Medina-Polo J, Guerrero-Ramos F, Pérez-Cadavid S, Arrébola-Pajares A, Sopeña-Sutil R, Benítez-Sala R, Jiménez-Alcaide E, García-González L, Alonso-Isa M, Lara-Isla A, Passas-Martínez J B, Tejido-Sánchez Á
Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
Actas Urol Esp. 2015 Mar;39(2):104-11. doi: 10.1016/j.acuro.2014.08.001. Epub 2014 Oct 7.
Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective.
A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed.
Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + β lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively.
CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.
尽管尿路感染（UTI）患者通常作为门诊患者进行治疗，但仍有一定比例的患者需要住院治疗。我们的目的是回顾需要住院治疗的社区获得性尿路感染（CAUTI）的危险因素和微生物学特征。
2011年11月至2013年12月进行了一项前瞻性观察研究。分析了需要住院治疗的CAUTI患者的发病率、微生物学特征和抗生素耐药模式。还分析了危险因素（包括糖尿病、尿路结石、导尿）和每种病原体的耐药率。
457例CAUTI患者在我科住院。平均年龄为56.2±19.85岁。其中，52.1%为女性，19.7%有留置导尿管，11.4%曾有过UTI。最常分离出的病原体是大肠埃希菌（60.6%），其次是克雷伯菌（9.2%）、肠球菌（8.4%）和铜绿假单胞菌（7.2%）。除大肠埃希菌外的肠杆菌科细菌在男性和老年患者中更为普遍。另一方面，既往有UTI和留置导尿管的患者中最常分离出的病原体是肠球菌。大肠埃希菌对氨苄西林/阿莫西林+β-内酰胺酶抑制剂的耐药率为23.5%，对第三代头孢菌素为16.6%，对氟喹诺酮类为31.3%，对氨基糖苷类为16.7%。11.4%的大肠埃希菌菌株产超广谱β-内酰胺酶（ESBL）。最后，肠球菌和铜绿假单胞菌对喹诺酮类的耐药率分别为50.0%和61.5%。
需要住院治疗的CAUTI在老年、男性、有导尿管、有尿路结石和既往有UTI发作的患者中最为常见。这些因素也与非大肠埃希菌病原体的分离和较高的耐药率有关。
