Chen Luke F, Chiu Chun-Ting, Lo Jui-Yo, Tsai Si-Yuan, Weng Li-Shiu, Anderson Deverick J, Chen Huan-Sheng
Program for Infection Prevention and Healthcare Epidemiology, Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, 27710, USA.
Medical Clinic at Taoyuan International Airport, Landseed Hospital, Taiwan.
Healthc Infect. 2013 Dec 16;19(1):20-25. doi: 10.1071/HI13033.
Community-acquired urinary tract infection (UTI) is the most common bacterial infection encountered at hospitals. Effective empirical antibiotic therapy relies on updated epidemiological data.
We described the epidemiology of patients with urosepsis presenting to a community hospital in Taiwan in order to assess the appropriateness of empirical therapy.
Retrospective cohort study of hospitalized adult patients with UTI from January 1 to December 31 in 2010. The clinical and microbiological characteristics were analyzed using descriptive statistics. Logistic regression analysis was performed to determine predictors of antibiotic resistance.
A total of 420 consecutive patients with 599 isolates were identified. Most patients were >=65 years old and women (75.4%), and 114 patients (27.1%) had bacteremia. (69%) was the most common organism. Cefazolin was effective against , and in greater than 80% of the cases. In male patients, urinary catheter and renal stone were independent predictors for cefazolin resistance; while diabetes mellitus and malignancy were predictors among female patients.
Patients admitted with UTI should be screened to identify risk factors for bacteremia and antimicrobial resistance. The treatment guideline in Taiwan needs to be revised in the current era of increasing antimicrobial resistance.
社区获得性尿路感染(UTI)是医院中最常见的细菌感染。有效的经验性抗生素治疗依赖于最新的流行病学数据。
我们描述了台湾一家社区医院中脓毒症患者的流行病学情况,以评估经验性治疗的适宜性。
对2010年1月1日至12月31日期间住院的成年UTI患者进行回顾性队列研究。使用描述性统计分析临床和微生物学特征。进行逻辑回归分析以确定抗生素耐药性的预测因素。
共识别出420例连续患者,分离出599株菌株。大多数患者年龄≥65岁且为女性(75.4%),114例患者(27.1%)有菌血症。大肠埃希菌(69%)是最常见的病原体。头孢唑林对大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的有效率超过80%。在男性患者中,导尿管和肾结石是头孢唑林耐药的独立预测因素;而糖尿病和恶性肿瘤是女性患者中的预测因素。
因UTI入院的患者应进行筛查,以确定菌血症和抗菌药物耐药性的危险因素。在当前抗菌药物耐药性增加的时代,台湾的治疗指南需要修订。