吸烟对疫苗或抗生素预防复发性尿路感染后细菌耐药性的影响。

The influence of smoking on bacterial resistance after vaccine or antibiotic prophylaxis against recurrent urinary tract infections.

机构信息

Departamento de Cirugía, Universidad de Salamanca, Salamanca, España; Servicio de Urología, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Grupo de Investigación Multidisciplinar Urológico Renal (GRUMUR), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.

Departamento de Cirugía, Universidad de Salamanca, Salamanca, España.

出版信息

Actas Urol Esp (Engl Ed). 2020 Sep;44(7):497-504. doi: 10.1016/j.acuro.2020.04.002. Epub 2020 Jun 25.

DOI:10.1016/j.acuro.2020.04.002

PMID:32595091

Abstract

INTRODUCTION

The influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status.

MATERIAL AND METHODS

Retrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n=495); Subgroups: GA1 non-smoker (n=417), GA2 smoker (n=78). Group B (GB): Vaccine (n=360); Subgroups: GB1 non-smoker (n=263), GB2 smoker (n=97).

VARIABLES

Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire.

RESULTS

Mean age 56.51 years (18-75), similar between groups (P=.2257). No difference in the number of pretreatment UTIs (P=.1329) or in the distribution of the bacterial spectrum (P=.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (P=.0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (P=.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin/clavulanic acid). In GB2 E. coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (P=.0144).

CONCLUSIONS

The development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.

摘要

简介

分析了烟草对复发性尿路感染（RUTI）患者微生物谱、耐药-敏感模式和进化的影响。评估多价细菌疫苗对预防 RUTI 和吸烟状况的影响。

材料和方法

对 2009 年至 2013 年间接受抑制性抗生素治疗或细菌疫苗治疗的 855 名 RUTI 女性进行回顾性多中心研究。A 组（GA）：抗生素（n=495）；亚组：GA1 不吸烟者（n=417），GA2 吸烟者（n=78）。B 组（GB）：疫苗（n=360）；亚组：GB1 不吸烟者（n=263），GB2 吸烟者（n=97）。

变量

年龄、治疗前 UTI、无病时间（DFT）、微生物种类、敏感性和耐药性。在 3、6 和 12 个月时进行随访，进行培养和 SF-36 问卷调查。

结果

平均年龄 56.51 岁（18-75 岁），两组间无差异（P=.2257）。治疗前 UTIs 的数量无差异（P=.1329），细菌谱分布也无差异（P=.7471）。B 组的 DFT 高于 A 组。GA1 中的尿液培养：大肠埃希菌 62.71%，耐药率 8.10%（33%喹诺酮类；33%复方新诺明；33%喹诺酮类+复方新诺明）；GA2 中的大肠埃希菌 61.53%，耐药率 75%（16.66%喹诺酮类；33.33%喹诺酮类+复方新诺明；16.66%阿莫西林克拉维酸；16.66%红霉素+磷霉素+克林霉素）（P=.0133）。GA 中接受复方新诺明和呋喃妥因治疗的患者之间无差异（P=.8724）。GB1 中的尿液培养：大肠埃希菌 47.36%，耐药率 22.22%（5.55%环丙沙星；5.55%复方新诺明；5.55%环丙沙星+复方新诺明；5.55%阿莫西林/克拉维酸）。GB2 中的大肠埃希菌 70.02%，耐药率 61.90%（30.76%喹诺酮类；30.76%复方新诺明；30.76%喹诺酮类+复方新诺明；17.69%阿莫西林/克拉维酸）（P=.0144）。