Mulder Marlies, Kiefte-de Jong Jessica C, Goessens Wil H F, de Visser Herman, Hofman Albert, Stricker Bruno H, Verbon Annelies
Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Inspectorate of Health Care, PO Box 2518, 6401 DA Heerlen, The Netherlands.
J Antimicrob Chemother. 2017 Jan;72(1):281-289. doi: 10.1093/jac/dkw399. Epub 2016 Sep 21.
Antimicrobial resistance to ciprofloxacin is rising worldwide, especially in bacteria causing urinary tract infections (UTIs). Prudent use of current antibiotic drugs is therefore necessary.
We analysed (modifiable) risk factors for ciprofloxacin-resistant Escherichia coli.
Urinary cultures of UTIs caused by E. coli were collected from participants in the Rotterdam Study, a prospective cohort study in an elderly population, and analysed for susceptibility to ciprofloxacin. Multivariate logistic regression was performed to investigate several possible risk factors for resistance.
Ciprofloxacin resistance in 1080 E. coli isolates was 10.2%. Multivariate analysis showed that higher age (OR 1.03; 95% CI 1.00-1.05) and use of two (OR 5.89; 95% CI 3.45-10.03) and three or more (OR 3.38; 95% CI 1.92-5.97) prescriptions of fluoroquinolones were associated with ciprofloxacin resistance, while no association between fluoroquinolone use more than 1 year before culture and ciprofloxacin resistance could be demonstrated. Furthermore, a high intake of pork (OR 3.68; 95% CI 1.36-9.99) and chicken (OR 2.72; 95% CI 1.08-6.85) and concomitant prescription of calcium supplements (OR 2.51; 95% CI 1.20-5.22) and proton pump inhibitors (OR 2.04; 95% CI 1.18-3.51) were associated with ciprofloxacin resistance.
Ciprofloxacin resistance in community-acquired UTI was associated with a high intake of pork and chicken and with concomitant prescription of calcium supplements and proton pump inhibitors. Modification of antibiotic use in animals as well as temporarily stopping the prescription of concomitant calcium and proton pump inhibitors need further evaluation as strategies to prevent ciprofloxacin resistance.
全球范围内对环丙沙星的耐药性正在上升，尤其是在引起尿路感染（UTIs）的细菌中。因此，谨慎使用当前的抗生素药物很有必要。
我们分析了耐环丙沙星大肠杆菌的（可改变的）危险因素。
从鹿特丹研究（一项针对老年人群的前瞻性队列研究）的参与者中收集由大肠杆菌引起的尿路感染的尿液培养物，并分析其对环丙沙星的敏感性。进行多变量逻辑回归以研究耐药的几种可能危险因素。
1080株大肠杆菌分离株中的环丙沙星耐药率为10.2%。多变量分析表明，年龄较大（比值比[OR]1.03；95%置信区间[CI]1.00 - 1.05）以及使用两种（OR 5.89；95% CI 3.45 - 10.03）和三种或更多种（OR 3.38；95% CI 1.92 - 5.97）氟喹诺酮类药物处方与环丙沙星耐药相关，而在培养前1年以上使用氟喹诺酮类药物与环丙沙星耐药之间未显示出关联。此外，大量摄入猪肉（OR 3.68；95% CI 1.36 - 9.99）和鸡肉（OR 2.72；95% CI 1.08 - 6.85）以及同时开具钙补充剂（OR 2.51；95% CI 1.20 - 5.22）和质子泵抑制剂（OR 2.04；95% CI 1.18 - 3.51）与环丙沙星耐药相关。
社区获得性尿路感染中的环丙沙星耐药与大量摄入猪肉和鸡肉以及同时开具钙补充剂和质子泵抑制剂有关。作为预防环丙沙星耐药的策略，改变动物抗生素使用以及暂时停止同时开具钙和质子泵抑制剂需要进一步评估。
