Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Infect. 2011 Aug;63(2):114-23. doi: 10.1016/j.jinf.2011.05.015. Epub 2011 Jun 12.
Urinary tract infections (UTIs) are among the most prevalent infectious diseases in the general population. They cause a substantial financial burden in the community and are associated with significant morbidity and mortality, particularly in hospitals. With increased rates of antimicrobial resistance, especially in the Asia-Pacific region, treatment of complicated UTIs (cUTIs) can be challenging for clinicians. Consideration of an optimal antimicrobial agent should be based on local resistance patterns, patient-specific factors, pharmacokinetic and pharmacodynamic principles, and cost. In the Asia-Pacific region, nearly half of Escherichia coli urinary isolates were resistant (including intermediate and resistant) to levofloxacin or ciprofloxacin and ≥30% were resistant to third-generation cephalosporins (cefotaxime, ceftriaxone, and ceftazidime) and cefepime. Overall, 33% of urinary E. coli isolates exhibited extended-spectrum β-lactamase (ESBL)-producing phenotypes. Prevalence of ESBL-producing urinary E. coli was highest in India (60%), followed by Hong Kong (48%) and Singapore (33%). All urinary isolates of E. coli were susceptible to both ertapenem and imipenem. All urinary isolates of Klebsiella pneumoniae were susceptible to imipenem and 4% of them were resistant to ertapenem. Care should be exercised when using trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and cephalosporins for the empirical treatment of UTIs, particularly cUTI among moderately to severely ill patients. Empiric antimicrobial treatment for serious cUTIs in which risk factors for resistant organisms exist should include broad-spectrum antibiotics such as carbapenems (ertapenem, imipenem, meropenem, and doripenem) and piperacillin-tazobactam. Aminoglycosides, tigecycline, and polymyxins (colistin or polymyxin B) can be used for the treatment of multidrug-resistant organisms or serious cUTIs when first-line options are deemed inappropriate or patients fail therapy. Because of considerable variability in different countries, local epidemiological data is critical in the effective management of UTIs in the Asia-Pacific region.
尿路感染（UTIs）是普通人群中最常见的传染病之一。它们在社区中造成了巨大的经济负担，并且与发病率和死亡率显著相关，特别是在医院中。由于抗生素耐药性的增加，特别是在亚太地区，治疗复杂性尿路感染（cUTIs）对临床医生来说是具有挑战性的。选择最佳的抗菌药物应基于当地的耐药模式、患者的具体情况、药代动力学和药效学原则以及成本。在亚太地区，近一半的大肠杆菌尿分离株对左氧氟沙星或环丙沙星（包括中介和耐药）具有耐药性，≥30%的分离株对第三代头孢菌素（头孢噻肟、头孢曲松和头孢他啶）和头孢吡肟具有耐药性。总体而言，33%的尿大肠杆菌分离株表现出产超广谱β-内酰胺酶（ESBL）的表型。产 ESBL 的大肠杆菌在印度的流行率最高（60%），其次是香港（48%）和新加坡（33%）。所有尿大肠杆菌分离株对厄他培南和亚胺培南均敏感。所有尿肺炎克雷伯菌分离株均对亚胺培南敏感，4%的分离株对厄他培南耐药。在经验性治疗尿路感染，特别是中重度感染患者的 cUTI 时，应谨慎使用复方磺胺甲噁唑（TMP-SMX）、氟喹诺酮类和头孢菌素。对于存在耐药菌危险因素的严重 cUTI，经验性抗菌治疗应包括广谱抗生素，如碳青霉烯类（厄他培南、亚胺培南、美罗培南和多尼培南）和哌拉西林他唑巴坦。当一线治疗方案不合适或患者治疗失败时，氨基糖苷类、替加环素和多黏菌素（多粘菌素 E 或黏菌素 B）可用于治疗多重耐药菌或严重 cUTI。由于不同国家之间存在相当大的差异，当地的流行病学数据对于有效管理亚太地区的 UTIs 至关重要。
