无并发症社区获得性尿路感染中的耐药大肠杆菌。
Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection.
机构信息
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Charité-Universitätsmedizin Berlin, Germany; LADR GmbH, Medizinisches Versorgungszentrum Plön, Germany; MVZ Dr. Stein und Kollegen GbR, Mönchengladbach, Germany; MVZ Labor Dr.Limbach & Kollegen GbR, Heidelberg, Germany; Medizinisches Versorgungszentrum, Labor 28 GmbH, Berlin, Germany; Department for Health Services Research, Institute for Public Health and Nursing Science, Bremen, Germany.
出版信息
Dtsch Arztebl Int. 2018 Jul 23;115(29-30):494-500. doi: 10.3238/arztebl.2018.0494.
BACKGROUND
Routine urine culture testing is not recommended for uncomplicated urinary tract infections (UTIs). As a result, the antibiotic resistance patterns or the organisms causing UTIs are not adequately reflected in routine data. We studied the sensitivity of Escherichia coli (E. coli) to trimethoprim (TMP) and to cotrimoxazole (i.e., trimethoprim/sulfamethoxazole, TMP/SMX) in community-acquired UTI and compared the findings with the resistance data of the Antimicrobial Resistance Surveillance System (ARS).
METHODS
General practitioners and internists in private practice prospectively recruited all of their adult patients with symptoms of a urinary tract infection from May 2015 to February 2016. Urine specimens from all patients were tested (including urine culture testing and antibiotic susceptibility) and infections were defined as uncomplicated or complicated UTIs.
RESULTS
1245 participants from 58 medical practices were enrolled in the study. Pathogenic organisms were found in the urine of 877 patients, of whom 74.5% had E. coli infections. Among the E.-coli-positive UTIs, 52.4% were classified as uncomplicated and 47.6% as complicated. The prevalence of E. coli that was resistant to TMP and to TMP/SMX in uncomplicated UTIs was 15.2% and 13.0%, respectively, compared to 25.3% and 24.4%, respectively, from all UTIs in ARS in 2015. Study participants who had previously taken antibiotics had the highest prevalence of E. coli resistance (30.9%), followed by those who had two or more UTIs within the past six months (28.9%).
CONCLUSION
E. coli with resistance to TMP was significantly less prevalent among the study patients with uncomplicated UTIs than in the routine data of the ARS. Accordingly, TMP should still be considered as an option for the treatment of uncomplicated UTIs. TMP/SMX is considered the agent of second choice because of its side effects. Surveillance systems based on routine data do not yield a representative sample for the evaluation of the resistance situation in patients with uncomplicated UTIs.
背景
不建议对简单型尿路感染（UTI）进行常规尿液培养检测。因此，常规数据中不能充分反映 UTI 的抗生素耐药模式或病原体。我们研究了社区获得性 UTI 中大肠埃希菌（E. coli）对甲氧苄啶（TMP）和复方磺胺甲噁唑（TMP/SMX，即trimethoprim/sulfamethoxazole）的敏感性，并将研究结果与抗菌药物耐药监测系统（ARS）的耐药数据进行了比较。
方法
私人执业的全科医生和内科医生前瞻性地招募了 2015 年 5 月至 2016 年 2 月期间所有有尿路感染症状的成年患者。对所有患者的尿液标本进行了检测（包括尿液培养检测和抗生素敏感性），并将感染定义为简单型或复杂型 UTI。
结果
58 家医疗诊所的 1245 名参与者入组了该研究。在 877 名有病原微生物的患者尿液中发现了病原体，其中 74.5%为大肠埃希菌感染。在大肠埃希菌阳性 UTI 中，52.4%为简单型，47.6%为复杂型。在简单型 UTI 中，TMP 和 TMP/SMX 耐药的大肠埃希菌的流行率分别为 15.2%和 13.0%，而 ARS 2015 年所有 UTI 中的相应比例分别为 25.3%和 24.4%。之前使用过抗生素的研究参与者的大肠埃希菌耐药率最高（30.9%），其次是过去 6 个月内有 2 次或以上 UTI 的参与者（28.9%）。
结论
与 ARS 常规数据相比，研究中简单型 UTI 患者的 TMP 耐药大肠埃希菌的流行率显著较低。因此，TMP 仍可被视为治疗简单型 UTI 的选择。由于其副作用，TMP/SMX 被认为是二线药物。基于常规数据的监测系统不能为评估简单型 UTI 患者的耐药情况提供代表性样本。
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