Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Mayo Clin Proc. 2012 Aug;87(8):753-9. doi: 10.1016/j.mayocp.2012.02.025. Epub 2012 Jul 13.
To better understand the epidemiology of drug-resistant Escherichia coli across health care and community settings.
We conducted a population-based cohort study of the incidence of antibiotic-resistant E coli bacteriuria among different patient groups. All urine cultures with monomicrobial growth of E coli obtained from Olmsted County, Minnesota, residents from January 1, 2005, through December 31, 2009, were identified. The initial isolate per patient per year was included. Analyses were stratified by patient age and location of infection onset (ie, nosocomial, health care associated, and community associated).
We evaluated 5619 E coli isolates and the associated patients. During the study period, the incidence of drug-resistant bacteriuria did not change among children but increased significantly among adults of all ages, most markedly among elderly patients older than 80 years. In elderly patients, the incidence of bacteriuria with isolates resistant to fluoroquinolones increased from 464 to 1116 per 100,000 person-years (P<.001), and the incidence of bacteriuria with isolates resistant to fluoroquinolones plus trimethoprim-sulfamethoxazole increased from 274 to 512 per 100,000 person-years (P<.05). When analyzed by location of infection onset, incidence of bacteriuria with isolates resistant to trimethoprim-sulfamethoxazole, fluoroquinolones, trimethoprim-sulfamethoxazole plus fluoroquinolones, extended-spectrum cephalosporins, and more than 3 drug classes increased significantly among community-associated but not among nosocomial or health care-associated cases.
In this population-based study, the incidence of antibiotic-resistant E coli bacteriuria nearly doubled during the 5-year study period among elderly patients and those with community-associated isolates. These patient groups should be targets of interventions to slow the emergence and spread of antibiotic-resistant E coli.
更好地了解卫生保健和社区环境中耐药大肠杆菌的流行病学。
我们对明尼苏达州奥姆斯特德县不同患者群体中抗生素耐药大肠埃希菌菌尿的发生率进行了基于人群的队列研究。所有从 2005 年 1 月 1 日至 2009 年 12 月 31 日获得的单种大肠埃希菌生长的尿液培养物均被识别。每位患者每年的初始分离株均被包括在内。分析根据患者年龄和感染起始部位（即医院内、卫生保健相关和社区相关）进行分层。
我们评估了 5619 株大肠埃希菌分离株及其相关患者。在研究期间，儿童耐药菌尿的发生率没有变化，但所有年龄段的成年人的发生率显著增加，尤其是 80 岁以上的老年患者。在老年患者中，对氟喹诺酮类药物耐药的菌尿发生率从 464 增至 1116 例/100000 人年（P<.001），对氟喹诺酮类药物加磺胺甲噁唑耐药的菌尿发生率从 274 增至 512 例/100000 人年（P<.05）。按感染起始部位分析时，对磺胺甲噁唑、氟喹诺酮类、磺胺甲噁唑加氟喹诺酮类、头孢菌素类、以及超过 3 类药物耐药的菌尿发生率在社区相关病例中显著增加，但在医院内或卫生保健相关病例中无显著增加。
在这项基于人群的研究中，在 5 年研究期间，老年患者和社区相关分离株的患者中，抗生素耐药大肠埃希菌菌尿的发生率几乎翻了一番。这些患者群体应成为减缓抗生素耐药大肠埃希菌出现和传播的干预措施的目标。
