Yılmaz Nisel, Ağuş Neval, Bayram Arzu, Şamlıoğlu Pınar, Şirin M Cem, Derici Yeşer Karaca, Hancı Sevgi Yılmaz
Clinic of Microbiology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
Turk J Urol. 2016 Mar;42(1):32-6. doi: 10.5152/tud.2016.90836.
Urinary tract infections (UTIs) are among the most frequently seen community-acquired infections worldwide. E. coli causes 90% of urinary system infections. To guide the empirical therapy, the resistance pattern of E. coli responsible for community-acquired UTI was evaluated throughout a seven-year period in this study.
The urine cultures of patients with urinary tract infections admitted to outpatient clinics between 1(st) January 2008 and 31(st) December 2014 were analyzed. Presence of ≥10(5) colony-forming units/mL in urine culture media was considered as significant for UTI. Isolated bacteria were identified by standard laboratory techniques or automated system VITEK2 (BioMerieux, France) and BD PhoenixTM 100 (BD, USA), as required. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion method using Clinical Laboratory Standard Institute (CLSI) criteria.
A total of 13281 uropathogens were isolated. Overall E. coli accounted for 8975 (67%) of all isolates. Resistance rates of E. coli to antimicrobial agents was demonstrated to be as follows: ampicillin 66.9%, cefazolin 30.9%, cefuroxime 30.9%, ceftazidime 14.9%, cefotaxime 28%, cefepime 12%, amoxicillin-clavulanic acid 36.9%, trimethoprim-sulfamethoxazole (TMP-SXT) 20%, ciprofloxacin 49.9%, amikacin 0.3%, gentamycin 24%, nitrofurantoin 0.9%, and fosfomycin 4.3%. There was no resistance to imipenem nor meropenem. The frequency of ESBL-producing E. coli strains was 24%.
It is concluded that fosfomycin and nitrofurantoin are appropriate empirical therapy for community-acquired UTI empirical therapy, but the fluoroquinolones and the TMP-SXT shall not be used in the emprical treatment of UTI at this stage. In conclusion, as resistance rates show regional differences, it is necessary to regularly examine regional resistance rates to determine the appropriate empiric antibiotic treatment and national antibiotic usage policies must be reorganized according to data obtained from these studies.
尿路感染（UTIs）是全球最常见的社区获得性感染之一。大肠杆菌导致90%的泌尿系统感染。在本研究中，我们评估了七年期间引起社区获得性UTI的大肠杆菌的耐药模式，以指导经验性治疗。
分析了2008年1月1日至2014年12月31日期间门诊收治的尿路感染患者的尿培养结果。尿培养基中菌落形成单位≥10⁵/mL被认为UTI阳性。根据需要，通过标准实验室技术或自动化系统VITEK2（法国生物梅里埃公司）和BD PhoenixTM 100（美国BD公司）鉴定分离出的细菌。采用 Kirby-Bauer 纸片扩散法，依据临床实验室标准协会（CLSI）标准进行药敏试验。
共分离出13281株尿路致病菌。总体而言，大肠杆菌占所有分离株的8975株（67%）。大肠杆菌对抗菌药物的耐药率如下：氨苄西林66.9%，头孢唑林30.9%，头孢呋辛30.9%，头孢他啶14.9%，头孢噻肟28%，头孢吡肟12%，阿莫西林-克拉维酸36.9%，甲氧苄啶-磺胺甲恶唑（TMP-SXT）20%，环丙沙星49.9%，阿米卡星0.3%，庆大霉素24%，呋喃妥因0.9%，磷霉素4.3%。对亚胺培南和美罗培南均无耐药。产超广谱β-内酰胺酶（ESBL）的大肠杆菌菌株频率为24%。
得出结论，磷霉素和呋喃妥因是社区获得性UTI经验性治疗的合适药物，但现阶段氟喹诺酮类药物和TMP-SXT不应作为UTI经验性治疗用药。总之，由于耐药率存在地区差异，有必要定期检查地区耐药率以确定合适的经验性抗生素治疗方案，并且必须根据这些研究获得的数据重新制定国家抗生素使用政策。
