Department of Microbiology, University of Washington School of Medicine, Seattle.
Kaiser Permanente Washington, Seattle.
Clin Infect Dis. 2019 Feb 15;68(5):781-787. doi: 10.1093/cid/ciy523.
The pandemic spread of antibiotic resistance increases the likelihood of ineffective empirical therapy. The recently emerged fluoroquinolone-resistant Escherichia coli sequence type (ST) 131-H30R subclone (H30) is a leading cause of multidrug-resistant urinary tract infection (UTI) and bloodstream infection worldwide.
We studied the relative impact of H30 on the likelihood that bacteria isolated from urine of urgent care patients would be resistant to the empirically prescribed antibiotic regimen for UTI.
Of 750 urinalysis-positive urine samples from urgent care patients with suspected UTI, 306 (41%) yielded E. coli, from 35 different clonal groups (clonotypes). H30 predominated (14% prevalence overall), especially among older patients (age ≥70 years: 26%) and those with diabetes (43%) or urinary catheterization (60%). Resistance to the empirically selected antibiotic regimen occurred in 16% (40/246) of patients overall, 28% (20/71) of older patients, 30% (8/27) of patients with diabetes, 60% (3/5) of catheterized patients, and 71% (22/30) of those with H30. H30's contribution to such mismatched antibiotic selection was 55% overall, 70% among older patients, and 100% among patients with diabetes or a urinary catheter. Among patients with ≥2 of these factors (older age, diabetes, or urinary catheter), 24% of all urinalysis-positive urine samples yielded H30, with a 92% likelihood of resistance to the selected empirical therapy.
The multidrug-resistant H30 subclone of E. coli ST131 is responsible for the great majority of mismatched empirical antibiotic prescriptions for suspected UTI at an urgent care clinic among patients ≥70 years old or with diabetes or urinary catheterization.
抗生素耐药性的大流行增加了经验性治疗无效的可能性。最近出现的氟喹诺酮耐药大肠杆菌序列型（ST）131-H30R 亚克隆（H30）是全球导致多药耐药尿路感染（UTI）和血流感染的主要原因。
我们研究了 H30 对从急诊就诊疑似 UTI 患者尿液中分离的细菌对 UTI 经验性处方抗生素方案产生耐药的可能性的相对影响。
在 750 份来自急诊就诊疑似 UTI 患者的尿液分析阳性样本中，306 份（41%）培养出大肠杆菌，来自 35 个不同的克隆群（克隆型）。H30 占主导地位（总体流行率为 14%），尤其是在年龄较大的患者（年龄≥70 岁：26%）和患有糖尿病（43%）或留置导尿管的患者（60%）中。经验性选择的抗生素方案总体耐药率为 16%（40/246），年龄较大的患者为 28%（20/71），糖尿病患者为 30%（8/27），留置导尿管的患者为 60%（3/5），而 H30 患者为 71%（22/30）。H30 对这种不匹配的抗生素选择的贡献总体为 55%，年龄较大的患者为 70%，患有糖尿病或留置导尿管的患者为 100%。在有≥2 个这些因素（年龄较大、糖尿病或留置导尿管）的患者中，所有尿液分析阳性样本的 24%产生 H30，对所选经验性治疗的耐药率为 92%。
在 70 岁以上或患有糖尿病或留置导尿管的患者中，大肠杆菌 ST131 的多药耐药 H30 亚克隆是导致急诊就诊疑似 UTI 时经验性抗生素处方不匹配的主要原因。
