Ferré Losa Carles, Llopis Roca Ferran, Jacob Rodríguez Javier, Giol Amich Jordi, Palom Rico Xavier, Bardés Robles Ignasi
Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
Rev Esp Geriatr Gerontol. 2019 May-Jun;54(3):143-146. doi: 10.1016/j.regg.2018.11.002. Epub 2018 Dec 31.
To compare the characteristics of acute bacterial prostatitis between patients ≥75 years old with those <75 years old attended in the Emergency Department.
A descriptive and observational study was conducted with a prospective follow-up including all consecutive patients with acute bacterial prostatitis that were admitted during one year to the Emergency Department of a tertiary-care hospital. Data were collected for demographic variables, comorbidities, clinical and microbiological findings, treatment, outcome, and re-consultation at 30 days follow-up. Patients were compared depending on age.
A total of 241 episodes of acute bacterial prostatitis were included. The mean age was 62.9±16 years, and 64 patients (26.5%) were ≥75 years old. In the microbiology findings, 104 out of 215 (48.4%) of urine cultures and 25 out of 136 (18.4%) blood cultures were positive. Escherichia coli was the most frequent isolation, with resistance rates in elderly patients above 30% for ciprofloxacin, amoxicillin-clavulanic, and cotrimoxazole, and 15.4% of extended spectrum beta-lactamase producing strains. In the univariate analysis, previous manipulation of the urinary tract, history of cancer, previous antibiotic treatment, resistant E. coli strains, renal impairment, and admission to the hospital were more frequent among patients ≥75 years. Nonetheless, in the multivariate analysis only inadequate empirical antibiotic treatment was found to be significantly more frequent in elderly patients (P=.004).
Drug-resistance patterns to commonly used antibiotics should be considered when choosing empirical treatment for acute bacterial prostatitis in the Emergency Department setting, especially for patients ≥75 years.
比较急诊科中75岁及以上与75岁以下急性细菌性前列腺炎患者的特征。
进行了一项描述性观察性研究，并进行前瞻性随访，纳入一家三级医院急诊科一年内收治的所有连续性急性细菌性前列腺炎患者。收集了人口统计学变量、合并症、临床和微生物学检查结果、治疗、结局以及30天随访时的再次就诊情况等数据。根据年龄对患者进行比较。
共纳入241例急性细菌性前列腺炎发作病例。平均年龄为62.9±16岁，64例患者（26.5%）年龄≥75岁。在微生物学检查结果中，215份尿培养中有104份（48.4%）阳性，136份血培养中有25份（18.4%）阳性。大肠埃希菌是最常见的分离菌，老年患者对环丙沙星、阿莫西林-克拉维酸和复方新诺明的耐药率超过30%，产超广谱β-内酰胺酶菌株占15.4%。单因素分析显示，75岁及以上患者尿路先前操作、癌症病史、先前抗生素治疗、耐药大肠埃希菌菌株、肾功能损害和住院情况更为常见。然而，多因素分析发现，仅经验性抗生素治疗不足在老年患者中显著更为常见（P = 0.004）。
在急诊科为急性细菌性前列腺炎选择经验性治疗时，应考虑常用抗生素的耐药模式，尤其是对于75岁及以上的患者。
