De Francesco Maria Antonia, Ravizzola Giuseppe, Peroni Laura, Negrini Riccardo, Manca Nino
Institute of Microbiology and Virology, Spedali Civili-University of Brescia, Brescia, Italy.
Med Sci Monit. 2007 Jun;13(6):BR136-44.
Urinary tract infections are associated with substantial morbidity and recurrent infections. Antibiotic therapy is generally initiated empirically because early treatment decreases the rate of morbidity resulting from UTI. Unfortunately, antibiotic resistance has become an increasingly pressing problem in many countries. In this study, the resistance patterns of urinary isolates to commonly used antimicrobials were determined in order to evaluate the options for empirical antibiotic therapy of UTI in out- and in- patients.
MATERIAL/METHODS: A retrospective study was carried out on urine samples examined in this laboratory in 2002-2005. The isolates were divided into the following three groups: isolates from hospital inpatients, isolates from community outpatients, and isolates from catheterized patients.
Escherichia coli was the most common etiologic agent isolated, followed by Enterococcus faecalis and Klebsiella pneumoniae. Over the four-year period, a decrease in the isolation of Pseudomonas aeruginosa and a parallel increase in Candida spp. in hospitalized patients were observed. Against Gram-positive isolates, enterococci in particular, ampicillin and glycopeptides demonstrated the best, most consistent activity. Among Escherichia coli isolates, nitrofurantoin, cephalosporins, and penicillin/betalactams were the best options for therapeutic treatment because of the presence of a rate of resistance to cotrimoxazole and fluoroquinolones of over 10%, while the most active drug against Pseudomonas aeruginosa was piperacillin/tazobactam.
Region-specific surveillance studies provide additional information about the type of pathogens causing UTIs and their antimicrobial susceptibility patterns. Therefore, these data can serve as a basis to develop national country-specific guidelines for the empirical treatment of UTIs.
尿路感染与较高的发病率及反复感染相关。由于早期治疗可降低尿路感染导致的发病率，抗生素治疗通常凭经验启动。不幸的是，抗生素耐药性在许多国家已成为日益紧迫的问题。在本研究中，确定了尿培养分离株对常用抗菌药物的耐药模式，以评估门诊和住院患者尿路感染经验性抗生素治疗的选择。
材料/方法：对2002年至2005年在本实验室检查的尿样进行回顾性研究。分离株分为以下三组：医院住院患者分离株、社区门诊患者分离株和导尿患者分离株。
分离出的最常见病原体是大肠埃希菌，其次是粪肠球菌和肺炎克雷伯菌。在这四年期间，观察到住院患者中铜绿假单胞菌的分离率下降，念珠菌属的分离率相应上升。对于革兰氏阳性分离株，尤其是肠球菌，氨苄西林和糖肽类药物表现出最佳、最一致的活性。在大肠埃希菌分离株中，由于对复方新诺明和氟喹诺酮类药物的耐药率超过10%，呋喃妥因、头孢菌素和青霉素/β-内酰胺类是治疗的最佳选择，而对铜绿假单胞菌最有效的药物是哌拉西林/他唑巴坦。
区域特异性监测研究提供了有关引起尿路感染的病原体类型及其抗菌药敏模式的更多信息。因此，这些数据可作为制定各国特异性尿路感染经验性治疗指南的依据。
