Section of Infectious Diseases, Rush University, Chicago, IL 60612, USA.
Am J Emerg Med. 2012 Jan;30(1):68-74. doi: 10.1016/j.ajem.2010.09.030. Epub 2010 Nov 13.
The objectives of this study are to examine antibiotic resistance rates and to determine appropriate empiric oral antibiotic for patients with urinary tract infections (UTIs) evaluated and discharged from the ED.
A retrospective, single-institution chart review study from August 2008 to March 2009 was conducted. Adult patients seen in the ED with UTI were identified for study inclusion from review of microbiology records. Hospitalized or asymptomatic bacteriuria cases were excluded. Health care-associated (HA)-UTI was defined as UTI with indwelling urinary catheters, health care exposure, or urologic procedures within 3 months. Prevalence of causative bacteria, antibiotic resistance rates, and risk factors for quinolone resistance were determined.
There were 337 eligible patients with 83% women. The most common uropathogens among 357 bacterial isolates were Escherichia coli (71%) and Klebsiella spp. (9%). Overall levofloxacin resistance rate was 17%. Resistance rates for HA-UTIs were significantly greater than those for community-associated-UTI: levofloxacin, 38% vs 10%; trimethoprim-sulfamethoxazole, 26% vs 17%; amoxicillin, 53% vs 45%; and amoxicillin-clavulanate, 16% vs 6%. Nitrofurantoin resistance rates were similar (9%). Independent risk factors for levofloxacin resistance were long-term medical conditions (adjusted odds ratio [aOR], 4.23; P = .001), HA-UTI (aOR, 2.56; P = .006), and prior quinolone use within 1 week (aOR, 14.90; P = .02) and within 1 to 4 weeks (aOR, 4.62; P = .04).
We report high rates of quinolone resistance in ED patients with UTIs at our institution. For patients with risk factors for quinolone resistance, empiric therapy with cephalosporins or nitrofurantoin may be preferred. Urine culture and susceptibility testing should be performed to guide definitive therapy for HA-UTIs.
本研究旨在检测抗生素耐药率，并为在急诊科就诊和出院的尿路感染（UTI）患者确定合适的经验性口服抗生素。
这是一项 2008 年 8 月至 2009 年 3 月进行的回顾性单机构图表回顾研究。从微生物学记录中确定在急诊科就诊的 UTI 成年患者进行研究纳入。排除住院或无症状菌尿病例。将与医疗保健相关的（HA）-UTI 定义为留置导尿管、卫生保健暴露或 3 个月内泌尿科手术的 UTI。确定致病细菌的患病率、抗生素耐药率以及喹诺酮类药物耐药的危险因素。
共纳入 337 例符合条件的患者，其中 83%为女性。357 株细菌分离株中最常见的尿路病原体为大肠埃希菌（71%）和克雷伯菌属（9%）。左氧氟沙星总耐药率为 17%。HA-UTI 的耐药率明显高于社区相关 UTI：左氧氟沙星分别为 38%和 10%；复方磺胺甲噁唑分别为 26%和 17%；阿莫西林分别为 53%和 45%；阿莫西林克拉维酸分别为 16%和 6%。呋喃妥因耐药率相似（9%）。左氧氟沙星耐药的独立危险因素包括长期疾病（调整优势比[aOR]，4.23；P =.001）、HA-UTI（aOR，2.56；P =.006）和 1 周内（aOR，14.90；P =.02）和 1 至 4 周内（aOR，4.62；P =.04）使用过喹诺酮类药物。
我们报告了本机构急诊科 UTI 患者喹诺酮类药物耐药率较高。对于有喹诺酮类药物耐药危险因素的患者，经验性头孢菌素或呋喃妥因治疗可能更为合适。对于 HA-UTI，应进行尿液培养和药敏试验以指导明确治疗。
