Assuta Ashdod University Hospital, Ashdod, Israel.
Israel Defense Forces Medical Corps, Tel Hashomer, Israel.
J Antimicrob Chemother. 2019 Feb 1;74(2):499-502. doi: 10.1093/jac/dky424.
Most studies addressing community-acquired urinary tract infections (UTIs) pertain to mixed cohorts, in which young healthy adults are under-represented. We aimed to dissect the intricate interrelation between exposures and subsequent antimicrobial resistance (AMR) patterns in a unique setting of young healthy adults, allowing further guidance in this group.
We carried out a retrospective cross-sectional study of all Enterobacteriaceae-associated outpatient UTIs during 2014-16 in soldiers, representing the young fit population in Israel. Electronic medical records were reviewed for demographic and clinical data, antimicrobial exposures and prescriptions. Risk factors for AMR were analysed by multivariate logistic regression.
Of 1207 cases, 1144 (94.8%) were females, with a median age of 20.2 years. Escherichia coli was the predominant species (83.2%). Only 686 (56.8%) isolates were fully susceptible. AMR rates were as follows: trimethoprim/sulfamethoxazole, 19.6%; oral cephalosporins, 9.7%-16.7%; amoxicillin/clavulanate, 12.1%; ciprofloxacin, 11.1%; and nitrofurantoin, 12.6%. Predictors of AMR were recurrent UTIs, past-year hospitalization, male gender and non E. coli strains. Antimicrobials prescribed >6 months preceding the culprit infection were not related to AMR. Fluoroquinolone and cephalosporin exposures were highly predictive of further AMR, yet nitrofurantoin and, to a lesser extent, amoxicillin/clavulanate had fewer associations with AMR induction and resistance to these antimicrobials was less associated with any exposure.
This nationwide study of community-related UTIs shows significant AMR rates for commonly used oral antimicrobials even in young fit adults. Nitrofurantoin proved once more to be an adequate empirical choice regardless of previous exposures, having a less detrimental effect on future AMR. Conversely, both resistance to fluoroquinolones following previous exposures and the associated heavy ecological burden should deter their common use as first-line agents for UTIs.
大多数研究都涉及社区获得性尿路感染（UTI），其中年轻健康成年人的代表性不足。我们的目的是在年轻健康成年人这一独特环境中，剖析暴露因素与随后出现的抗生素耐药性（AMR）模式之间复杂的相互关系，从而为该人群提供进一步的指导。
我们对 2014 年至 2016 年期间在士兵中发生的所有肠杆菌科相关门诊 UTI 进行了回顾性横断面研究，士兵代表了以色列年轻健康的人群。对电子病历进行了人口统计学和临床数据、抗生素暴露和处方的回顾。采用多变量逻辑回归分析 AMR 的危险因素。
在 1207 例病例中，1144 例（94.8%）为女性，中位年龄为 20.2 岁。大肠埃希菌是主要的病原体（83.2%）。仅有 686 株（56.8%）分离株完全敏感。AMR 率如下：复方磺胺甲噁唑 19.6%；口服头孢菌素 9.7%-16.7%；阿莫西林/克拉维酸 12.1%；环丙沙星 11.1%；和呋喃妥因 12.6%。AMR 的预测因素包括复发性 UTI、过去一年住院治疗、男性和非大肠埃希菌株。在感染前 6 个月以上使用的抗生素与 AMR 无关。氟喹诺酮类和头孢菌素类药物的暴露与更高的 AMR 密切相关，然而，呋喃妥因类药物（以及在较小程度上，阿莫西林/克拉维酸类药物）与 AMR 的诱导相关性较低，且对这些抗生素的耐药性与任何暴露的相关性较低。
这项针对社区相关 UTI 的全国性研究表明，即使在年轻健康的成年人中，常用的口服抗生素也存在显著的 AMR 率。呋喃妥因类药物再次被证明是一种合适的经验性选择，无论之前是否有暴露，都对未来的 AMR 产生较小的负面影响。相反，氟喹诺酮类药物的耐药性及其相关的严重生态负担应阻止其作为 UTI 的一线药物的常规使用。
