Division of Microbiology, Frischmann Aisengart/DASA Medicina Diagnóstica and VITA Curitiba Hospital, Curitiba, PR, Brazil.
Braz J Infect Dis. 2012 Mar-Apr;16(2):115-21. doi: 10.1016/s1413-8670(12)70291-x.
Optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics.
Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients > 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age.
The female-to-male ratio decreased with age, from 28.1 (among 20-29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3-4% higher (fluoroquinolones, gentamicin) to > 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (> 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded > 80% susceptibility in any age cohort.
Few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed.
尿路感染的最佳经验性治疗需要准确了解当地的药敏模式，而这些模式可能因病原体和患者特征而异。
在巴西库里蒂巴的一家临床实验室和一所学术医疗中心，连续收集了 9798 例门诊患者的非重复社区来源尿培养标本（2009 年 5 月 1 日至 12 月 1 日），比较了这些标本中不同病原体和患者的性别及年龄与氨苄西林、呋喃妥因、复方磺胺甲噁唑、庆大霉素、氟喹诺酮类药物和头孢曲松/头孢噻肟的药敏数据。
女性与男性的比例随年龄增加而下降，从 20-29 岁的 28.1 降至 80 岁以上的 3.3。总体而言，不同药物类别之间的药敏率差异很大，氨苄西林和复方磺胺甲噁唑的药敏率很低（分别为 53.5%和 61.1%），氟喹诺酮类药物、头孢曲松、呋喃妥因和庆大霉素的药敏率虽可接受但不理想（81.2%至 91.7%）。大肠埃希菌的药敏率高于其他病原体，从高 3-4%（氟喹诺酮类药物、庆大霉素）到高 30%以上（呋喃妥因、头孢曲松）。男性的药敏率低于女性。在每个性别中，随着年龄的增加，药敏率都呈下降趋势。对于女性，只有呋喃妥因和庆大霉素在所有年龄组都适合经验性治疗（> 80%的药敏率）；氟喹诺酮类药物仅适用于 60 岁以下人群，头孢曲松仅适用于 80 岁以下人群。对于男性，只有庆大霉素在任何年龄组都有> 80%的药敏率。
对于 60 岁以上的女性或任何年龄的男性，很少有合适的经验性治疗社区获得性尿路感染的选择。经验性治疗建议必须考虑患者的人口统计学特征。需要针对所有病原体进行基于地点、年龄和性别分层的药敏监测。
