Kumar Nitin, Chatterjee Kuhu, Deka Sangeeta, Shankar Ravi, Kalita Deepjyoti
General Practice, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND.
Microbiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, IND.
Cureus. 2021 Mar 11;13(3):e13837. doi: 10.7759/cureus.13837.
Management of community-acquired urinary tract infection (CA-UTI) relies heavily on empirical antibiotic therapy. Knowledge of the proportion of drug-resistant isolates especially extended-spectrum beta-lactamase (ESBL)-producing (), and various risk factors for acquisition are essential.
Outpatient-treated CA-UTI cases were enrolled (continuously for three months), and microbiological analysis of urine sample was performed for significant bacterial growth followed by identification of conventional and matrix-assisted laser desorption/ionization-time of flight (MALDI-ToF) spectrometry method. Subsequent drug resistance and phenotypic ESBL detection were as per guidelines of the Clinical Laboratory Standard Institute (CLSI, USA). Univariate and multivariate analyses (logistic regression) of known and relevant risk factors of ESBL were performed as per standard statistical technique, using the SPSS computer package (IBM Corp., Armonk, NY). Results: Two hundred and forty-one samples (of 694 samples) yielded significant growth. Sixty-one of 131 (46.6%) isolates were found to be ESBL producers. Non-beta-lactam antibiotic resistance in ESBL producers was high compared to non-ESBL producers (e.g., 88.5% vs 42.3% for quinolone resistance, 80.3% vs 34.3% for gentamicin resistance, etc.). Multivariate analysis (after univariate analysis detected probable factors of a likely ESBL model) indicated significant associations of ESBL-producing with advancing age (>55 years), prior hospitalization in last one year, use of antibiotics in previous six months, and presence of comorbid illness such as diabetes mellitus and chronic lung disease.
High proportion of our community-acquired uropathogens are ESBL-producing and likely resistant to important antimicrobial agents such as quinolones, gentamicin, etc. Factors like advancing age, prior hospitalization, and antibiotic use, as well as comorbidities such as diabetes and chronic lung disease, may be strongly associated with ESBL and should be rememberedwhile administering or preparing guidelines for empiric management of CA-UTI subjects.
社区获得性尿路感染（CA-UTI）的管理在很大程度上依赖于经验性抗生素治疗。了解耐药菌株的比例，尤其是产超广谱β-内酰胺酶（ESBL）的菌株比例，以及各种感染获得的风险因素至关重要。
纳入门诊治疗的CA-UTI病例（连续三个月），对尿样进行微生物分析以检测显著的细菌生长，随后采用传统方法和基质辅助激光解吸/电离飞行时间（MALDI-ToF）光谱法进行鉴定。随后按照美国临床实验室标准协会（CLSI）的指南进行耐药性检测和ESBL表型检测。使用SPSS计算机软件包（IBM公司，纽约州阿蒙克），按照标准统计技术对ESBL的已知相关风险因素进行单因素和多因素分析（逻辑回归）。
694份样本中有241份样本有显著生长。131株分离菌中有61株（46.6%）被发现产ESBL。与非ESBL产菌者相比，ESBL产菌者对非β-内酰胺类抗生素的耐药性较高（例如，喹诺酮耐药率分别为88.5%和42.3%，庆大霉素耐药率分别为80.3%和34.3%等）。多因素分析（在单因素分析检测出可能的ESBL模型的相关因素后）表明，产ESBL菌株与年龄增长（>55岁）、过去一年曾住院、过去六个月使用过抗生素以及存在糖尿病和慢性肺病等合并症显著相关。
我们社区获得性尿路病原菌中产ESBL的比例很高，并且可能对喹诺酮、庆大霉素等重要抗菌药物耐药。年龄增长、既往住院史、抗生素使用以及糖尿病和慢性肺病等合并症等因素可能与产ESBL菌株密切相关，在制定或准备CA-UTI患者经验性治疗指南时应予以考虑。
