Stapleton P J, Lundon D J, McWade R, Scanlon N, Hannan M M, O'Kelly F, Lynch M
Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Urology and Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Ir J Med Sci. 2017 Aug;186(3):733-741. doi: 10.1007/s11845-016-1538-z. Epub 2017 Jan 4.
Escherichia coli is a common cause of urinary tract infections (UTI). Reviews of antibiotic resistance of this organism can inform choice of empiric treatment of UTI and other infections and strategies for combating antimicrobial resistance. We reviewed laboratory and hospital pharmacy records to assess trends in non-susceptibility rates and the effect of antimicrobial stewardship interventions.
A retrospective observational study of isolates of E. coli from MSU samples at a Dublin teaching hospital from inpatients and community, obtained from January 2005 to December 2014. Susceptibility to a panel of antibiotics was determined using the disc diffusion method, as well as extended-spectrum beta-lactamase (ESBL) production status. Trends in resistance were plotted graphically and analysed in a descriptive manner.
Except for nitrofurantoin and gentamicin, non-susceptibility increased for all antimicrobials tested. Co-amoxiclav non-susceptibility reached 48% in hospital and 32.6% in the community by 2014. Piperacillin-tazobactam non-susceptibility increased from 6.8 to 23.8% in hospital and from <1 to 12.5% in community, with similar increases for ESBL producing isolates. Ciprofloxacin non-susceptibility peaked at 25.5% in hospital in 2012 and 11.44% in the community in 2014.
Escherichia coli isolates from community MSU samples have high rates of non-susceptibility to trimethoprim and co-amoxiclav. Nitrofurantoin remains the best empiric therapy for cystitis. Increasing non-susceptibility to co-amoxiclav and piperacillin-tazobactam in hospital isolates is concerning. Ciprofloxacin non-susceptibility is increasing faster in the community than in hospital. A sharp reduction in hospital fluoroquinolone consumption did not result in a significant reduction in ciprofloxacin non-susceptibility of hospital E. coli isolates.
大肠杆菌是尿路感染（UTI）的常见病因。对该生物体抗生素耐药性的综述可为UTI和其他感染的经验性治疗选择以及对抗抗菌药物耐药性的策略提供参考。我们回顾了实验室和医院药房记录，以评估非敏感性率的趋势以及抗菌药物管理干预措施的效果。
对2005年1月至2014年12月期间从都柏林一家教学医院的住院患者和社区的中段尿（MSU）样本中分离出的大肠杆菌进行回顾性观察研究。使用纸片扩散法测定对一组抗生素的敏感性以及超广谱β-内酰胺酶（ESBL）的产生情况。以图表形式绘制耐药性趋势并进行描述性分析。
除呋喃妥因和庆大霉素外，所有测试抗菌药物的非敏感性均有所增加。到2014年，医院中阿莫西林克拉维酸的非敏感性达到48%，社区中为32.6%。哌拉西林他唑巴坦的非敏感性在医院中从6.8%增加到23.8%，在社区中从<1%增加到12.5%，产ESBL菌株的增加情况类似。环丙沙星的非敏感性在2012年医院中达到峰值25.5%，2014年在社区中达到11.44%。
社区MSU样本中的大肠杆菌分离株对甲氧苄啶和阿莫西林克拉维酸的非敏感性率较高。呋喃妥因仍然是膀胱炎的最佳经验性治疗药物。医院分离株中对阿莫西林克拉维酸和哌拉西林他唑巴坦的非敏感性增加令人担忧。社区中环丙沙星的非敏感性增加速度比医院更快。医院氟喹诺酮类药物消费量的大幅下降并未导致医院大肠杆菌分离株中环丙沙星非敏感性的显著降低。
