扩展谱头孢菌素耐药性在复发性社区获得性肠杆菌科尿路感染中的作用：一项回顾性队列研究。
The role of extended-spectrum cephalosporin-resistance in recurrent community-onset Enterobacteriaceae urinary tract infections: a retrospective cohort study.
机构信息
Division of Infectious Diseases, Department of Medicine; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 719 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
Division of Infectious Diseases, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
BMC Infect Dis. 2019 Feb 14;19(1):163. doi: 10.1186/s12879-019-3804-y.
BACKGROUND
Bacterial resistance to first line antibiotics used to treat community-onset urinary tract infections (UTIs) continues to emerge. We sought to determine the association between extended-spectrum cephalosporin resistance (ESC-R) and recurrence among Enterobacteriaceae (EB) UTIs.
METHODS
A retrospective cohort study was performed. All patients presenting to the Emergency Departments (EDs) or outpatient practices in a large health system with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed patients 1:1 on study year. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between ESC-R EB UTI and time to recurrent UTI within 12 months.
RESULTS
A total of 302 patients with an index community-onset EB UTI were included, with 151 exposed and 151 unexposed. Overall, 163 (54%) patients experienced a recurrent UTI with a median time to recurrence of 69 days (interquartile range 25-183). On multivariable analyses, ESC-resistance was associated with an increased hazard of recurrent UTI (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.01-1.91, P = 0.04). Other variables that were independently associated with recurrence included a history of UTI prior to the index UTI and presence of a urinary catheter at the time of the index UTI. Secondarily, we found that when the treatment for the index UTI was adjusted for, there was no longer a significant association between ESC-R status and time to recurrent UTI (aHR 1.26, 95% CI 0.91-1.76, P = 0.17).
CONCLUSIONS
Community-onset UTI due to EB demonstrating ESC-resistance is associated with a significantly increased hazard of recurrent UTI within 12 months compared to ESC-susceptible EB, even after adjusting for baseline factors that predispose patients to UTI recurrence. This association appears to be driven primarily by delayed or inappropriate treatment for the index ESC-R EB UTI.
背景
用于治疗社区获得性尿路感染（UTI）的一线抗生素的细菌耐药性不断出现。我们旨在确定肠杆菌科（EB）UTI 中广谱头孢菌素耐药（ESC-R）与复发之间的关联。
方法
进行了一项回顾性队列研究。纳入了 2010 年至 2013 年间在大型医疗系统的急诊科（ED）或门诊诊所就诊的所有患有 EB UTI 的患者。暴露组患者为 ESC-R EB UTI。未暴露组患者为 ESC 敏感的 EB UTI，且在研究年度与暴露组患者 1:1 匹配。采用多变量 Cox 比例风险回归分析评估 ESC-R EB UTI 与 12 个月内复发性 UTI 之间的关系。
结果
共纳入 302 例指数社区获得性 EB UTI 患者，其中 151 例为暴露组，151 例为未暴露组。总体而言，163 例（54%）患者发生了复发性 UTI，中位复发时间为 69 天（四分位距 25-183）。多变量分析显示，ESC 耐药与复发性 UTI 的风险增加相关（风险比 [HR] 1.39，95%置信区间 [CI] 1.01-1.91，P=0.04）。与复发独立相关的其他变量包括指数 UTI 之前的 UTI 病史和指数 UTI 时存在导尿管。其次，我们发现，当调整指数 UTI 的治疗时，ESC-R 状态与复发性 UTI 时间之间不再存在显著关联（调整后 HR 1.26，95%CI 0.91-1.76，P=0.17）。
结论
与 ESC 敏感的 EB 相比，社区获得性 UTI 中 ESC 耐药的 EB 与 12 个月内复发性 UTI 的风险显著增加相关，即使在调整了易使患者发生 UTI 复发的基线因素后。这种关联似乎主要是由对指数 ESC-R EB UTI 的延迟或不适当治疗引起的。
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