Dökmetaş İlyas, Hamidi Aziz Ahmad, Bulut Mehmet Emin, Çetin Sinan, Öncül Ahsen, Uzun Nuray
Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Department of Medical Microbiology, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.
Turk J Urol. 2017 Dec;43(4):543-548. doi: 10.5152/tud.2017.58538. Epub 2017 Dec 1.
It has been shown in previous studies that inadequate empirical treatment is associated with mortality in a variety of infections caused by Gram-negative bacteria. In this study, the clinical effect of discordance in empirical treatment was investigated in patients with urinary tract infection (UTI) accompanied by bacteremia.
We retrospectively reviewed the files of adult (>18 years old) patients who were diagnosed with UTI in our clinic between January 2014 and December 2015. Cases in which the same causative microorganism grew in both blood and urine cultures were included in the study. Patients using ceftriaxone and carbapenem as empirical antibiotic therapy (EAT) were compared as two different groups. In cases that the ethiologic agents were extended- spectrum beta lactamase (ESBL)-producing and isolates, if the microorganism was resistant to initial antibiotic treatment the situation was defined as EAT discordance, and if it was sensitive it was defined as EAT concordance.
After the exclusion criteria were applied, 65 of the 266 cases examined were taken into the study. Clinical and laboratory features of cases of ceftriaxone and carbapenem groups were similar. There was no statistically significant difference between the two groups in terms of hospital stay and survival (p>0.05). Of 28 cases of ESBL-producing and , 18 were EAT discordant and 10 were EAT concordant. Clinical and laboratory features of EAT concordant and EAT discordant groups were similar. No statistically significant difference was found between the two groups in terms of hospital stay and survival (p>0.05).
It was considered that ceftriaxone can still be a viable option in the EAT of UTI, which is accompanied by bacteremia without severe sepsis and septic shock findings. It was concluded that EAT discordance may not have a negative effect on the duration of hospital stay and survival rates in neither total cases nor ESBL positive ones.
先前的研究表明，经验性治疗不足与革兰氏阴性菌引起的多种感染的死亡率相关。在本研究中，对伴有菌血症的尿路感染（UTI）患者经验性治疗不一致的临床效果进行了调查。
我们回顾性分析了2014年1月至2015年12月在我院门诊诊断为UTI的成年（>18岁）患者的病历。血液和尿液培养中培养出相同致病微生物的病例纳入研究。将使用头孢曲松和碳青霉烯作为经验性抗生素治疗（EAT）的患者分为两个不同的组进行比较。对于产超广谱β-内酰胺酶（ESBL）的病原体和分离株，如果微生物对初始抗生素治疗耐药，则情况定义为EAT不一致，如果敏感则定义为EAT一致。
应用排除标准后，266例检查病例中有65例纳入研究。头孢曲松组和碳青霉烯组病例的临床和实验室特征相似。两组在住院时间和生存率方面无统计学显著差异（p>0.05）。在28例产ESBL的病例中，18例EAT不一致，10例EAT一致。EAT一致组和EAT不一致组的临床和实验室特征相似。两组在住院时间和生存率方面无统计学显著差异（p>0.05）。
认为头孢曲松在伴有菌血症但无严重脓毒症和脓毒性休克表现的UTI的EAT中仍是一个可行的选择。得出的结论是，EAT不一致对总病例数和ESBL阳性病例的住院时间和生存率可能没有负面影响。
