Cherednichenko A G, Kulchavenya E V
Novosibirsk Tuberculosis Research Institute of Minzdrav of Russia.
Novosibirsk State Medical University of Minzdrav of Russia, Novosibirsk, Russia.
Urologiia. 2017 Jun(2):66-70. doi: 10.18565/urol.2017.2.66-70.
In the structure of tuberculosis morbidity, urogenital tuberculosis (UGT) ranks second or third only to pulmonary tuberculosis. Every fourth patient has the stage of cavern formation at first presentation. Seventy five percent of nephrotuberculosis cases co-occur with nonspecific pyelonephritis, which excludes "sterile pyuria". We aimed to determine the microbial spectrum of urine and gonadal appendages in patients with suspected UGT and to investigate the susceptibility of the isolated microorganisms to the main antibacterial drugs.
The study investigated the spectrum of pathogenic microflora isolated from patients admitted to the urogenital clinic of the TB Research Institute from January 1, 2012 to September 30, 2016 to rule out UGT. Microorganism species were identified by time-of-flight mass spectrometry using the microbiological analyzer Phoenix 100 (Becton Dickinson, USA). Antibiotic resistance was determined using the Phoenix 100 microbiological analyzer (Becton Dickinson, USA).
A total of 3004 bacteriological tests for nonspecific microflora were performed during the analyzed period. In the structure of pathogens, E. coli comprised about half of the cases thus confirming its role as the leading uropathogen. Only piperacillin/tazobactam and nitrofurantoin provided relatively plausible antimicrobial resistance rates, for other antibacterial drugs the rates of susceptible strains progressively decreased and by 2016 dropped to 40% and lower.
Our findings cannot be extrapolated to the entire population since patients presenting for differential diagnosis receive multiple courses of treatment with various antibacterial drugs, which led to the selection of resistant strains. The findings emphasize the need for a strict selection of antibiotics for urogenital infection empirical therapy. In the absence of response, the patient should be immediately examined for tuberculosis using molecular and genetic diagnostic techniques.
在结核病发病结构中，泌尿生殖系统结核（UGT）仅次于肺结核，位列第二或第三。每四名患者中就有一人在首次就诊时处于空洞形成阶段。75%的肾结核病例与非特异性肾盂肾炎并发，这排除了“无菌性脓尿”。我们旨在确定疑似UGT患者尿液和性腺附属器的微生物谱，并研究分离出的微生物对主要抗菌药物的敏感性。
本研究调查了2012年1月1日至2016年9月30日入住结核病研究所泌尿生殖科以排除UGT的患者所分离的致病微生物谱。使用美国贝克顿·迪金森公司的微生物分析仪Phoenix 100通过飞行时间质谱法鉴定微生物种类。使用美国贝克顿·迪金森公司的Phoenix 100微生物分析仪测定抗生素耐药性。
在分析期间共进行了3004次非特异性微生物的细菌学检测。在病原体结构中，大肠杆菌约占病例的一半，从而证实了其作为主要尿路病原体的作用。只有哌拉西林/他唑巴坦和呋喃妥因提供了相对合理的抗菌耐药率，对于其他抗菌药物，敏感菌株的比例逐渐下降，到2016年降至40%及以下。
由于前来进行鉴别诊断的患者接受了多种抗菌药物的多疗程治疗，从而导致了耐药菌株的选择，因此我们的研究结果不能外推至整个人群。这些发现强调了在泌尿生殖系统感染经验性治疗中严格选择抗生素的必要性。如果没有反应，应立即使用分子和基因诊断技术对患者进行结核病检查。
