单纯性症状性尿路感染的治疗：耐药模式与抗生素的滥用
Treatment of uncomplicated symptomatic urinary tract infections: Resistance patterns and misuse of antibiotics.
作者信息
George Carolin Elizabeth, Norman Gift, Ramana G Venkata, Mukherjee Devashri, Rao Tata
机构信息
Department of Community Health and Family Medicine, Bangalore Baptist Hospital, Hebbal, Bellary Road, Bengaluru, Karnataka, India.
出版信息
J Family Med Prim Care. 2015 Jul-Sep;4(3):416-21. doi: 10.4103/2249-4863.161342.
INTRODUCTION
Uncomplicated but symptomatic urinary tract infections (UTIs) are a common problem seen in practice. The study was undertaken to assess the most common pathogens responsible for uncomplicated symptomatic UTIs and the antimicrobial resistance pattern in a hospital in Bangalore. The study also explores the issue of antibiotic usage for these patients.
MATERIALS AND METHODS
The study was conducted in the Medicine department of a tertiary hospital in Bangalore. In all, 196 patients presented with symptoms of UTI. Bacterial growth was determined by standard microbiology techniques on freshly voided mid-steam urine samples collected from recruited patients. Patients' demographic data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed.
RESULTS
The prevalence of UTI was 32.1%; majority (67.9%) of the symptomatic did not have UTI based on culture report. Gram-negative bacteria constituted the largest group with a prevalence of 84.1% (53/63), with Escherichia coli being the most common (70%) uropathogen. Gram-negative isolates showed high level of sensitivity to amikacin (90.6%) and nitrofurantoin (77.4%). Most of the gram-positive organisms were susceptible to nitrofurantoin (70%) and gentamicin (50%). Uropathogens isolated demonstrated high resistance to cotrimoxazole, fluoroquinolones, and beta-lactam antibiotics. It was found out that 30.1% of the patients were wrongly managed of which 14.7% were over treated.
CONCLUSION
UTI can be over diagnosed and over treated on the basis of clinical signs, symptoms and urine microscopy. In the era of emerging anti-microbial resistance, effective counseling and delay in antibiotic initiation or empirical therapy with a short course of nitrofurantoin is highly recommended. Empirical therapy guidelines should be updated periodically to reflect changes in antimicrobial resistance of uropathogens.
引言
单纯性但有症状的尿路感染（UTIs）是临床上常见的问题。本研究旨在评估班加罗尔一家医院中导致单纯性有症状UTIs的最常见病原体及其抗菌药物耐药模式。该研究还探讨了这些患者的抗生素使用问题。
材料与方法
本研究在班加罗尔一家三级医院的内科进行。共有196例出现UTI症状的患者。通过标准微生物学技术对从招募患者收集的新鲜中段尿样本进行细菌培养，以确定细菌生长情况。分析了患者的人口统计学数据、尿培养结果、对抗菌药物的耐药率以及规定的经验性抗菌治疗。
结果
UTI的患病率为32.1%；根据培养报告，大多数有症状的患者（67.9%）没有UTI。革兰氏阴性菌占最大比例，患病率为84.1%（53/63），其中大肠杆菌是最常见的尿路病原体（70%）。革兰氏阴性菌分离株对阿米卡星（90.6%）和呋喃妥因（77.4%）表现出高度敏感性。大多数革兰氏阳性菌对呋喃妥因（70%）和庆大霉素（50%）敏感。分离出的尿路病原体对复方新诺明、氟喹诺酮类和β-内酰胺类抗生素表现出高度耐药性。结果发现，30.1%的患者治疗不当，其中14.7%的患者治疗过度。
结论
基于临床体征、症状和尿镜检，UTI可能会被过度诊断和过度治疗。在抗菌药物耐药性不断出现的时代，强烈建议进行有效的咨询，并延迟使用抗生素或采用短疗程呋喃妥因进行经验性治疗。经验性治疗指南应定期更新，以反映尿路病原体抗菌药物耐药性的变化。
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