Czaja Christopher A, Scholes Delia, Hooton Thomas M, Stamm Walter E
Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA.
Clin Infect Dis. 2007 Aug 1;45(3):273-80. doi: 10.1086/519268. Epub 2007 Jun 19.
Acute pyelonephritis is a potentially severe disease for which there are few population-based studies. We performed a population-based analysis of trends in the incidence, microbial etiology, antimicrobial resistance, and antimicrobial therapy of outpatient and inpatient pyelonephritis.
A total of 4887 enrollees of Group Health Cooperative, based in Seattle, Washington, who received an International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis of acute pyelonephritis from 1997 through 2001 were identified using computerized records. Diagnoses were linked to urine culture and antibiotic prescription data. Case patients (n=3236) included subjects who had received an inpatient or culture-confirmed outpatient diagnosis of acute pyelonephritis.
Among the female population, annual rates of outpatient and inpatient pyelonephritis were 12-13 cases per 10,000 population and 3-4 cases per 10,000 population, respectively; among the male population, the rates were 2-3 cases per 10,000 population and 1-2 cases per 10,000 population, respectively. Rates were relatively stable from year to year. Incidence was highest among young women, followed by infants and the elderly population. The ratio of outpatient to inpatient cases was highest among young women (ranging from 5 : 1 to 6 : 1). Escherichia coli caused 80% of cases of acute pyelonephritis in women and 70% of cases in men and was less dominant in older age groups. Among E. coli strains, the rate of ciprofloxacin resistance increased from 0.2% of isolates to 1.5% of isolates (P=.03), and the rate of trimethoprim-sulfamethoxazole resistance decreased from 25% of isolates to 13% of isolates (P<.01) from 1997 to 2001. Among outpatient cases, the rate of fluoroquinolone use increased from 35% to 61%, whereas the rate of trimethoprim-sulfamethoxazole use decreased from 53% to 32% over the 5-year period (P<.01).
This comprehensive, population-based analysis adds to our limited knowledge of the epidemiology of acute pyelonephritis, especially among outpatients, in whom the majority of cases now occur.
急性肾盂肾炎是一种潜在的严重疾病，但基于人群的研究较少。我们对门诊和住院肾盂肾炎的发病率、微生物病因、抗菌药物耐药性及抗菌治疗趋势进行了基于人群的分析。
利用计算机记录，在华盛顿州西雅图的健康合作组织中，共识别出4887名在1997年至2001年期间接受国际疾病分类第九版临床修订本诊断为急性肾盂肾炎的登记参与者。诊断结果与尿培养及抗生素处方数据相关联。病例患者（n = 3236）包括接受住院或经培养确诊的门诊急性肾盂肾炎诊断的受试者。
在女性人群中，门诊和住院肾盂肾炎的年发病率分别为每10000人12 - 13例和每10000人3 - 4例；在男性人群中，发病率分别为每10000人2 - 3例和每10000人1 - 2例。发病率逐年相对稳定。年轻女性的发病率最高，其次是婴儿和老年人群。门诊与住院病例的比例在年轻女性中最高（范围为5∶1至6∶1）。大肠杆菌导致女性急性肾盂肾炎病例的80%，男性病例的70%，在老年人群中所占比例较低。在大肠杆菌菌株中，环丙沙星耐药率从分离株的0.2%升至1.5%（P = 0.03），甲氧苄啶 - 磺胺甲恶唑耐药率从分离株的25%降至13%（P < 0.01），时间跨度为1997年至2001年。在门诊病例中，氟喹诺酮类药物的使用比例从35%增至61%，而甲氧苄啶 - 磺胺甲恶唑的使用比例在5年期间从53%降至32%（P < 0.01）。
这项全面的基于人群的分析增加了我们对急性肾盂肾炎流行病学的有限认识，尤其是在门诊患者中，目前大多数病例发生在该群体中。
