Master Program of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2022 Mar 31;17(3):e0266416. doi: 10.1371/journal.pone.0266416. eCollection 2022.
Diabetic patients are at risk of severe urinary tract infections (UTIs). Due to the emerging resistance rates to fluoroquinolones and β-lactams, we aimed to evaluate the effectiveness of β-lactams versus fluoroquinolones as empirical therapy for diabetic patients hospitalized for UTIs.
A retrospective cohort study was conducted in a medical center in Taiwan between 2016 and 2018. Patients with type 2 diabetes, aged ≥20 and hospitalized for UTIs were enrolled. Patients with UTI diagnosis within one year before the admission, co-infections at the admission, or ≥2 pathogens in the urine cultures were excluded. The primary outcome was empiric treatment failure.
298 patients were followed for at least 30 days after the admission. Escherichia coli (61.07%) was the most common pathogen. The resistance rates of the pathogens to levofloxacin were 28.52% and 34.22% according to the historical Clinical and Laboratory Standards Institute (CLSI) breakpoints and the updated 2019 CLSI breakpoints, respectively. The resistance rates of ceftazidime and cefepime were 21.81% and 11.41%, respectively. Empirical β-lactams were associated with less treatment failure compared to fluoroquinolones (adjusted OR = 0.32, 95% CI = 0.17-0.60). Beta-lactams were associated with less treatment failure than fluoroquinolones when appropriatness was determined by the pre-2019 CLSI breakpoints but not the 2019 CLSI breakpoints.
In diabetic patients hospitalized for UTIs, β-lactams were associated with less empiric treatment failure compared to fluoroquinolones when the resistance rate to fluoroquinolone is higher than β-lactams. The updated 2019 CLSI breakpoint for fluoroquinolone was better than pre-2019 CLSI breakpoints to correlate with treatment outcomes for hospitalized UTIs in diabetic patients.
糖尿病患者存在发生严重尿路感染（UTI）的风险。由于氟喹诺酮类和β-内酰胺类药物的耐药率不断上升，我们旨在评估β-内酰胺类药物与氟喹诺酮类药物作为糖尿病患者因 UTI 住院的经验性治疗的疗效。
本研究为 2016 年至 2018 年在台湾一家医疗中心进行的回顾性队列研究。纳入年龄≥20 岁且因 UTI 住院的 2 型糖尿病患者。排除入院前一年内有 UTI 诊断、入院时合并感染或尿培养中存在≥2 种病原体的患者。主要结局为经验性治疗失败。
298 例患者在入院后至少随访 30 天。大肠埃希菌（61.07%）是最常见的病原体。根据历史临床和实验室标准协会（CLSI）折点和更新的 2019 CLSI 折点，病原体对左氧氟沙星的耐药率分别为 28.52%和 34.22%。头孢他啶和头孢吡肟的耐药率分别为 21.81%和 11.41%。与氟喹诺酮类药物相比，经验性使用β-内酰胺类药物治疗失败的风险较低（校正 OR=0.32，95%CI=0.17-0.60）。当根据 2019 年 CLSI 折点而非 2019 年 CLSI 折点来判断β-内酰胺类药物的适用性时，与氟喹诺酮类药物相比，β-内酰胺类药物治疗失败的风险较低。
在因 UTI 住院的糖尿病患者中，当氟喹诺酮类药物的耐药率高于β-内酰胺类药物时，与氟喹诺酮类药物相比，β-内酰胺类药物的经验性治疗失败率较低。与治疗 2019 年 CLSI 折点之前相比，更新的 2019 年 CLSI 折点更能反映糖尿病住院患者 UTI 的治疗结局。
