Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Centre for Family and Community Medicine, Faculty of Health Sciences, The Medical University of Lodz, Lodz, Poland.
PLoS One. 2021 Aug 31;16(8):e0256464. doi: 10.1371/journal.pone.0256464. eCollection 2021.
Given rising antibiotic resistance and increasing use of delayed prescription for uncomplicated lower urinary tract infections (UTI), patients at risk for treatment failure should be identified early. We assessed risk factors for clinical and microbiological failure in women with lower UTI. This case-control study nested within a randomized clinical trial included all women in the per-protocol population (PPP), those in the PPP with microbiologically confirmed UTI, and those in the PPP with UTI due to Escherichia coli. Cases were women who experienced clinical and/or microbiologic failure; controls were those who did not. Risk factors for failure were assessed using multivariate logistic regression. In the PPP, there were 152 clinical cases for 307 controls. Among 340 women with microbiologically confirmed UTI, 126 and 102 cases with clinical and microbiological failure were considered with, respectively, 214 and 220 controls. Age ≥52 years was independently associated with clinical (adjusted OR 3.01; 95%CI 1.84-4.98) and microbiologic failure (aOR 2.55; 95%CI 1.54-4.25); treatment with fosfomycin was associated with clinical failure (aOR 2.35; 95%CI 1.47-3.80). The association with age persisted among all women, and women with E. coli-related UTI. Diabetes was not an independent risk factor, nor were other comorbidities. Postmenopausal age emerged as an independent risk factor for both clinical and microbiological treatment failure in women with lower UTI and should be considered to define women at-risk for non-spontaneous remission, and thus for delayed antibiotic therapy; diabetes mellitus was not associated with failure.
鉴于抗生素耐药性的上升和延迟处方用于治疗简单性下尿路感染 (UTI) 的增加，应及早识别有治疗失败风险的患者。我们评估了患有下尿路感染的女性发生临床和微生物学失败的危险因素。这项病例对照研究嵌套在一项随机临床试验中，纳入了所有符合方案人群 (PPP) 中的女性、PPP 中经微生物学证实的 UTI 女性以及 PPP 中因大肠埃希菌引起的 UTI 女性。病例是经历临床和/或微生物学失败的女性；对照是未经历失败的女性。使用多变量逻辑回归评估失败的危险因素。在 PPP 中，有 152 例临床病例和 307 例对照。在 340 名经微生物学证实患有 UTI 的女性中，分别有 126 例和 102 例出现临床和微生物学失败的病例，并分别有 214 例和 220 例对照。年龄≥52 岁与临床（校正 OR 3.01；95%CI 1.84-4.98）和微生物学失败（aOR 2.55；95%CI 1.54-4.25）独立相关；使用磷霉素治疗与临床失败相关（aOR 2.35；95%CI 1.47-3.80）。这种与年龄的关联在所有女性和大肠埃希菌相关 UTI 女性中仍然存在。糖尿病不是独立的危险因素，其他合并症也不是。绝经后年龄是下尿路感染女性临床和微生物学治疗失败的独立危险因素，应考虑将其定义为非自发性缓解风险的女性，从而延迟抗生素治疗；糖尿病与失败无关。
