Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea.
Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea.
J Infect Chemother. 2019 Jul;25(7):498-502. doi: 10.1016/j.jiac.2019.02.006. Epub 2019 Mar 7.
This study was performed to evaluate what percentage of urinary tract infections (UTIs) caused by extended spectrum β-lactamase (ESBL)-producing strains recurs with ESBL-producing strains during follow up and to assess the risk factors for recurrence with ESBL-producing Escherichia coli strains on subsequent first recurrence episode. We enrolled female patients with UTIs caused by ESBL-producing E. coli between May 2012 and December 2015, who were longitudinally followed up for at least 24 months. Among the 206 patients with ESBL positive UTI, 180 completed the study. 60 (60/180, 33.3%) of patient with first episode of UTI caused by ESBL-producing E. coli experienced recurrent UTIs during follow up. Of 60 patients, 43 (43/60, 71.7%) recurred with ESBL-producing E. coli on the first UTI recurrence episode. On multivariate analysis, the time to recurrence and history of cephalosporin usage in the last 6 months were identified as risk factors for recurrence with ESBL-producing E. coli per se (odds ratio [OR] = 0.9, 95% confidence interval [CI] 0.8-1.0, p = 0.030 and OR = 27.0, 95% CI 2.4-299.8, p = 0.007, respectively). These findings show that high proportion of patient with UTI caused by ESBL-producing E. coli recurs with ESBL-producing E. coli on subsequent recurrence episode. While result of antibiotic susceptibility cannot be identified on the visit day empirical treatment should be referred to the antecedent antibiotic resistance profile in patients whose previous UTIs were due to ESBL-producing strains.
本研究旨在评估产超广谱β-内酰胺酶（ESBL）的大肠埃希菌引起的尿路感染（UTI）在随访期间有多少比例会复发为产 ESBL 的菌株，并评估在随后的首次复发中，产 ESBL 的大肠埃希菌菌株复发的危险因素。我们招募了 2012 年 5 月至 2015 年 12 月期间由产 ESBL 的大肠埃希菌引起的 UTI 的女性患者，对其进行了至少 24 个月的纵向随访。在 206 名 ESBL 阳性 UTI 患者中，180 名完成了研究。在由产 ESBL 的大肠埃希菌引起的首次 UTI 发作的 180 名患者中，有 60 名（60/180，33.3%）在随访期间发生了复发性 UTI。在 60 名患者中，43 名（43/60，71.7%）在首次 UTI 复发时复发为产 ESBL 的大肠埃希菌。多变量分析显示，复发时间和最近 6 个月内使用头孢菌素史是产 ESBL 的大肠埃希菌本身复发的危险因素（比值比 [OR] = 0.9，95%置信区间 [CI] 0.8-1.0，p = 0.030 和 OR = 27.0，95%CI 2.4-299.8，p = 0.007）。这些发现表明，由产 ESBL 的大肠埃希菌引起的 UTI 患者中，有很大比例会在随后的复发中复发为产 ESBL 的大肠埃希菌。虽然在就诊当天无法确定抗生素敏感性的结果，但在以前的 UTI 是由产 ESBL 菌株引起的患者中，应该根据先前的抗生素耐药谱来选择经验性治疗。
