Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida-College of Medicine, 1600 SW Archer Rd, Gainesville, Florida 32610, USA.
Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida-College of Medicine, 1600 SW Archer Rd, Gainesville, Florida 32610, USA.
Int J Antimicrob Agents. 2018 Jan;51(1):57-61. doi: 10.1016/j.ijantimicag.2017.06.008. Epub 2017 Jun 27.
Vancomycin-resistant enterococci (VRE) are a common cause of urinary tract infections (UTIs) and are typically multidrug resistant, including ampicillin. This retrospective study evaluated outcomes of 84 adult patients hospitalized between January 2007 and December 2015 with ampicillin- and vancomycin-resistant enterococcus isolates causing UTI and treated with ampicillin. Treatment response was classified as clinical cure and microbiological eradication. Clinical cure was achieved in 88.1% (74/84) of patients. In patients with follow-up cultures, microbiological eradication was achieved in 86% (50/58) of patients. Cure rates were similar in patients with indwelling urinary catheters (n = 45) receiving catheter exchange/removal (90.47%; 19/21) versus catheter retention (87.5%; 21/24). Presence of co-morbidities, such as diabetes and chronic kidney disease, were not associated with increased risk of treatment failure. Immunocompromised patients achieved lower cure rates of 78.1% (25/32) compared with 94.2% (49/52) among those without immune impairment (P = 0.038). Presence of an underlying urinary tract abnormality was also associated with a lower cure rate of 71.4% (15/21) compared with 93.7% (59/63) in those without urinary tract abnormalities (P = 0.0135). Overall cure rates remained high in all groups providing good evidence to support ampicillin for the treatment of complicated UTI caused by ampicillin- and vancomycin-resistant enterococci.
耐万古霉素肠球菌（VRE）是尿路感染（UTI）的常见病因，通常对多种药物具有耐药性，包括氨苄西林。本回顾性研究评估了 2007 年 1 月至 2015 年 12 月期间 84 例住院成人患者的结局，这些患者的尿路感染由氨苄西林和万古霉素耐药肠球菌分离株引起，并接受氨苄西林治疗。将治疗反应分为临床治愈和微生物学清除。88.1%（74/84）的患者达到临床治愈。在有随访培养的患者中，86%（50/58）的患者达到微生物学清除。留置导尿管（n=45）的患者中，导管更换/拔除（90.47%，19/21）与保留导管（87.5%，21/24）的治愈率相似。合并症（如糖尿病和慢性肾脏病）的存在与治疗失败的风险增加无关。免疫功能低下的患者治愈率为 78.1%（25/32），而无免疫功能损害的患者治愈率为 94.2%（49/52）（P=0.038）。存在潜在的泌尿道异常也与治愈率较低（71.4%，15/21）相关，而无泌尿道异常的患者治愈率为 93.7%（59/63）（P=0.0135）。所有组别的总体治愈率均较高，为氨苄西林治疗氨苄西林和万古霉素耐药肠球菌引起的复杂性 UTI 提供了良好的证据支持。
