菌的患者出现“排尿频率或疼痛”以及“无法正常活动”的风险增加。对于对甲氧苄啶耐药的大肠杆菌感染患者，报告至少有一种症状的最长天数中位数为12天；对氨苄西林耐药的感染患者为7天；对任何抗生素耐药的感染患者为7天；对所有测试抗生素敏感的感染患者为5天。即使使用适当的抗生素治疗，耐药菌株引起的感染症状持续时间更长。对于感染至少一种抗生素耐药菌的患者，因UTI在接下来30天内再次就诊于全科医生的比值比（OR）为1.47（95%置信区间[CI]=1.10至1.95）。氨苄西林耐药的OR为1.49（95%CI=1.11至2.00），甲氧苄啶耐药的OR为2.48（95%CI=1.70至3.59）。
结论
耐抗生素大肠杆菌引起的UTI症状持续时间更长，且会增加全科医疗的工作量。
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