School of Medicine, University of St Andrews, Fife, Scotland.
University of West of Scotland, Paisley, Scotland.
BMC Infect Dis. 2022 Oct 28;22(1):805. doi: 10.1186/s12879-022-07768-7.
Urinary tract infections are one of the most common infections in primary and secondary care, with the majority of antimicrobial therapy initiated empirically before culture results are available. In some cases, however, over 40% of the bacteria that cause UTIs are resistant to some of the antimicrobials used, yet we do not know how the patient outcome is affected in terms of relapse, treatment failure, progression to more serious illness (bacteraemia) requiring hospitalization, and ultimately death. This study analyzed the current patterns of antimicrobial use for UTI in the community in Scotland, and factors for poor outcomes.
To explore antimicrobial use for UTI in the community in Scotland, and the relationship with patient characteristics and antimicrobial resistance in E. coli bloodstream infections and subsequent mortality.
We included all adult patients in Scotland with a positive blood culture with E. coli growth, receiving at least one UTI-related antimicrobial (amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim, and nitrofurantoin) between 1st January 2009 and 31st December 2012. Univariate and multivariate logistic regression analysis was performed to understand the impact of age, gender, socioeconomic status, previous community antimicrobial exposure (including long-term use), prior treatment failure, and multi-morbidity, on the occurrence of E. coli bacteraemia, trimethoprim and nitrofurantoin resistance, and mortality.
There were 1,093,227 patients aged 16 to 100 years old identified as receiving at least one prescription for the 5 UTI-related antimicrobials during the study period. Antimicrobial use was particularly prevalent in the female elderly population, and 10% study population was on long-term antimicrobials. The greatest predictor for trimethoprim resistance in E. coli bacteraemia was increasing age (OR 7.18, 95% CI 5.70 to 9.04 for the 65 years old and over group), followed by multi-morbidity (OR 5.42, 95% CI 4.82 to 6.09 for Charlson Index 3+). Prior antimicrobial use, along with prior treatment failure, male gender, and higher deprivation were also associated with a greater likelihood of a resistant E. coli bacteraemia. Mortality was significantly associated with both having an E. coli bloodstream infection, and those with resistant growth.
Increasing age, increasing co-morbidity, lower socioeconomic status, and prior community antibiotic exposure were significantly associated with a resistant E. coli bacteraemia, which leads to increased mortality.
尿路感染是初级和二级保健中最常见的感染之一，大多数抗菌治疗在培养结果出来之前都是经验性地开始的。然而，在某些情况下，超过 40%引起尿路感染的细菌对一些使用的抗菌药物有耐药性，但我们不知道患者的复发、治疗失败、病情进展为更严重的疾病（菌血症）需要住院治疗以及最终死亡的情况如何受到影响。本研究分析了苏格兰社区中尿路感染的抗菌药物使用现状以及与患者特征和大肠埃希菌血流感染中抗菌药物耐药性的关系以及随后的死亡率。
探讨苏格兰社区中尿路感染的抗菌药物使用情况，以及与大肠埃希菌血流感染和随后死亡率相关的患者特征和抗菌药物耐药性的关系。
我们纳入了所有在苏格兰接受至少一次与尿路感染相关的抗菌药物（阿莫西林、阿莫西林/克拉维酸、环丙沙星、甲氧苄啶和呋喃妥因）治疗的阳性血培养中生长的大肠埃希菌的成年患者，这些患者的治疗时间为 2009 年 1 月 1 日至 2012 年 12 月 31 日。我们进行了单变量和多变量逻辑回归分析，以了解年龄、性别、社会经济地位、之前的社区抗菌药物暴露（包括长期使用）、先前的治疗失败和多种合并症对大肠埃希菌菌血症、甲氧苄啶和呋喃妥因耐药性以及死亡率的影响。
在研究期间，我们确定了 1093227 名年龄在 16 至 100 岁之间的患者至少接受了一次与 5 种尿路感染相关的抗菌药物处方。抗菌药物的使用在老年女性中尤为普遍，10%的研究人群长期使用抗菌药物。在大肠埃希菌菌血症中，导致甲氧苄啶耐药的最大预测因素是年龄的增加（年龄在 65 岁及以上的患者组的比值比[OR]为 7.18，95%置信区间[CI]为 5.70 至 9.04），其次是多种合并症（Charlson 指数为 3+的患者的 OR 为 5.42，95%CI 为 4.82 至 6.09）。先前的抗菌药物使用、先前的治疗失败、男性性别和更高的贫困程度也与更有可能发生耐药性大肠埃希菌菌血症相关。死亡率与大肠埃希菌血流感染和耐药菌生长显著相关。
年龄的增加、合并症的增加、社会经济地位的降低以及之前的社区抗生素暴露与耐药性大肠埃希菌菌血症显著相关，这会导致死亡率增加。
