Artero-López Javier, Gutiérrez-Soto Blanca, Expósito-Ruiz Manuela, Sorlózano-Puerto Antonio, Navarro-Marí José María, Gutiérrez-Fernández José
Departamento de Microbiología, Facultad de Medicina, Universidad de Granada-ibs. Granada. España.
Unidad de Medicina de Familia. Centro de Salud San Fernando. Badajoz. España.
Arch Esp Urol. 2021 Mar;74(2):197-207.
Adequate empirical treatment should be established for treatment urinary tract infections, considering the prevalence of the most frequent microorganisms in each geographic area and their susceptibility to different antibiotics. The objective of the study is to analyze the epidemiology of UTIs in our Health Area as well as to understand the antibiotic susceptibility of the most prevalent isolated microorganisms to guide empirical treatment. The objective was to establish a reasoned system for recommending ITU empirical therapy, based on the microorganisms causing episodes assisted in a Regional Hospital, knowing their antibiotic susceptibility. PATIENTS AND METHODS: A descriptive-retrospective study was carried out based on the results of 12,204 urine cultures of the year 2018. The overall empirical activity of the antibiotics tested was calculated, differentiating between episodes of the community and of in patients, adults and children. RESULTS: Escherichia coli was the most frequently isolated microorganism in all studied groups. The following microorganisms in frequency, in adults, were Enterococcus faecalis, Klebsiella pneumoniae and yeasts (8%). In the group of children these were Enterococcus faecalis and Proteus mirabilis. There was no difference in the activity of antibiotics against Escherichia coli, in adults or in children, of the community or in patients, with sensitivityto fosfomycin and nitrofuranto in greater than 96%; at imipenem and piperacillin-tazobactam greater than 94% and third generation cephalosporins greater than 90%. However, the overall empirical activity, without distinction by microorganism, was for fosfomycin 77.96-80.60% in adults and 92.73-94.50% in children; to prevent 77.70-78.74% in adults and 92.36-91.28% in children; for piperacillin-tazobactam of 77.57-80.03% in adults and 89.09-94.04% in children; and for cefotaxime of 53.28-54.76% in adults and 68.73-74.77% in children. CONCLUSIONS: Fosfomycin, piperacillin-tazobactam or imipenem were the best option for empirical treatment without covering all episodes in adults. Each Center must establish a reasoned profile of empirical treatment of the infection, which should also take into account risk factors for a microorganism and clinical severity.
应根据每个地理区域最常见微生物的流行情况及其对不同抗生素的敏感性，确立足够的经验性治疗方案来治疗尿路感染。本研究的目的是分析我们健康区域内尿路感染的流行病学情况，并了解最常见分离微生物的抗生素敏感性，以指导经验性治疗。目标是基于地区医院收治的感染病例中所涉及的微生物及其抗生素敏感性，建立一个合理的推荐尿路感染经验性治疗的系统。患者与方法：基于2018年12204份尿培养结果进行了一项描述性回顾性研究。计算了所测试抗生素的总体经验性活性，区分了社区感染和住院患者感染、成人和儿童感染。结果：在所有研究组中，大肠埃希菌是最常分离出的微生物。在成人中，按出现频率依次为粪肠球菌、肺炎克雷伯菌和酵母菌（8%）。在儿童组中则是粪肠球菌和奇异变形杆菌。无论在成人还是儿童中，无论社区感染还是住院患者感染，抗生素对大肠埃希菌的活性无差异，对磷霉素和呋喃妥因的敏感性大于96%；对亚胺培南和哌拉西林-他唑巴坦的敏感性大于94%，对第三代头孢菌素的敏感性大于90%。然而，不区分微生物的总体经验性活性方面，成人中磷霉素为77.96 - 80.60%，儿童中为92.73 - 94.50%；预防用抗生素成人中为77.70 - 78.74%，儿童中为92.36 - 91.28%；哌拉西林-他唑巴坦成人中为77.57 - 80.03%，儿童中为89.09 - 94.04%；头孢噻肟成人中为53.28 - 54.76%，儿童中为68.73 - 74.77%。结论：磷霉素、哌拉西林-他唑巴坦或亚胺培南是成人经验性治疗的最佳选择，但不能涵盖所有病例。每个中心必须建立一个合理的感染经验性治疗方案，同时还应考虑微生物的危险因素和临床严重程度。
