肾移植后革兰氏阴性尿路病原体的耐药性增加。
Increased resistance of gram-negative urinary pathogens after kidney transplantation.
作者信息
Korth Johannes, Kukalla Julia, Rath Peter-Michael, Dolff Sebastian, Krull Marco, Guberina Hana, Bienholz Anja, Wilde Benjamin, Becker Stefan, Ross Birgit, Anastasiou Olympia Evdoxia, Kribben Andreas, Witzke Oliver
机构信息
Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Institute for Medical Microbiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
出版信息
BMC Nephrol. 2017 May 19;18(1):164. doi: 10.1186/s12882-017-0580-z.
BACKGROUND
Urinary tract infection is the most common complication after kidney transplantation. It can cause severe sepsis and transplant loss. Emergence of drug resistance among gram-negative urinary pathogens is the current challenge for urinary tract infection treatment after kidney transplantation.
METHODS
This study analyzes the antimicrobial susceptibility of gram-negative urinary pathogens after kidney transplantation from 2009 to 2012 at the Transplant Outpatient Clinic of the University Hospital Essen, Germany. Kidney transplant patients at the University Hospital Essen receive regular follow up examinations after transplantation. Midstream urines were examined for bacteriuria at each follow up visit.
RESULTS
From 2009 to 2012 15.741 urine samples were obtained from 859 patients. In 2985 (19%) samples bacterial growth was detected. The most frequently detected gram-negative bacteria were E.coli 1109 (37%), Klebsiella spp. 242 (8%) and Pseudomonas aeruginosa 136 (4.5%). Klebsiella spp. showed a significant increase of resistance to trimethoprim-sulfamethoxazole by 19% (p = 0.02), ciprofloxacin by 15% (p = 0.01) and ceftazidime by 17% (p = 0.004). E.coli and P. aeruginosa isolates presented no significant differences of antimicrobial susceptibility to the analyzed antibiotics.
CONCLUSIONS
Antimicrobial resistance of Klebsiella spp. increased significant to trimethoprim-sulfamethoxazole, ciprofloxacin and ceftazidime from 2009 to 2012.
背景
尿路感染是肾移植后最常见的并发症。它可导致严重的败血症和移植肾丧失。革兰氏阴性尿路病原体耐药性的出现是肾移植后尿路感染治疗的当前挑战。
方法
本研究分析了2009年至2012年德国埃森大学医院移植门诊肾移植后革兰氏阴性尿路病原体的抗菌药敏情况。埃森大学医院的肾移植患者在移植后接受定期随访检查。每次随访时对中段尿进行细菌尿检查。
结果
2009年至2012年，从859例患者中获取了15741份尿液样本。在2985份（19%）样本中检测到细菌生长。最常检测到的革兰氏阴性菌是大肠杆菌1109例（37%）、克雷伯菌属242例（8%）和铜绿假单胞菌136例（4.5%）。克雷伯菌属对甲氧苄啶-磺胺甲恶唑的耐药性显著增加了19%（p = 0.02），对环丙沙星的耐药性增加了15%（p = 0.01），对头孢他啶的耐药性增加了17%（p = 0.004）。大肠杆菌和铜绿假单胞菌分离株对所分析抗生素的抗菌药敏无显著差异。
结论
2009年至2012年，克雷伯菌属对甲氧苄啶-磺胺甲恶唑、环丙沙星和头孢他啶的耐药性显著增加。
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