产超广谱β-内酰胺酶肠杆菌科导致的尿路感染的非碳青霉烯类治疗。
Non-carbapenem therapy of urinary tract infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae.
机构信息
Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
Service des maladies infectieuses, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
出版信息
Med Mal Infect. 2015 May;45(5):169-72. doi: 10.1016/j.medmal.2015.03.003. Epub 2015 Apr 4.
PURPOSE
We determined the prevalence of ESBL Enterobacteriaceae in urinary tract infections among inpatients, identified risk factors of acquisition, and evaluated the effectiveness of alternatives to carbapenems.
METHODS
The clinical, microbiological, and therapeutic data as well as the outcomes were recorded for all ESBL-E positive urine samples for three months.
RESULTS
Thirty-one (4%) of the 762 Enterobacteriaceae positive cultures were ESBL producers. The predisposing conditions for being infected with those strains were: immunodepression (61%), recent hospitalization (52%), recent antibiotic therapy (52%), and urinary catheterization (61%). 19% of infections were community acquired. The seven cases of acute pyelonephritis and five of prostatitis were treated with piperacillin-tazobactam (5), fluoroquinolones (4), ceftazidime (2), or carbapenems (only 1) after specialized advice. Four (33%) patients relapsed at week 10: three were immunodepressed and three presented with bacteremia.
CONCLUSIONS
Alternatives to carbapenems (especially piperacillin-tazobactam) seem to be a good option for non-bacteremic UTI in immunocompetent patients.
目的
我们确定了住院患者尿路感染中产超广谱β-内酰胺酶（ESBL）肠杆菌科的流行率，确定了获得的危险因素，并评估了碳青霉烯类药物替代品的有效性。
方法
对三个月内所有 ESBL-E 阳性尿液样本的临床、微生物学和治疗数据以及结果进行了记录。
结果
在 762 株肠杆菌科阳性培养物中，有 31 株（4%）为 ESBL 产生菌。感染这些菌株的易感条件为：免疫抑制（61%）、近期住院（52%）、近期抗生素治疗（52%）和导尿（61%）。19%的感染为社区获得性感染。7 例急性肾盂肾炎和 5 例前列腺炎经专业咨询后分别采用哌拉西林/他唑巴坦（5 例）、氟喹诺酮类（4 例）、头孢他啶（2 例）或碳青霉烯类（仅 1 例）治疗。4 例（33%）患者在第 10 周复发：3 例免疫抑制，3 例出现菌血症。
结论
对于免疫功能正常的患者，碳青霉烯类药物（尤其是哌拉西林/他唑巴坦）的替代品似乎是一种非菌血症性尿路感染的良好选择。
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