瓜德罗普岛门诊患者中耐抗菌药物肠杆菌科细菌尿液分离株的时间趋势和危险因素
Temporal trends and risks factors for antimicrobial resistant Enterobacteriaceae urinary isolates from outpatients in Guadeloupe.
作者信息
Guyomard-Rabenirina Stéphanie, Malespine Joyce, Ducat Célia, Sadikalay Syndia, Falord Mélanie, Harrois Dorothée, Richard Vincent, Dozois Charles, Breurec Sébastien, Talarmin Antoine
机构信息
Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France.
Laboratoire de Biologie Clinique, Centre Hospitalier de Basse-Terre, Basse-Terre, Guadeloupe, France.
出版信息
BMC Microbiol. 2016 Jun 24;16(1):121. doi: 10.1186/s12866-016-0749-9.
BACKGROUND
Urinary tract infections are bacterial infections most commonly encountered in the community. The resistance rate of uropathogens to commonly prescribed antibiotics has increased worldwide but there are no published data concerning the resistance of strains isolated from community-acquired UTI in Guadeloupe. To assess the susceptibility patterns of Enterobacteriaceae strains isolated from outpatients in Guadeloupe we conducted a prospective study from December 2012 to May 2014 among outpatients consulting at private and public laboratories for urine analysis. Risk factors for E. coli resistance to amoxicillin, third-generation cephalosporin, and ciprofloxacin were also determined. To study the trends of E. coli resistance rates over the past 10 years, data on the susceptibility patterns of E. coli from 2003 to 2014 were also collected from three major laboratories for a retrospective study.
RESULTS
During the prospective study, we isolated 1293 bacterial strains from the urine of outpatients presenting for urine analysis. The most commonly isolated bacteria were E. coli (57 %) and Klebsiella pneumoniae (15.5 %). Thirty seven per cent of the E. coli strains were resistant to amoxicillin. Resistance rates to third generation cephalosporin were low for E. coli and other Enterobacteriaceae (3.1 and 12.2 % respectively) and mostly due to the presence of an Extended Spectrum Beta-lactamase. Resistance to cotrimoxazole and ciprofloxacin was moderate (17.8 and 15.6 % respectively). However, the resistance rate of E. coli to ciprofloxacin has significantly increased during the last 10 years. Risk factors were consistent with previously reported data, especially for the increasing ciprofloxacin resistance with age.
CONCLUSION
General practitioners in Guadeloupe need to be better informed to favor the prescription of fosfomycin-trometamol to reduce the risk of resistance to fluoroquinolones.
背景
尿路感染是社区中最常见的细菌感染。全球范围内，尿路病原体对常用抗生素的耐药率有所上升，但瓜德罗普岛社区获得性尿路感染分离菌株的耐药情况尚无公开数据。为评估瓜德罗普岛门诊患者分离的肠杆菌科菌株的药敏模式，我们于2012年12月至2014年5月在私立和公立实验室进行尿液分析的门诊患者中开展了一项前瞻性研究。还确定了大肠杆菌对阿莫西林、第三代头孢菌素和环丙沙星耐药的危险因素。为研究过去10年大肠杆菌耐药率的变化趋势，还从三个主要实验室收集了2003年至2014年大肠杆菌药敏模式的数据进行回顾性研究。
结果
在前瞻性研究期间，我们从进行尿液分析的门诊患者尿液中分离出1293株细菌菌株。最常分离出的细菌是大肠杆菌（57%）和肺炎克雷伯菌（15.5%）。37%的大肠杆菌菌株对阿莫西林耐药。大肠杆菌和其他肠杆菌科对第三代头孢菌素的耐药率较低（分别为3.1%和12.2%），主要是由于存在超广谱β-内酰胺酶。对复方新诺明和环丙沙星的耐药率中等（分别为17.8%和15.6%）。然而，在过去10年中，大肠杆菌对环丙沙星的耐药率显著上升。危险因素与先前报道的数据一致，尤其是环丙沙星耐药率随年龄增加。
结论
瓜德罗普岛的全科医生需要更多信息，以便更倾向于开具磷霉素氨丁三醇，以降低氟喹诺酮类耐药风险。
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