Bean David C, Krahe Daniel, Wareham David W
Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK.
Ann Clin Microbiol Antimicrob. 2008 Jun 18;7:13. doi: 10.1186/1476-0711-7-13.
Escherichia coli is the commonest cause of community and nosocomial urinary tract infection (UTI). Antibiotic treatment is usually empirical relying on susceptibility data from local surveillance studies. We therefore set out to determine levels of resistance to 8 commonly used antimicrobial agents amongst all urinary isolates obtained over a 12 month period.
Antimicrobial susceptibility to ampicillin, amoxicillin/clavulanate, cefalexin, ciprofloxacin, gentamicin, nitrofurantoin, trimethoprim and cefpodoxime was determined for 11,865 E. coli urinary isolates obtained from community and hospitalised patients in East London.
Nitrofurantoin was the most active agent (94% susceptible), followed by gentamicin and cefpodoxime. High rates of resistance to ampicillin (55%) and trimethoprim (40%), often in combination were observed in both sets of isolates. Although isolates exhibiting resistance to multiple drug classes were rare, resistance to cefpodoxime, indicative of Extended spectrum beta-lactamase production, was observed in 5.7% of community and 21.6% of nosocomial isolates.
With the exception of nitrofurantoin, resistance to agents commonly used as empirical oral treatments for UTI was extremely high. Levels of resistance to trimethoprim and ampicillin render them unsuitable for empirical use. Continued surveillance and investigation of other oral agents for treatment of UTI in the community is required.
大肠杆菌是社区获得性和医院获得性尿路感染（UTI）最常见的病因。抗生素治疗通常是经验性的，依赖于当地监测研究的药敏数据。因此，我们着手确定在12个月期间获得的所有尿液分离株对8种常用抗菌药物的耐药水平。
对从东伦敦社区和住院患者中分离出的11865株大肠杆菌尿液分离株，测定其对氨苄西林、阿莫西林/克拉维酸、头孢氨苄、环丙沙星、庆大霉素、呋喃妥因、甲氧苄啶和头孢泊肟酯的药敏情况。
呋喃妥因是最有效的药物（94%敏感），其次是庆大霉素和头孢泊肟酯。两组分离株中均观察到对氨苄西林（55%）和甲氧苄啶（40%）的高耐药率且常合并存在。虽然对多种药物耐药的分离株很少见，但在5.7%的社区分离株和21.6%的医院分离株中观察到对头孢泊肟酯的耐药，这表明产生了超广谱β-内酰胺酶。
除呋喃妥因外，对常用于UTI经验性口服治疗的药物耐药率极高。对甲氧苄啶和氨苄西林的耐药水平使其不适合经验性使用。需要持续监测和研究社区中用于治疗UTI的其他口服药物。
