Etani Toshiki, Naiki Taku, Yamaguchi Sachiyo, Mori Saori, Nagai Takashi, Iida Keitaro, Ando Ryosuke, Kawai Noriyasu, Tozawa Keiichi, Mogami Tohru, Yasui Takahiro
Department of Urology, JA Mie Komono Kosei Hospital, Fukumura 75, Komono-cho, Mie-gun, Mie, 510-1234, Japan; Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
J Infect Chemother. 2017 Oct;23(10):692-697. doi: 10.1016/j.jiac.2017.07.011. Epub 2017 Aug 12.
We hypothesized that cases of uncomplicated cystitis treated in a Urology Department would display higher antimicrobial susceptibility than those reported by the hospital antibiogram. This would suggest narrow spectrum antibiotics could still be an effective treatment for uncomplicated cystitis despite this era of antimicrobial resistance. The objective of this study was thus to evaluate the rates of antimicrobial susceptibility of isolates cultured from uncomplicated cystitis cases that presented to the Urology Department of a community hospital in Japan. We evaluated the efficacy of cefaclor, a narrow spectrum antibiotic, for uncomplicated cystitis. We further compared the rates of antimicrobial susceptibility of isolates from uncomplicated cystitis cases to those reported in a hospital-wide antibiogram. A retrospective chart review was performed of patients diagnosed with uncomplicated cystitis in the Urology Department. The patients were mainly treated orally by cefaclor at 750 mg/day for seven days. Significantly greater susceptibilities to cefazolin (87.0% vs 65.7%), trimethoprim-sulfamethoxazole (89.4% vs 79.1%) and levofloxacin (84.6% vs 66.9%) were observed in a cystitis antibiogram for Escherichia coli compared with a hospital-wide antibiogram. The clinical efficacy of cefaclor for acute cystitis was also demonstrated. The greater susceptibility of Escherichia coli to antimicrobials observed in this study supports the hypothesis that antimicrobial susceptibility rates in uncomplicated cystitis cases that present to the Urology Department would be greater than those reported in the hospital antibiogram. Therefore, uncomplicated acute cystitis can be treated by narrow spectrum antibiotics such as cefaclor even in this ''antimicrobial resistance era''.
我们假设，在泌尿外科治疗的单纯性膀胱炎病例，其抗菌药物敏感性会高于医院抗菌谱报告的病例。这表明，尽管处于抗菌药物耐药时代，但窄谱抗生素仍可能是治疗单纯性膀胱炎的有效方法。因此，本研究的目的是评估从日本一家社区医院泌尿外科就诊的单纯性膀胱炎病例中培养的分离株的抗菌药物敏感性率。我们评估了窄谱抗生素头孢克洛治疗单纯性膀胱炎的疗效。我们还比较了单纯性膀胱炎病例分离株与全院抗菌谱报告的抗菌药物敏感性率。对泌尿外科诊断为单纯性膀胱炎的患者进行了回顾性病历审查。患者主要口服头孢克洛，剂量为750毫克/天，共七天。与全院抗菌谱相比，在大肠杆菌膀胱炎抗菌谱中观察到对头孢唑林（87.0%对65.7%）、甲氧苄啶-磺胺甲恶唑（89.4%对79.1%）和左氧氟沙星（84.6%对66.9%）的敏感性显著更高。头孢克洛治疗急性膀胱炎的临床疗效也得到了证实。本研究中观察到的大肠杆菌对抗菌药物的更高敏感性支持了这一假设，即到泌尿外科就诊的单纯性膀胱炎病例的抗菌药物敏感性率高于医院抗菌谱报告的敏感性率。因此，即使在这个“抗菌药物耐药时代”，单纯性急性膀胱炎也可以用头孢克洛等窄谱抗生素治疗。
