Laupland K B, Ross T, Pitout J D D, Church D L, Gregson D B
Calgary Laboratory Services, Centre for Anti-microbial Resistance, University of Calgary and Calgary Health Region, Room 1W-415, #9, 3535 Research Road NW, T2L 2K8 Calgary, AB, Canada.
Infection. 2007 Jun;35(3):150-3. doi: 10.1007/s15010-007-6180-2.
Although multiple studies have investigated community-onset urinary tract infections (UTI), population-based data are lacking. We therefore conducted population-based laboratory surveillance in order to define the incidence, demographic risk factors, etiology, and antimicrobial susceptibilities of community onset UTI in a large Canadian region.
Laboratory surveillance for all community onset UTIs among residents of the Calgary Health Region (population approximately 1.2 million) was conducted during 2004/2005. Repeated positive samples within a 1-month period and those infections first cultured more than 2 days after admission to a hospital were excluded.
A total of 40,618 episodes of community onset UTI occurred among 30,851 residents for an overall annual incidence of 17.5 per 1,000. Seventy-four percent of the cultures were submitted from ambulatory patients, 18% from hospitalized patients within the first 2 days of admission, and 9% from nursing home residents. Females were at significantly increased risk as compared to males (30.0 vs 5.0 per 1,000, RR 5.98; 95% CI, 5.81-6.15; p < 0.0001) as were the very young and very old. The most common infecting organisms were Escherichia coli (70%), Klebsiella pneumoniae (7%) and Enterococcus species (6%). Overall resistance rates among first isolates per patient tested were 14% for trimethoprim/sulfamethoxazole, 8% for cefazolin, 7% for nitrofurantoin, 6% for ciprofloxacin, 4% for gentamicin, and 2% for ceftriaxone although rates differed significantly based on sending location and patient age.
This study provides novel information on the epidemiology of community-onset UTIs in a non-selected Canadian population. The occurrence, etiology, and resistance rates of community onset UTI differ significantly among definable population groups.
尽管多项研究已对社区获得性尿路感染（UTI）进行了调查，但缺乏基于人群的数据。因此，我们开展了基于人群的实验室监测，以确定加拿大一个大区域内社区获得性UTI的发病率、人口统计学风险因素、病因及抗菌药物敏感性。
2004/2005年期间，对卡尔加里健康区域（人口约120万）的所有社区获得性UTI进行了实验室监测。排除1个月内重复出现的阳性样本以及入院2天以上首次培养出感染菌的情况。
30851名居民中共发生40618例社区获得性UTI，总体年发病率为每1000人中有17.5例。74%的培养样本来自门诊患者，18%来自入院后头2天内的住院患者，9%来自疗养院居民。与男性相比，女性、非常年轻和非常年长者的发病风险显著增加（每1000人分别为30.0例和5.0例，相对危险度5.98；95%可信区间，5.81 - 6.15；p < 0.0001）。最常见的感染菌为大肠埃希菌（70%）、肺炎克雷伯菌（7%）和肠球菌属（6%）。每位患者首次分离菌的总体耐药率分别为：甲氧苄啶/磺胺甲恶唑14%、头孢唑林8%、呋喃妥因7%、环丙沙星6%、庆大霉素4%、头孢曲松2%，不过耐药率因送检地点和患者年龄不同而有显著差异。
本研究提供了关于未选择的加拿大人群中社区获得性UTI流行病学的新信息。社区获得性UTI的发生率、病因及耐药率在可明确的人群组中存在显著差异。
