Hines Michelle C, Al-Salamah Tareq, Heil Emily L, Mallemat Haney, Witting Michael D, Johnson Jennifer K, Winters Michael E, Hayes Bryan D
Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland.
Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland; King Saud University, Riyadh, Kingdom of Saudi Arabia.
J Emerg Med. 2015 Dec;49(6):998-1003. doi: 10.1016/j.jemermed.2015.06.028. Epub 2015 Aug 15.
Urine cultures are not always performed for female Emergency Department (ED) patients with uncomplicated urinary tract infection (UTI). Accordingly, hospital, and even ED-specific, antibiograms might be skewed toward elderly patients with many comorbidities and relatively high rates of antimicrobial resistance, and thus do not accurately reflect otherwise healthy women. Our ED antibiogram indicates Escherichia coli resistance rates for ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) of 42%, 26%, and 33%, respectively.
This study aims to compare resistance rates of urinary E. coli from otherwise healthy women with uncomplicated UTI and pyelonephritis in the ED to rates in our ED antibiogram.
Females > 18 years old with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell count > 10/high-power field) were prospectively enrolled in the ED of an urban, academic medical center. Exclusion criteria indicating a complicated UTI were consistent with Infectious Diseases Society of America guidelines. Susceptibility patterns of E. coli to ciprofloxacin, levofloxacin, and TMP-SMX in the study group were compared to our ED antibiogram.
Forty-five patients grew E. coli. Pyelonephritis was suspected in nine (20%) subjects. Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed. Six patients grew non-E. coli uropathogens. All were susceptible to both levofloxacin and TMP-SMX.
ED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in women.
对于患有单纯性尿路感染（UTI）的女性急诊科（ED）患者，并非总是进行尿培养。因此，医院甚至特定于急诊科的抗菌谱可能偏向于患有多种合并症且抗菌药物耐药率相对较高的老年患者，从而无法准确反映健康女性的情况。我们急诊科的抗菌谱显示，大肠杆菌对环丙沙星、左氧氟沙星和甲氧苄啶 - 磺胺甲恶唑（TMP - SMX）的耐药率分别为42%、26%和33%。
本研究旨在比较急诊科中患有单纯性UTI和肾盂肾炎的健康女性尿液中大肠杆菌的耐药率与我们急诊科抗菌谱中的耐药率。
前瞻性纳入一家城市学术医疗中心急诊科中年龄大于18岁、有尿频、尿急或尿痛急性发作且尿液分析显示脓尿（白细胞计数>10/高倍视野）的女性。表明复杂性UTI的排除标准与美国传染病学会指南一致。将研究组中大肠杆菌对环丙沙星、左氧氟沙星和TMP - SMX的药敏模式与我们急诊科的抗菌谱进行比较。
45例患者培养出大肠杆菌。9例（20%）患者怀疑患有肾盂肾炎。与急诊科抗菌谱相比，观察到对环丙沙星（2%对42%，p<0.001）、左氧氟沙星（2%对26%，p<0.001）和TMP - SMX（16%对33%，p = 0.016）的耐药率显著更低。6例患者培养出非大肠杆菌尿路病原体。所有这些病原体对左氧氟沙星和TMP - SMX均敏感。
急诊科抗菌谱可能高估了导致单纯性UTI的尿路病原体的耐药率。在不能使用呋喃妥因的情况下，氟喹诺酮类药物以及可能的TMP - SMX可能仍是治疗女性单纯性UTI和肾盂肾炎的可行选择。
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