Cunha B A, Cunha C B, Lam B, Giuga J, Chin J, Zafonte V F, Gerson S
Infectious Disease Division, Winthrop-University Hospital, 222 Station Plaza North (Suite #432), Mineola, NY, 11501, USA.
State University of New York, School of Medicine, Stony Brook, NY, USA.
Eur J Clin Microbiol Infect Dis. 2017 Jul;36(7):1213-1216. doi: 10.1007/s10096-017-2911-1. Epub 2017 Feb 2.
Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl < 60 ml/min) with nitrofurantoin. Excluded were complicated urinary tract infections. Urinary isolated susceptibility testing was done by micro broth dilution (MBD). Treatment duration was 5-7 days. Cure was defined as eradication of the uropathogen and failure was defined as minimal/no decrease in urine colony counts. Of 26 evaluable patients with renal insufficiency (CrCl < 60 ml/min), nitrofurantoin eradicated the uropathogen in 18/26 (69%) of patients, and failed in 8/26 (31%). Of the eight failures, five were due to intrinsically resistant uropathogens, e.g., Proteus sp., and one failure was related to an alkaline urine. Of the treatment failures, only two were due to renal insufficiency, i.e., CrCl < 30 ml/min. Since there are few oral antibiotics available to treat AUC due to MDR GNB uropathogens, these results have important ASP implications. Currently, nitfurantoin is not recommended if CrCl < 60 ml/min. In our experience, used appropriately against susceptible uropathogens, nitrofurantoin was highly effective in nearly all patients with CrCl = 30-60 ml/min., and only failed in two patients due to renal insufficiency (CrCl < 30 ml/ml).
对于由耐多药（MDR）革兰氏阴性杆菌（GNB）引起的急性单纯性膀胱炎（AUC），呋喃妥因仍是关键的口服抗生素管理计划（ASP）用药选择。然而，人们一直担心肾功能不全时呋喃妥因的疗效会降低。根据我们过去三十年的经验，呋喃妥因在治疗肾功能不全的住院成人AUC方面一直是安全有效的。因此，我们回顾性分析了近期使用呋喃妥因治疗肾功能减退（肌酐清除率<60 ml/min）的住院成人AUC的经验。排除复杂性尿路感染。尿液分离菌药敏试验采用微量肉汤稀释法（MBD）。治疗疗程为5 - 7天。治愈定义为尿路病原体根除，失败定义为尿菌落计数无减少或仅有轻微减少。在26例可评估的肾功能不全患者（肌酐清除率<60 ml/min）中，呋喃妥因在18/26（69%）的患者中根除了尿路病原体，8/26（31%）的患者治疗失败。在这8例失败病例中，5例是由于固有耐药的尿路病原体，如变形杆菌属，1例失败与尿液碱化有关。在治疗失败病例中，只有2例是由于肾功能不全，即肌酐清除率<30 ml/min。由于治疗由MDR GNB尿路病原体引起的AUC的口服抗生素很少，这些结果对ASP具有重要意义。目前，如果肌酐清除率<60 ml/min，不建议使用呋喃妥因。根据我们的经验，在针对易感尿路病原体适当使用时，呋喃妥因在几乎所有肌酐清除率为30 - 60 ml/min的患者中都非常有效，仅2例因肾功能不全（肌酐清除率<30 ml/ml）治疗失败。
