Pedro Kourí Tropical Medicine Institute (IPK), Havana, Cuba.
Héroes de Baire Hospital, Isle of Youth Special Municipality, Cuba.
MEDICC Rev. 2022 May 16;24(2):20-25. doi: 10.37757/mr2022.v24.n2.2.
Urinary tract infection is the second-leading reason for consults in primary health care. Bacterial urinary tract infections are the most common, of which is the main etiologic agent. Antimicrobial resistance and multidrug resistance complicate effective community treatment, especially if resistance is caused by extended-spectrum beta-lactamase production. WHO recommends that antimicrobial susceptibility be evaluated in different regions of the world at different times. Community-acquired E. coli's susceptibility to colistin has not yet been studied in Cuba, and mcr-1 gene screening is necessary.
Evaluate community-acquired uropathogenic isolates' susceptibility to antibiotics, including colistin, and identify extended-spectrum beta-lactamase-producing bacteria.
We conducted a descriptive cross-sectional study that included 281 community-acquired uropathogenic isolates (153 from the Isle of Youth Special Municipality's Hygiene, Epidemiology, and Microbiology Center and 128 from Microbiology Laboratories of 7 institutions in Havana) from June 2016 through July 2018. We used the disk diffusion method to determine susceptibility to ampicillin, ampicillin/sulbactam, cefazolin, trimethoprim/sulfamethoxazole, ciprofloxacin, nitrofurantoin and fosfomycin. The disk elution method was used to determine susceptibility to colistin. The combined disk method was used to identify extended-spectrum beta-lactamases. Estimates were made regarding the frequency and percentages of antimicrobial susceptibility and resistance, as well as multidrug-resistance patterns.
Of the 281 isolates, 68.3% (192/281) were resistant to ampicillin, 54.8% (154/281) were resistant to ciprofloxacin, and 49.5% (139/281) were resistant to trimethoprim/sulfamethoxazole. Resistance to colistin was not detected. On the other hand, 14.2% (40/281) were susceptible to the 8 antibiotics we evaluated, 22.1% (62/281) showed resistance to only 1 antibiotic, and 63.7% (179/281) were resistant to 2 or more antibiotics. In the extended-spectrum beta-lactamase determination, 34.5% (97/281) had inhibition zones ≤14 mm with cefazolin. Of those with inhibition zones, 64.9% (63/97) were positive in the phenotype test, and 35.1% (34/97) were negative. In extended-spectrum beta-lactamase-producing bacteria, 1.6% (1/63) were resistant to fosfomycin, and 3.2% (2/63) were resistant to nitrofurantoin. The most common multidrug-resistance pattern (22.9%; 30/131) was to ampicillin/sulbactam, ampicillin, cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole.
Uropathogenic resistance to the antibiotics most frequently used in community medical practice is quite common, and extended-spectrum beta-lactamase-producing bacteria is the mechanism for beta-lactam antibiotic resistance. Multidrug-resistance patterns include resistance to the antibiotics most used in community-acquired infections. Fosfomycin and nitrofurantoin are the most active in extended-spectrum beta-lactamase producing bacteria. All the isolates were susceptible to colistin.
尿路感染是基层医疗保健中第二大就诊原因。细菌性尿路感染最为常见，其中 是主要的病原体。抗生素耐药性和多重耐药性使有效的社区治疗变得复杂，尤其是如果耐药性是由扩展谱β-内酰胺酶产生引起的。世界卫生组织建议在不同时间和不同地区评估抗菌药物敏感性。古巴尚未研究社区获得性大肠杆菌对黏菌素的敏感性，需要进行 mcr-1 基因筛查。
评估社区获得性尿路致病性 分离株对包括黏菌素在内的抗生素的敏感性，并鉴定产生扩展谱β-内酰胺酶的细菌。
我们进行了一项描述性的横断面研究，包括 281 株社区获得性尿路致病性 分离株（153 株来自青年岛特别市卫生、流行病学和微生物中心，128 株来自哈瓦那 7 个机构的微生物实验室），时间为 2016 年 6 月至 2018 年 7 月。我们使用纸片扩散法测定氨苄西林、氨苄西林/舒巴坦、头孢唑林、复方磺胺甲噁唑、环丙沙星、呋喃妥因和磷霉素的敏感性。采用纸片洗脱法测定黏菌素的敏感性。采用联合纸片法鉴定产超广谱β-内酰胺酶。估计了抗菌药物敏感性和耐药性的频率和百分比，以及多药耐药模式。
在 281 株分离株中，68.3%（192/281）对氨苄西林耐药，54.8%（154/281）对环丙沙星耐药，49.5%（139/281）对复方磺胺甲噁唑耐药。未检测到对黏菌素的耐药性。另一方面，14.2%（40/281）对我们评估的 8 种抗生素敏感，22.1%（62/281）仅对 1 种抗生素耐药，63.7%（179/281）对 2 种或更多种抗生素耐药。在产超广谱β-内酰胺酶的测定中，34.5%（97/281）头孢唑林的抑菌圈直径≤14mm。在有抑菌圈的菌株中，64.9%（63/97）表型试验阳性，35.1%（34/97）阴性。在产超广谱β-内酰胺酶的细菌中，1.6%（1/63）对磷霉素耐药，3.2%（2/63）对呋喃妥因耐药。最常见的多药耐药模式（22.9%；30/131）是对氨苄西林/舒巴坦、氨苄西林、头孢唑林、环丙沙星和复方磺胺甲噁唑耐药。
尿路致病性 对抗生素的耐药性在社区医疗实践中非常常见，而产超广谱β-内酰胺酶的细菌是β-内酰胺类抗生素耐药的机制。多药耐药模式包括对社区获得性感染最常用的抗生素的耐药性。磷霉素和呋喃妥因对产超广谱β-内酰胺酶的细菌最有效。所有分离株均对黏菌素敏感。
