Banerjee Tuhina, Anupurba Shampa
Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Indian J Med Res. 2016 Oct;144(4):604-610. doi: 10.4103/0971-5916.200897.
BACKGROUND & OBJECTIVES: Fluoroquinolone resistance in both Gram-positive and Gram-negative bacteria has increased with the widespread use of fluoroquinolones. Fluoroquinolone resistance in Gram-negative bacilli has been widely studied, though staphylococci and enterococci are also notably resistant. Enterococci being the second most common cause of healthcare-associated urinary tract infections (UTIs) fluoroquinolones are often the drug of choice. This study was undertaken to assess the risk factors associated with fluoroquinolone-resistant enterococcal UTI in a tertiary level health facility in north India.
A total of 365 patients with UTI caused by enterococci were studied over a period of two years. Patients with ciprofloxacin-resistant and susceptible UTI were considered as cases and controls, respectively. Resistance profile of the isolates against common antibiotics was studied by minimum inhibitory concentration (MIC) determination. Mechanisms for fluoroquinolone resistance was studied by efflux pump inhibitor activity and multiplex PCR targeting the qnr genes.
A total of 204 (55.89%) cases and 161 (44.1%) controls were identified. The fluoroquinolone-resistant isolates were significantly resistant to ampicillin, high strength aminoglycosides and vancomycin. The majority (78%) of the resistant isolates showed efflux pump activity. Treatment in indoor locations, presence of urinary catheters and pregnancy along with recent exposure to antibiotics especially fluoroquinolones, third generation cephalosporins and piperacillin-tazobactam were identified as independent risk factors.
INTERPRETATION & CONCLUSIONS: Our results showed that fluoroquinolone resistance in enterococcal UTI was largely associated with indoor usage of antibiotics and use of indwelling devices. Knowledge of risk factors is important to curb this emergence of resistance.
随着氟喹诺酮类药物的广泛使用，革兰氏阳性菌和革兰氏阴性菌对氟喹诺酮类药物的耐药性均有所增加。革兰氏阴性杆菌对氟喹诺酮类药物的耐药性已得到广泛研究，不过葡萄球菌和肠球菌也具有显著耐药性。肠球菌是医疗保健相关尿路感染（UTIs）的第二大常见病因，氟喹诺酮类药物通常是首选药物。本研究旨在评估印度北部一家三级医疗机构中与耐氟喹诺酮肠球菌性UTI相关的危险因素。
在两年时间里共研究了365例由肠球菌引起的UTI患者。对环丙沙星耐药和敏感的UTI患者分别被视为病例组和对照组。通过最低抑菌浓度（MIC）测定研究分离株对常见抗生素的耐药谱。通过外排泵抑制剂活性和靶向qnr基因的多重PCR研究氟喹诺酮类药物耐药机制。
共确定了204例（55.89%）病例和161例（44.1%）对照。耐氟喹诺酮分离株对氨苄西林、高强度氨基糖苷类和万古霉素具有显著耐药性。大多数（78%）耐药分离株表现出外排泵活性。室内治疗、留置导尿管、妊娠以及近期接触抗生素，尤其是氟喹诺酮类、第三代头孢菌素和哌拉西林 - 他唑巴坦被确定为独立危险因素。
我们的结果表明，肠球菌性UTI中的氟喹诺酮类药物耐药性在很大程度上与室内使用抗生素和使用留置装置有关。了解危险因素对于遏制这种耐药性的出现很重要。
