Elnasasra Aref, Alnsasra Hilmi, Smolyakov Rozalia, Riesenberg Klaris, Nesher Lior
Division of Internal Medicine, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Infectious Disease Institute, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Isr Med Assoc J. 2017 Sep;19(9):538-542.
Little is known about the incidence of urinary tract infections (UTI) in the dispersed Bedouin population. UTIs are routinely treated empirically according to local resistance patterns, which is important when evaluating the risk factors and antibiotic resistance patterns in the Bedouin population.
To analyze risk factors, pathogens, and antibiotic resistance patterns of UTIs in the Bedouin population compared to the general population in southern Israel. To compare data from this study to that from a previous study conducted at our center.
We prospectively followed all patients hospitalized with community acquired UTIs during a 4 month period at Soroka Medical Center. We also compared results from this study to those from a study conducted in 2000.
The study comprised 223 patients: 44 Bedouin (19.7%), 179 (80.3) non-Bedouin; 158 female (70.9%), 65 male (29.1). The Bedouin were younger (51.7 vs. 71.1 years of age, P < 0.001) and had a lower Charlson Comorbidity Index (2.25 vs. 4.87, P < 0.001). Enterobacteriaceae were the most common pathogens identified, and Escherichia coli (E. coli) was the most common with 156 (70%) strains identified, followed by Klebsiella spp. with 29 (13%), Proteus spp. with 18 (8%), pseudomonas with 9 (4%), and other bacteria including enterococci with 11 (5%). The prevalence of E. coli increased significantly from 56% in 2000 to 70% in this study. We also noted an increase in community acquired extended spectrum beta lactamase (ESBL) pathogens from 4.5% in 2000 to 25.5% in the present study. No statistically significant difference was observed between the Bedouin and general populations in the causal pathogens, resistance to antibiotics, length of therapy, and readmission rate within 60 days.
The Bedouin population hospitalized for UTIs is younger and presents with fewer co-morbidities. Isolated pathogens were similar to those found in the general population as was the presence of drug resistant infections. Overall, a substantial percentage of pathogens were resistant to standard first-line antibiotics, driving the need to change from empiric therapy to aminoglycoside therapy.
关于散居的贝都因人群中尿路感染（UTI）的发病率所知甚少。UTI通常根据当地的耐药模式进行经验性治疗，这在评估贝都因人群中的危险因素和抗生素耐药模式时很重要。
分析与以色列南部普通人群相比，贝都因人群中UTI的危险因素、病原体及抗生素耐药模式。将本研究的数据与我们中心之前进行的一项研究的数据进行比较。
我们前瞻性地追踪了索罗卡医疗中心在4个月期间因社区获得性UTI住院的所有患者。我们还将本研究的结果与2000年进行的一项研究的结果进行了比较。
该研究包括223名患者：44名贝都因人（19.7%），179名（80.3%）非贝都因人；158名女性（70.9%），65名男性（29.1%）。贝都因人更年轻（51.7岁对71.1岁，P<0.001），查尔森合并症指数更低（2.25对4.87，P<0.001）。肠杆菌科是最常见的病原体，其中大肠杆菌（E. coli）最为常见，共鉴定出156株（70%），其次是克雷伯菌属29株（13%）、变形杆菌属18株（8%）、假单胞菌9株（4%），其他细菌包括肠球菌11株（5%）。大肠杆菌的患病率从2000年的56%显著增加到本研究中的70%。我们还注意到社区获得性产超广谱β-内酰胺酶（ESBL）病原体从2000年的4.5%增加到本研究中的25.5%。在致病病原体、抗生素耐药性、治疗时间以及60天内的再入院率方面，贝都因人群和普通人群之间未观察到统计学上的显著差异。
因UTI住院的贝都因人群更年轻，合并症更少。分离出的病原体与普通人群中发现的相似，耐药感染的情况也是如此。总体而言，相当比例的病原体对标准一线抗生素耐药，这促使需要从经验性治疗转向氨基糖苷类治疗。
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