Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Int J Antimicrob Agents. 2022 Mar;59(3):106532. doi: 10.1016/j.ijantimicag.2022.106532. Epub 2022 Jan 26.
Clinical guidelines recommend empirical fluoroquinolone therapy for urinary tract infections (UTIs) only where local Escherichia coli resistance does not exceed 10%; however, access to local susceptibility data is not uniform across Canada and it is not known which regions meet this threshold. Our objective was to collect susceptibility data from across Canada to evaluate regional trends of E. coli resistance to fluoroquinolones. Antibiogram data were collected retrospectively for the years 2015-2019 from the most local level within each province, typically regional health authorities (RHAs) or local health zones. Antibiogram data were collected from publicly available sources or by directly contacting RHAs or health zones. Susceptibility data were aggregated into regional or population-level data. Antibiograms were collected from 72 regions across 10 provinces. These included 1 949 515 E. coli isolates. Only seven regions throughout Canada met the IDSA target of <10% resistance to consider empirical fluoroquinolone therapy at any point during the study period. The data consistently show that outpatient populations tend to have the highest susceptibility to fluoroquinolones, followed by inpatient populations, and finally long-term care patients. Rural populations also generally had higher susceptibility than urban. Nationally, the Atlantic provinces tended to show the highest susceptibility, especially towards the end of the study period. Fluoroquinolone resistance in E. coli appears to be plateauing within Canada after a rapid increase in the past 20 years. However, fluoroquinolones are rarely appropriate first-line treatment options for UTIs within Canada in the absence of factors eliminating other therapeutic options.
临床指南建议，只有在当地大肠杆菌耐药率不超过 10%的情况下，才对尿路感染（UTI）采用经验性氟喹诺酮类药物治疗；然而，加拿大各地并非都能获得当地药敏数据，也不知道哪些地区符合这一标准。我们的目的是收集加拿大各地的药敏数据，评估大肠杆菌对氟喹诺酮类药物耐药的地区趋势。2015 年至 2019 年，从每个省的最基层（通常是区域卫生局或当地卫生区）收集回顾性抗生素谱数据。抗生素谱数据从公开来源收集，或直接联系区域卫生局或卫生区收集。将药敏数据汇总为地区或人群水平的数据。从加拿大 10 个省的 72 个地区收集了抗生素谱。其中包括 1949515 株大肠杆菌分离株。在研究期间的任何时候，只有加拿大的 7 个地区符合 IDSA 的目标，即耐药率<10%，可以考虑采用经验性氟喹诺酮类药物治疗。这些数据一致表明，门诊人群对氟喹诺酮类药物的敏感性最高，其次是住院人群，最后是长期护理患者。农村人口的敏感性通常也高于城市人口。从全国范围来看，大西洋省份的敏感性最高，尤其是在研究后期。在过去 20 年里，加拿大大肠杆菌对氟喹诺酮类药物的耐药性呈快速上升后趋于平稳。然而，在加拿大，氟喹诺酮类药物很少作为 UTI 的一线治疗选择，除非有其他治疗方案可以替代。
