Global Medical Affairs, Zambon SpA, Via Lillo del Duca 10, 20091 Bresso (MI), Italy.
Department of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171, Blindern 0318, Norway; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark.
Int J Antimicrob Agents. 2022 May;59(5):106574. doi: 10.1016/j.ijantimicag.2022.106574. Epub 2022 Mar 18.
Urinary tract infections (UTIs) are prevalent worldwide, particularly among women. Their incidence increases with age, and treatment is increasingly challenging owing to antibiotic resistance and the lack of new agents. We investigated the susceptibility of current urinary isolates to fosfomycin and other antibiotics across Europe. This cross-sectional study collected consecutive urinary isolates from non-hospitalised women at 20 centres in Belgium, the UK, Italy, Spain and Russia. Bacteria were tested by disk diffusion with relevant antibiotics. As a quality control, a central laboratory re-tested, by agar dilution, (i) isolates found resistant to fosfomycin and (ii) every tenth isolate; all non-Russian sites were included. A total of 2848 isolates were analysed, principally Escherichia coli (2064; 72.5%), Klebsiella spp. (275; 9.7%) and Proteus spp. (103; 3.6%). For E. coli, agents active against >90% of isolates were nitrofurantoin (98.5%), fosfomycin (96.4%) and mecillinam (91.8%). Fosfomycin and nitrofurantoin remained active against >90% of cephalosporin-resistant E. coli. Among 143 E. coli recorded as susceptible locally by disk tests, 138 (96.5%) were confirmed susceptible by minimum inhibitory concentration (MIC) tests, however resistance was only confirmed in 29/58 (50.0%) of those reported resistant by local disk tests. Escherichia coli was found to be the most common uropathogen isolated and was highly susceptible to fosfomycin, nitrofurantoin and mecillinam, all used effectively for more than 30 years. Guidelines advocating fosfomycin for uncomplicated UTIs in women remain microbiologically valid.
尿路感染（UTI）在全球范围内普遍存在，尤其在女性中更为常见。随着年龄的增长，其发病率逐渐增加，且由于抗生素耐药性的出现和缺乏新的药物，治疗变得愈发具有挑战性。我们调查了欧洲目前尿分离株对磷霉素和其他抗生素的敏感性。这项横断面研究在比利时、英国、意大利、西班牙和俄罗斯的 20 个中心连续收集了非住院女性的尿分离株。细菌通过药敏纸片扩散法与相关抗生素进行检测。作为质量控制，一个中央实验室对发现对磷霉素耐药的（i）分离株和（ii）每 10 个分离株进行琼脂稀释法重新检测；所有非俄罗斯站点都包括在内。共分析了 2848 株分离株，主要为大肠埃希菌（2064 株；72.5%）、克雷伯菌属（275 株；9.7%）和普罗维登斯菌属（103 株；3.6%）。对于大肠埃希菌，对>90%的分离株有效的药物有：呋喃妥因（98.5%）、磷霉素（96.4%）和美西林（91.8%）。磷霉素和呋喃妥因对头孢菌素耐药的大肠埃希菌仍保持>90%的活性。在 143 株当地药敏纸片试验记录为敏感的大肠埃希菌中，通过最低抑菌浓度（MIC）试验证实为敏感的有 138 株（96.5%），然而，只有在当地药敏纸片试验报告的 58 株耐药株中，有 29 株（50.0%）的耐药性得到了证实。大肠埃希菌是最常见的尿病原体，对磷霉素、呋喃妥因和美西林高度敏感，这三种药物均已使用超过 30 年，疗效确切。对于女性单纯性尿路感染，指南仍推荐使用磷霉素，这在微生物学上仍然是合理的。
