Vallano Antonio, Rodríguez Dolores, Barceló M Estrella, López Anna, Cano Angel, Viñado Belén, Diogene Eduard
Fundación Instituto Catalán de Farmacología. Servicio de Farmacología Clínica. Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona. España.
Enferm Infecc Microbiol Clin. 2006 Aug-Sep;24(7):418-25. doi: 10.1157/13091778.
An increase in the resistance to antimicrobial agents among bacteria causing urinary tract infections (UTI) has been reported. The aim of this study was to relate uropathogen susceptibility to prescribed antibiotics for UTI to the clinical outcome after therapy in primary health care patients.
A prospective longitudinal study, including 118 women diagnosed with UTI was carried out in primary health care centers. The results of urine culture, antimicrobial susceptibility testing and the prescribed antibiotic treatment were recorded. The patients' clinical outcome and the results of follow-up urine cultures after therapy were also recorded.
The uropathogens isolated were susceptible to the prescribed antibiotic in 86% of patients. Clinical improvement at two weeks was observed in 91% of patients with bacteria sensitive to the prescribed antibiotics and 7% of patients with resistant bacteria (P = 0.06). At 4-6 weeks, there were no clinical symptoms in 88% of patients with sensitive bacteria and 71% of patients with resistant bacteria (p = 0.23). In follow-up urine cultures, bacteria had been eradicated in 74% of patients with sensitive bacteria and 50% with resistant bacteria (p = 0.34).
The majority of women diagnosed with UTI in primary health care had uropathogens sensitive to the prescribed antibiotic and treatment was effective at short term in this study. The results of antimicrobial susceptibility testing were not always related to the clinical outcome; bacterial resistance may overestimate the risk of therapeutic failure in UTI.
据报道，引起尿路感染（UTI）的细菌对抗菌药物的耐药性有所增加。本研究的目的是将原发性医疗保健患者中尿路感染致病菌对规定抗生素的敏感性与治疗后的临床结果相关联。
在初级卫生保健中心开展了一项前瞻性纵向研究，纳入了118名被诊断为UTI的女性。记录了尿培养结果、抗菌药物敏感性试验及规定的抗生素治疗情况。还记录了患者的临床结果及治疗后随访尿培养的结果。
86%的患者中分离出的尿路致病菌对规定的抗生素敏感。在对规定抗生素敏感的细菌感染患者中，91%在两周时临床症状改善，而耐药细菌感染患者中这一比例为7%（P = 0.06）。在4 - 6周时，敏感细菌感染患者中88%无临床症状，耐药细菌感染患者中这一比例为71%（p = 0.23）。在随访尿培养中，敏感细菌感染患者中74%的细菌被清除，耐药细菌感染患者中这一比例为50%（p = 0.34）。
在本研究中，初级卫生保健中大多数被诊断为UTI的女性尿路致病菌对规定的抗生素敏感，且治疗在短期内有效。抗菌药物敏感性试验结果并不总是与临床结果相关；细菌耐药性可能高估了UTI治疗失败的风险。
