巴基斯坦尿路感染患者的抗生素耐药性
Antibiotic resistance in patients with urinary tract infections in Pakistan.
作者信息
Bullens M, de Cerqueira Melo A, Raziq S, Lee J, Khalid G G, Khan S N, Zada A, Wailly Y, Zeshan S M, Saad N J, Gil-Cuesta J, Williams A
机构信息
Timurgara District Hospital Project, Médecins Sans Frontières Operational Centre Brussels (MSF OCB), Timurgara, Pakistan.
MSF OCB, Medical Department, Brussels, Belgium.
出版信息
Public Health Action. 2022 Mar 21;12(1):48-52. doi: 10.5588/pha.21.0071.
BACKGROUND
The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017-2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in in Pakistan.
METHODS
A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18-65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test.
RESULTS
Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: was isolated in 27 samples, spp. in 7 and in 6. Overall resistance to ciprofloxacin was observed in 51.8% of isolates, and ceftriaxone resistance in 66.7% of isolates and in 33.3% of . Resistance to fosfomycin was low (one isolate).
CONCLUSIONS
This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.
背景
引起单纯性尿路感染（UTIs）的病原体的抗生素耐药水平正在上升。2017 - 2018年全球抗菌药物耐药与使用监测系统（GLASS）报告显示，在巴基斯坦，超过70%的病原体对头孢曲松和环丙沙星耐药。
方法
2017年9月至2018年12月，在巴基斯坦蒂穆尔加拉无国界医生组织（MSF）支持的蒂穆尔加拉地区医院进行了一项前瞻性研究。邀请18 - 65岁因单纯性UTI（膀胱炎/肾盂肾炎）症状到急诊科就诊的女性参与。我们对尿试纸或亚硝酸盐试验呈阳性的样本进行了微生物培养和药敏试验。
结果
在参与的200名患者中，109名（54.5%）被诊断为肾盂肾炎，91名（45.5%）为膀胱炎。43个样本（21.5%）培养呈阳性：27个样本分离出大肠杆菌，7个样本分离出克雷伯菌属，6个样本分离出肠球菌。在分离出的大肠杆菌中，51.8%对环丙沙星耐药，66.7%的大肠杆菌和33.3%的肠球菌对头孢曲松耐药。对磷霉素的耐药率较低（1株大肠杆菌分离株）。
结论
本研究发现，按照无国界医生组织的方案，治疗UTIs的一线和二线抗生素存在耐药情况。提高认识以及对当地处方做法进行潜在改变对于遏制引起UTIs的抗菌药物耐药病原体的传播是必要的。
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