Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
Department of Medical Microbiology, Medical University of Warsaw, Chalubinskiego 5, 02-004, Warsaw, Poland.
BMC Infect Dis. 2018 Nov 20;18(1):590. doi: 10.1186/s12879-018-3507-9.
Men with urinary retention secondary to benign prostatic hyperplasia (BPH) are prone to genitourinary infections. Physicians should be aware of the current antimicrobial susceptibility pattern in this population if empirical treatment is needed. The goal of this study was to evaluate variations in prevalence, composition and antimicrobial susceptibility of bacterial flora in men with indwelling catheters subjected to surgery for BPH in chosen time periods since 1994. Necessary changes in empirical therapy were also assessed.
All patients with indwelling catheters admitted to a single urological center for BPH surgery in the years 1994-1996, 2004-2006, and 2011-2015 were considered. Catheterization times and results of urine cultures from samples collected at admission were evaluated. Susceptibility for selected antimicrobials was compared separately for Gram negative and Gram positive species. For each agent and for their combinations effectiveness of empirical therapy was calculated dividing the number of patients with bacteriuria susceptible to the agents by the total number of patients with bacteriuria.
Bacteriuria was present in 70% of 169, 72% of 132, and 69% of 156 men in the respective time periods. The incidence of Gram-positive strains increased from 10 to 37% (P < 0.001). Their susceptibility to amoxicillin/clavulanate was fluctuating (81, 61, 77%; P=NS). No vancomycin-resistant strain was present. Gram-negative flora composition was stable. Their susceptibility decreased to ciprofloxacin (70 to 53%; P = 0.01) and amoxicillin/clavulanate (56 to 37%; P < 0.01) while it increased to gentamycin (64 to 88%; P < 0.001) and co-trimoxazole (14 to 62%; P < 0.001); susceptibility to amikacin remained high (> 85%). Only two cases of resistance to carbapenems in 2004-2006 were found. In vitro effectiveness of amikacin + amoxicillin/clavulanate in empirical therapy was slowly decreasing (87 to 77%; P=NS). Imipenem was found the most effective single agent (90-95%) and its efficacy was even improved by adding vancomycin (97-98%).
Substantial rise in the incidence of Gram-positive species and fluctuations in antimicrobial susceptibility patterns were found. Empirical therapy of genitourinary infection in catheterized men with BPH should now involve antimicrobial agents effective both to Enterococci and Enterobacteriaceae. Periodic monitoring and publishing data on antimicrobial susceptibility for this population is necessary.
患有良性前列腺增生（BPH）导致尿潴留的男性容易发生泌尿生殖道感染。如果需要经验性治疗，医生应该了解当前此类人群中抗菌药物的敏感性模式。本研究的目的是评估自 1994 年以来不同时期接受 BPH 手术的留置导尿管男性中细菌菌群的流行率、组成和抗菌药物敏感性的变化，并评估经验性治疗的必要变化。
考虑了 1994-1996 年、2004-2006 年和 2011-2015 年在单一泌尿科中心因 BPH 手术接受留置导尿管的所有患者。评估导尿管时间和入院时采集的尿液培养结果。分别比较革兰氏阴性和革兰氏阳性菌对所选抗菌药物的敏感性。对于每种药物及其组合，将对药物敏感的菌尿患者数量除以总菌尿患者数量，计算经验性治疗的有效性。
在相应的时间段内，169 名男性中有 70%、132 名男性中有 72%和 156 名男性中有 69%存在菌尿。革兰氏阳性菌的发生率从 10%增加到 37%（P<0.001）。它们对阿莫西林/克拉维酸的敏感性波动（81、61、77%；P=NS）。没有发现万古霉素耐药株。革兰氏阴性菌群组成稳定。它们对环丙沙星（70 至 53%；P=0.01）和阿莫西林/克拉维酸（56 至 37%；P<0.01）的敏感性降低，而对庆大霉素（64 至 88%；P<0.001）和复方磺胺甲噁唑（14 至 62%；P<0.001）的敏感性增加；对阿米卡星的敏感性仍然很高（>85%）。仅在 2004-2006 年发现两例对碳青霉烯类药物的耐药性。在体外，阿米卡星+阿莫西林/克拉维酸的经验性治疗效果逐渐降低（87 至 77%；P=NS）。亚胺培南被发现是最有效的单一药物（90-95%），添加万古霉素甚至提高了其疗效（97-98%）。
发现革兰氏阳性菌的发生率显著增加，抗菌药物敏感性模式波动。现在，患有 BPH 的留置导尿管男性的泌尿道感染的经验性治疗应该包括对肠球菌和肠杆菌科都有效的抗菌药物。有必要定期监测和公布此类人群的抗菌药物敏感性数据。
