Pharmacy Department, Indiana University Health Bloomington Hospital, 601 W. Second Street, Bloomington, IN 47403, United States.
Am J Emerg Med. 2018 Nov;36(11):2054-2057. doi: 10.1016/j.ajem.2018.08.016. Epub 2018 Aug 8.
The purpose of this study was to assess treatment with a fluoroquinolone or trimethoprim-sulfamethoxazole versus cephalosporins for pyelonephritis in discharged patients from a community hospital setting.
A retrospective chart review was completed for adult female patients who received a prescription for a cephalosporin, fluoroquinolone or trimethoprim-sulfamethoxazole for the treatment of pyelonephritis within the network of a large healthcare system. The primary endpoint evaluated the failure rate of each treatment group. The secondary endpoint evaluated the difference between rates of resistance on culture and sensitivity reports for treatment groups.
A total of 55 patients in the cephalosporin group and 43 patients in the fluoroquinolone and trimethoprim-sulfamethoxazole group were reviewed. The primary endpoint occurred in 0% of the patients in the cephalosporin group and in 23% of the patients in the fluoroquinolone and trimethoprim-sulfamethoxazole group, p < 0.001. Of the 98 urine samples collected, 71 samples were positive for pathogen growth. Upon evaluation of these isolates, 6% were resistant to cephalexin, 1% was resistant to cefdinir, 3% were resistant to ciprofloxacin and 23% were resistant to trimethoprim-sulfamethoxazole. Trimethoprim-sulfamethoxazole showed statistical significance for more bacterial resistance compared to the other agents, p < 0.01.
Failure of therapy for pyelonephritis occurred more often in the fluoroquinolone and trimethoprim-sulfamethoxazole group than in the cephalosporin group. The findings in this study are most applicable to patients who are treated on an outpatient basis. A prospective, randomized clinical trial is necessary to confirm these results.
本研究旨在评估氟喹诺酮类或磺胺甲噁唑-甲氧苄啶与头孢菌素治疗社区医院出院患者肾盂肾炎的效果。
对在大型医疗保健系统网络内接受头孢菌素、氟喹诺酮类或磺胺甲噁唑-甲氧苄啶治疗肾盂肾炎的成年女性患者的病历进行回顾性分析。主要终点评估每组治疗的失败率。次要终点评估治疗组的培养和药敏报告中耐药率的差异。
共对头孢菌素组的 55 例患者和氟喹诺酮类和磺胺甲噁唑-甲氧苄啶组的 43 例患者进行了回顾。头孢菌素组的主要终点发生率为 0%，而氟喹诺酮类和磺胺甲噁唑-甲氧苄啶组为 23%，p<0.001。在收集的 98 份尿液样本中，有 71 份样本有病原菌生长。对这些分离株进行评估后，6%的分离株对头孢氨苄耐药，1%的分离株对头孢地尼耐药，3%的分离株对环丙沙星耐药，23%的分离株对磺胺甲噁唑-甲氧苄啶耐药。磺胺甲噁唑-甲氧苄啶的细菌耐药率明显高于其他药物，p<0.01。
氟喹诺酮类和磺胺甲噁唑-甲氧苄啶组治疗肾盂肾炎的失败率高于头孢菌素组。本研究的结果最适用于门诊治疗的患者。需要进行前瞻性、随机临床试验来证实这些结果。
