Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong SAR, China.
Diagn Microbiol Infect Dis. 2010 Jan;66(1):87-93. doi: 10.1016/j.diagmicrobio.2009.03.027. Epub 2009 May 15.
A prospective multicenter study was conducted to assess the epidemiology of antimicrobial resistance among uropathogens causing uncomplicated cystitis. Adult women with clinical diagnosis of uncomplicated cystitis were enrolled from 54 participating centers distributed all over Hong Kong during 2006 to 2008. A positive urine culture was found in 59.5% (352/592) patients. The patients had mean age of 44.9 years, and most (89.2%) were otherwise healthy. The most prevalent causative organism was Escherichia coli (77%), followed by other Enterobacteriaceae (14.2%), staphylococci (5.1%), and other Gram-positive bacteria (3.7%). The resistance rates of E. coli to co-trimoxazole and ciprofloxacin were 29.5% and 12.9%, respectively, and 14 isolates (5.2%) were confirmed as extended-spectrum beta-lactamase (ESBL) producers. Of the ESBL producers, molecular studies showed CTX-M-14, CTX-M-24, or CTX-M-9. Nitrofurantoin and fosfomycin were active against >90% of the isolates, regardless of resistance phenotypes for other drugs. Pulsed-field gel electrophoresis of representative isolates showed that the antibiotic-resistant strains were genetically diverse. Patients with history of recent antibiotic use were significantly more likely to have infection by E. coli with co-trimoxazole resistance (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4-5.7; P = 0.003) and ciprofloxacin resistance (OR, 2.5; 95% CI, 1.1-5.8; P = 0.03). Knowledge of the resistance data and risk factors could inform better use of antibiotics for empiric therapy for acute uncomplicated cystitis.
一项前瞻性多中心研究评估了引起单纯性膀胱炎的尿路病原体的抗生素耐药性的流行病学。2006 年至 2008 年期间，从分布在香港各地的 54 个参与中心招募了患有单纯性膀胱炎的临床诊断为成人女性。59.5%（352/592）患者的尿液培养阳性。患者的平均年龄为 44.9 岁，大多数（89.2%）身体健康。最常见的病原体是大肠埃希菌（77%），其次是其他肠杆菌科（14.2%）、葡萄球菌（5.1%）和其他革兰氏阳性菌（3.7%）。大肠埃希菌对复方新诺明和环丙沙星的耐药率分别为 29.5%和 12.9%，14 株（5.2%）确认为产超广谱β-内酰胺酶（ESBL）。在产 ESBL 的细菌中，分子研究显示 CTX-M-14、CTX-M-24 或 CTX-M-9。无论其他药物的耐药表型如何，呋喃妥因和磷霉素对>90%的分离株均有效。代表分离株的脉冲场凝胶电泳显示，抗生素耐药株具有遗传多样性。近期使用抗生素的患者感染复方新诺明耐药的大肠埃希菌（优势比 [OR]，2.8；95%置信区间 [CI]，1.4-5.7；P=0.003）和环丙沙星耐药的大肠埃希菌（OR，2.5；95%CI，1.1-5.8；P=0.03）的可能性显著更高。了解耐药数据和危险因素可以更好地指导经验性治疗急性单纯性膀胱炎的抗生素使用。
