门诊患者中多药耐药大肠埃希菌对呋喃妥因的耐药率和敏感性的时间趋势。

Time trend of prevalence and susceptibility to nitrofurantoin of urinary MDR Escherichia coli from outpatients.

机构信息

Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Belgium.

Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.

出版信息

J Antimicrob Chemother. 2019 Nov 1;74(11):3264-3267. doi: 10.1093/jac/dkz323.

DOI:10.1093/jac/dkz323

PMID:31377782

Abstract

OBJECTIVES

To assess the time trend of the prevalence of urinary MDR Escherichia coli in Belgian outpatients (2005 versus 2011-12), the antibiotic susceptibility of urinary MDR E. coli, and the time trend of non-susceptibility to nitrofurantoin, i.e. first-line treatment for uncomplicated urinary tract infections (UTIs), of urinary MDR E. coli (2005 versus 2011-12).

METHODS

In this secondary analysis of a multicentre study, which collected a convenience sample of voluntary participating laboratories (15 and 8 in 2005 and 2011-12, respectively), we analysed antimicrobial susceptibilities (ampicillin, amoxicillin/clavulanate, cefalotin, ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole) of urinary E. coli. MDR was defined as resistance to three or more of these agents. The prevalence of MDR E. coli and its non-susceptibility to nitrofurantoin was compared between 2005 and 2011-12 using a generalized estimating equation model.

RESULTS

MDR status could be determined for 9704 and 12512 urinary E. coli isolates from 7911 and 9441 patients in 2005 and 2011-12, respectively, with most patients being women (79% in both study periods). The prevalence of MDR increased from 28.4% (2758/9704) in 2005 to 34.3% (4286/12512) in 2011-12 (adjusted OR 1.305; 95% CI 1.220-1.397). Within the MDR isolates, the prevalence of nitrofurantoin non-susceptibility decreased from 23.2% (623/2684) in 2005 to 10.7% (455/4253) in 2011-12 (adjusted OR 0.424; 95% CI 0.363-0.494).

CONCLUSIONS

Despite a high prevalence of MDR E. coli in urinary samples from Belgian outpatients, nitrofurantoin could still be recommended as first-line empirical treatment in uncomplicated UTIs.

摘要

目的

评估比利时门诊患者尿液中多重耐药性大肠杆菌（MDR）的流行率（2005 年与 2011-12 年）、尿液中 MDR 大肠杆菌的抗生素敏感性以及 MDR 大肠杆菌对呋喃妥因（治疗单纯性尿路感染的一线药物）的耐药率的时间趋势（2005 年与 2011-12 年）。

方法

本研究为多中心研究的二次分析，收集了自愿参与实验室的便利样本（2005 年和 2011-12 年分别为 15 个和 8 个），分析了尿液大肠杆菌的抗菌药物敏感性（氨苄西林、阿莫西林/克拉维酸、头孢洛林、环丙沙星、呋喃妥因和复方磺胺甲噁唑）。将对三种或三种以上药物耐药的大肠杆菌定义为 MDR 大肠杆菌。使用广义估计方程模型比较 2005 年和 2011-12 年 MDR 大肠杆菌的流行率及其对呋喃妥因的耐药率。

结果

在 2005 年和 2011-12 年，分别对 7911 名和 9441 名患者的 9704 株和 12512 株尿液大肠杆菌进行了 MDR 状态的检测，大多数患者为女性（两个研究期间均为 79%）。2005 年 MDR 大肠杆菌的流行率为 28.4%（2758/9704），2011-12 年增至 34.3%（4286/12512）（调整后的 OR 1.305；95%CI 1.220-1.397）。在 MDR 分离株中，呋喃妥因耐药率从 2005 年的 23.2%（623/2684）降至 2011-12 年的 10.7%（455/4253）（调整后的 OR 0.424；95%CI 0.363-0.494）。