Mayo Clinic, Department of Emergency Medicine, Jacksonville, Florida.
Mayo Clinic, Division of Clinical Trials and Biostatistics, Jacksonville, Florida.
West J Emerg Med. 2022 Aug 19;23(5):613-617. doi: 10.5811/westjem.2022.4.54872.
Urinary tract infections (UTI) are one of the most common infections encountered in the emergency department (ED) with an estimated 2-3 million annual visits. Commonly prescribed antibiotics for UTIs have shown growing rates of resistance. Previous studies lack direction on improving UTI treatment based on the labs available to the bedside clinician.
We sought to determine if antibiotic resistance in UTIs was related to demographics, urinalysis, and history of renal failure or kidney stones. We conducted an analysis of 892 women ≥18 years of age discharged from the ED with a UTI diagnosis. We assessed predictors of nitrofurantoin resistance, cefazolin resistance, ciprofloxacin resistance, and trimethoprim-sulfamethoxazole resistance using unadjusted and multivariable logistic regression models.
Antibiotic resistance was 13.6% for nitrofurantoin, 11.9% for cefazolin, 12.8% for ciprofloxacin, and 17.1% for trimethoprim-sulfamethoxazole. In multivariable analysis, significant independent associations with an increased likelihood of resistance to nitrofurantoin were observed for less urine blood (OR [per 1 category increase of score] 0.81; P = 0.02); greater mucous (OR [per 1 category increase of score] 1.22; P = 0.02); less specific gravity urine (OR [per 1 category increase] 0.87; P = 0.04), and presence of any history of kidney stones (OR 3.24; P = 0.01). There were no significant predictors for cefazolin resistance (all P ≥0.06); age was the only significant predictor of ciprofloxacin resistance (OR per 10 year increase] 1.10, P = 0.05), and lower specific gravity urine was significantly associated with an increased risk of resistance to trimethoprim- sulfamethoxazole (OR [per 1 category increase] 0.88, P = 0.04).
Women with any history of kidney stones may have bacteriuria resistant to nitrofurantoin, suggesting that providers might consider alternative antibiotic therapies in this scenario.
尿路感染（UTI）是急诊科最常见的感染之一，估计每年有 200 至 300 万人次就诊。常用于治疗 UTI 的抗生素的耐药率不断上升。先前的研究缺乏根据床边临床医生可用的实验室来改善 UTI 治疗的方向。
我们试图确定 UTI 的抗生素耐药性是否与人口统计学、尿液分析以及肾衰竭或肾结石病史有关。我们对 892 名年龄在 18 岁及以上、从急诊科出院的 UTI 诊断女性进行了分析。我们使用未调整和多变量逻辑回归模型评估了呋喃妥因耐药、头孢唑林耐药、环丙沙星耐药和复方磺胺甲噁唑耐药的预测因素。
抗生素耐药率分别为：呋喃妥因 13.6%，头孢唑林 11.9%，环丙沙星 12.8%，复方磺胺甲噁唑 17.1%。在多变量分析中，尿液中血液成分较少（每增加一个评分类别，比值比 [OR] 0.81；P = 0.02）、粘液较多（OR [每增加一个评分类别] 1.22；P = 0.02）、尿液比重较低（OR [每增加一个类别] 0.87；P = 0.04）以及有任何肾结石病史与增加呋喃妥因耐药的可能性有显著的独立关联（OR 3.24；P = 0.01）。头孢唑林耐药没有显著的预测因素（所有 P 值均≥0.06）；年龄是环丙沙星耐药的唯一显著预测因素（每增加 10 年，OR 1.10，P = 0.05），尿液比重较低与对复方磺胺甲噁唑的耐药风险增加显著相关（OR [每增加一个类别] 0.88，P = 0.04）。
有肾结石病史的女性可能有对呋喃妥因耐药的菌尿，这表明在这种情况下，提供者可能会考虑替代抗生素治疗。
