瑞典初级保健中的单纯性尿路感染；病因、耐药性和治疗。
Uncomplicated urinary tract infections in Swedish primary care; etiology, resistance and treatment.
机构信息
Department of Clinical Sciences, Malmö, Family Medicine, Lund University, Malmö, Sweden.
Regional Centre for Communicable Disease Control, Malmö, Sweden.
出版信息
BMC Infect Dis. 2019 Feb 13;19(1):155. doi: 10.1186/s12879-019-3785-x.
BACKGROUND
Uncomplicated urinary tract infection (uUTI) is common and a majority of patients are prescribed antibiotics. There is little knowledge about antibiotic resistance in urine samples from patients with uUTI in primary health care (PHC). The aim was to describe antibiotic treatment, bacterial findings, the prevalence of resistant E.coli and factors associated with antibiotic resistance. The aim was also to compare the prevalence of resistant E.coli in clinical practice with the prevalence of resistant E.coli in routine microbiological laboratory data.
METHODS
This observational study in PHC setting started in November 2014 and ended in March 2016. Women aged 17 years and older with symptoms indicating uUTI from eight PHCs were included. Questionnaires were used to retrieve anamnestic data. All urine samples were sent to the local laboratory of microbiology for diagnostic analysis and susceptibility testing. Proportions of resistant E.coli were compared with corresponding data from the regional laboratory.
RESULTS
Urine cultures were analysed in 304 women with a median age of 46 (IQR 32-66) years. Bacterial growth was found in 243 (80%) of urine samples, and E.coli in 72% of the positive samples. A total of 80% of detected E.coli isolates were susceptible to all tested antimicrobials and resistance rates to ciprofloxacin were lower than reported from the local clinical laboratory. Antibiotic treatment within the last year was independently associated with antibiotic resistant E.coli in the urine sample adjusted OR 4.97 (95% CI 2.04-12.06). A total of 74% of the women were treated with antibiotics. The most prescribed was pivmecillinam followed by nitrofurantoin.
CONCLUSIONS
Antibiotic resistance in E.coli was low. Antibiotic treatment within the last year was associated with antibiotic resistant E.coli. Data from the clinical microbiology laboratory indicates that laboratory data may overestimate antibiotic resistance and lead to an unnecessary change in empiric antibiotic treatment of uUTI in primary care. The empirically prescribed antibiotics, were inline with Swedish treatment recommendations for uUTI.
背景
单纯性尿路感染（uUTI）很常见，大多数患者都被开了抗生素。在初级保健（PHC）中，人们对 uUTI 患者尿液样本中的抗生素耐药性知之甚少。本研究旨在描述抗生素治疗、细菌检出情况、大肠埃希菌耐药的流行情况以及与抗生素耐药相关的因素。本研究还旨在比较临床实践中大肠埃希菌耐药的流行情况与常规微生物实验室数据中大肠埃希菌耐药的流行情况。
方法
这是一项在 PHC 环境中进行的观察性研究，于 2014 年 11 月开始，2016 年 3 月结束。纳入了来自 8 家 PHC 的 17 岁及以上有 uUTI 症状的女性。使用问卷获取病史资料。所有尿液样本均送至当地微生物实验室进行诊断分析和药敏试验。比较了大肠埃希菌耐药率与相应的区域实验室数据。
结果
对 304 名中位年龄为 46（IQR 32-66）岁的女性进行了尿液培养分析。243 份（80%）尿液样本中有细菌生长，72%的阳性样本中检出大肠埃希菌。检出的大肠埃希菌分离株对所有检测的抗菌药物均有 80%的敏感性，环丙沙星的耐药率低于当地临床实验室报告的耐药率。在过去一年中接受过抗生素治疗与尿液样本中抗生素耐药大肠埃希菌独立相关，调整后的 OR 值为 4.97（95%CI 2.04-12.06）。共有 74%的女性接受了抗生素治疗。最常开的是匹美西林，其次是呋喃妥因。
结论
大肠埃希菌的抗生素耐药率较低。在过去一年中接受过抗生素治疗与抗生素耐药大肠埃希菌有关。临床微生物学实验室的数据表明，实验室数据可能高估了抗生素耐药性，并导致在初级保健中对 uUTI 进行经验性抗生素治疗时不必要地改变。经验性开的抗生素与瑞典治疗 uUTI 的推荐相符。
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