Paul Foster School of Medicine, Texas Tech University Health Sciences El Paso, El Paso, TX, USA.
Department of Emergency Medicine, Texas Tech University Health Sciences El Paso, El Paso, TX, USA.
Am J Emerg Med. 2022 Nov;61:12-17. doi: 10.1016/j.ajem.2022.08.023. Epub 2022 Aug 14.
Urinary tract infections (UTIs) seen in the emergency department are commonly treated as an outpatient with oral antibiotics. Given that antibiotics are available for over-the-counter purchase in Mexico, there is speculation that potential misuse and overuse of antibiotics in United States-Mexico border areas could lead to antibiotic resistance patterns that would render some empiric treatments for UTIs less effective. The purpose of this study was to examine the effectiveness of Infectious Disease Society of America (IDSA) guideline-recommended antibiotics for treatment of outpatient UTI diagnosed in the emergency department. Data were collected from a county hospital on the U.S.-Mexico border with a metropolitan area of over 2 million people. Secondary analysis included frequency of urine culture isolated, resistance rates of urine pathogens, and prescriber habits.
This study was a retrospective chart review of adult patients diagnosed and treated for UTI from August 1, 2019, to February 29, 2020. Culture results of included patients were analyzed against in vitro-tested antibiotics. Bacterial isolate frequency, resistance rates, and prescribing habits were collected.
A total of 985 patient charts were reviewed, of which 520 patients met inclusion criteria for analysis of prescribing habits. Of these, 329 positive bacterial culture growths were included in the analysis of antibiotic resistance rates. Oral antibiotics with comparatively lower resistance rates were amoxicillin/clavulanate, cefdinir, cefuroxime, and nitrofurantoin. Oral antibiotics with notably high resistance rates included trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline, ciprofloxacin, levofloxacin, and cephalexin. Nitrofurantoin was prescribed most frequently for outpatient treatment of UTI/cystitis (41.6%) while cephalexin was the most commonly prescribed antibiotic for outpatient treatment of pyelonephritis (50%).
Our findings suggest that, while part of standard IDSA guidelines, fluoroquinolones and TMP-SMX are not ideal empiric antibiotics for treatment of outpatient UTI in the U.S.-Mexico border region studied due to high resistance rates. Although not listed as first line agents per current IDSA recommendations, 2nd and 3rd generation cephalosporins, and amoxicillin/clavulanate would be acceptable options given resistance patterns demonstrated in accordance with IDSA allowance for tailoring selection to local resistance. Nitrofurantoin appears to be consistent with recommendations and demonstrates a favorable resistance profile for treatment of outpatient UTI within this region.
在急诊科就诊的尿路感染（UTI）通常采用口服抗生素进行门诊治疗。鉴于抗生素在墨西哥可在柜台购买，因此有人推测，在美国-墨西哥边境地区，抗生素的潜在误用和滥用可能导致抗生素耐药模式的出现，从而使一些用于治疗 UTI 的经验性治疗效果降低。本研究旨在检查传染病学会（IDSA）指南推荐的抗生素治疗急诊科诊断出的门诊 UTI 的有效性。数据来自一个拥有 200 多万人口的大都市的美国-墨西哥边境县医院。次要分析包括尿培养分离的频率、尿病原体的耐药率以及处方习惯。
这是一项回顾性图表研究，纳入了 2019 年 8 月 1 日至 2020 年 2 月 29 日期间因 UTI 就诊并接受治疗的成年患者。分析纳入患者的培养结果与体外测试的抗生素相对照。收集细菌分离株的频率、耐药率和处方习惯。
共回顾了 985 份患者图表，其中 520 份患者的处方习惯分析符合纳入标准。在这些患者中，329 例阳性细菌培养物纳入了抗生素耐药率分析。具有相对较低耐药率的口服抗生素包括阿莫西林/克拉维酸、头孢地尼、头孢呋辛和呋喃妥因。具有显著高耐药率的口服抗生素包括复方磺胺甲噁唑（TMP-SMX）、四环素、环丙沙星、左氧氟沙星和头孢氨苄。呋喃妥因最常用于门诊治疗 UTI/膀胱炎（41.6%），而头孢氨苄是门诊治疗肾盂肾炎最常用的抗生素（50%）。
我们的研究结果表明，尽管氟喹诺酮类药物和 TMP-SMX 是 IDSA 指南的一部分，但由于耐药率较高，它们并不是我们所研究的美国-墨西哥边境地区治疗门诊 UTI 的理想经验性抗生素。尽管根据当前 IDSA 建议，它们未被列为一线药物，但根据 IDSA 允许根据当地耐药情况调整选择的规定，第二代和第三代头孢菌素以及阿莫西林/克拉维酸将是可以接受的选择。呋喃妥因似乎符合建议，并表现出有利于该地区门诊 UTI 治疗的耐药谱。
