Etienne M, Van Elslande H, Choplin-Renard J, Pestel-Caron M, Caron F
Infectiologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Groupe de recherche sur les antimicrobiens et les micro-organismes [GRAM, EA 2656], université de Rouen, IRIB, 22, boulevard Gambetta, 76000 Rouen, France.
Infectiologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Med Mal Infect. 2014 May;44(5):217-22. doi: 10.1016/j.medmal.2014.03.003. Epub 2014 Apr 28.
The empiric treatment of acute pyelonephritis (APN) with third generation cephalosporins (3GC) or fluoroquinolones (FQ) has been challenged by Escherichia coli resistance reported by community surveillance networks. But these could overestimate resistance because they do not discriminate between uncomplicated and complicated, or between community and care-related infections.
We had for aim to: quantify resistance rates in hospitalized patients presenting with APN; identify subgroups with resistance <10% that could still be treated empirically with FQ or 3GC.
We retrospectively analyzed files of patients presenting with documented APN, hospitalized in an Infectious Diseases Department from October 2010 to December 2012.
Hundred and fifty-six female patients (median age: 66, interquartile range: 37), were admitted for uncomplicated APN (36%) or APN (64%) at risk of complications by 1 (46%), 2 (40%), or 3 or more (14%) risk factors. Bacteremia was associated in 44% of uncomplicated and 8% of APN at risk of complications. E. coli was predominant (82%), resistant to 3GC in 6% of patients (including 4% ESBL) and to FQ in 15% of patients. The rate of resistance to FQ increased with the number of risk factors for complication, from 6% in uncomplicated APN, to 25% in patients with ≥3 risk factors. No enterobacteria was resistant to either 3GC or aminoglycosides.
The resistance rates of 3GC and aminoglycosides were <10% in patients hospitalized for APN. FQ resistance rates reached 15% but only 6% in uncomplicated APN. Hence, FQ empiric regimen should now be restricted to the treatment of uncomplicated APN without severe sepsis.
社区监测网络报告的大肠杆菌耐药性对用第三代头孢菌素（3GC）或氟喹诺酮类（FQ）经验性治疗急性肾盂肾炎（APN）提出了挑战。但这些可能高估了耐药性，因为它们没有区分单纯性和复杂性，也没有区分社区感染和医疗相关感染。
我们旨在：量化住院APN患者的耐药率；确定耐药率<10%且仍可用FQ或3GC进行经验性治疗的亚组。
我们回顾性分析了2010年10月至2012年12月在传染病科住院的有记录的APN患者的病历。
156例女性患者（中位年龄：66岁，四分位间距：37岁）因单纯性APN（36%）或有并发症风险的APN（64%）入院，有1个（46%）、2个（40%）或3个或更多（14%）风险因素。44%的单纯性APN和8%的有并发症风险的APN伴有菌血症。大肠杆菌占主导（82%），6%的患者对3GC耐药（包括4%产超广谱β-内酰胺酶），15%的患者对FQ耐药。对FQ的耐药率随着并发症风险因素数量的增加而升高，从单纯性APN中的6%升至≥3个风险因素患者中的25%。没有肠杆菌对3GC或氨基糖苷类耐药。
住院APN患者中3GC和氨基糖苷类的耐药率<10%。FQ耐药率达15%，但单纯性APN中仅为6%。因此，FQ经验性治疗方案现在应限于治疗无严重脓毒症的单纯性APN。
