Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
S Afr Med J. 2021 Feb 1;111(2):124-128. doi: 10.7196/SAMJ.2021.v111i2.14905.
Urinary tract infections (UTIs) are very common in community practice. Both the South African (SA) antibiotic stewardship programme (2015) and the Essential Medicines List for SA (2018) recommend ciprofloxacin as first-line treatment for community-acquired urinary tract infections (CAUTIs). The pathogens responsible for CAUTIs and their susceptibility profiles need to be documented, which is important for developing and updating treatment protocols.
To determine the causative pathogens of CAUTIs in the greater Bloemfontein area, central SA, and to review their susceptibilities to commonly prescribed antibiotics.
Urine samples sent for microscopy and culture between 2011 and 2015 by the three largest primary healthcare facilities in Bloemfontein were analysed retrospectively. Specimens with a significant count (>105 CFU/mL) of a single uropathogen were included. These results were obtained from the National Health Laboratory Service central data warehouse after the required consent. Data regarding age, gender, pathogen cultured and antimicrobial susceptibilities were captured. All calculations were carried out with statistical analysis software SPSS 17.0 (SPSS Inc., USA).
A total of 712 samples met the inclusion criteria. Women accounted for 481 (67.6%) of the infections. The prevalence of UTIs per age group was as follows: 1 month - 25 years (n=146; 20.51%); 26 - 50 years (n=324; 45.5%); and 51 - 75 years (n=199; 27.9%). The distribution of pathogens did not differ between age groups. Escherichia coli was the most prevalent uropathogen cultured from 410 (57.6%) specimens, followed by Klebsiella spp. from 97 (13.6%) and Enterococcus spp. from 71 (10.0%) specimens. E. coli showed resistance rates of 77.1% to amoxicillin, 15.6% to amoxicillin-clavulanate, 18.5% to ciprofloxacin, 4% to nitrofurantoin and 11% to trimethoprim-sulfamethoxazole (TMP-SMX). The distribution of uropathogens was different for men and women, with a lower prevalence of E. coli in men (p=0.045).
As expected, E. coli comprised most of the isolates, with a higher than expected number of Klebsiella isolates cultured. The susceptibility of E. coli to commonly prescribed oral antibiotics has decreased in the research setting, which mirrors a global trend. This study provides data showing that TMP-SMX and nitrofurantoin can be used safely as alternatives to first-line ciprofloxacin in CAUTIs in central SA.
尿路感染（UTI）在社区实践中非常常见。南非（SA）抗生素管理计划（2015 年）和 SA 基本药物清单（2018 年）都推荐环丙沙星作为社区获得性尿路感染（CAUTI）的一线治疗药物。需要记录导致 CAUTI 的病原体及其药敏谱，这对于制定和更新治疗方案很重要。
确定南非布隆方丹地区 CAUTI 的病原体，并回顾其对常用处方抗生素的敏感性。
对布隆方丹三家最大的初级保健机构在 2011 年至 2015 年间送检的尿液样本进行回顾性分析。包括有单一尿路病原体的显著计数（>105 CFU/mL）的标本。这些结果是在获得所需同意后从国家卫生实验室服务中心数据仓库中获得的。收集了有关年龄、性别、培养的病原体和抗菌药物敏感性的数据。所有计算均使用统计分析软件 SPSS 17.0（美国 SPSS 公司）进行。
共有 712 个样本符合纳入标准。女性占 481 例（67.6%）感染。按年龄组计算的 UTI 患病率如下：1 个月至 25 岁（n=146；20.51%）；26-50 岁（n=324；45.5%）；51-75 岁（n=199；27.9%）。病原体的分布在不同年龄组之间没有差异。从 410 份标本中培养出最常见的尿路病原体是大肠埃希菌（57.6%），其次是克雷伯氏菌属（13.6%）和肠球菌属（10.0%）。大肠埃希菌对阿莫西林的耐药率为 77.1%，对阿莫西林-克拉维酸的耐药率为 15.6%，对环丙沙星的耐药率为 18.5%，对呋喃妥因的耐药率为 4%，对甲氧苄啶-磺胺甲噁唑（TMP-SMX）的耐药率为 11%。男性和女性的尿路病原体分布不同，男性大肠埃希菌的检出率较低（p=0.045）。
与预期的一样，大肠埃希菌是大多数分离株的主要成分，培养出的克雷伯菌属分离株数量高于预期。在研究环境中，大肠埃希菌对常用口服抗生素的敏感性下降，这反映了全球趋势。本研究提供的数据表明，TMP-SMX 和呋喃妥因可安全替代 CAUTI 的一线环丙沙星。
