经验性与基于培养的抗生素治疗绝经后女性尿路感染。
Empiric versus culture-based antibiotic therapy for UTIs in menopausal women.
机构信息
Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9113, USA.
出版信息
World J Urol. 2023 Mar;41(3):791-796. doi: 10.1007/s00345-023-04303-4. Epub 2023 Feb 7.
PURPOSE
To assess the benefits and risks associated with empiric prescription of antibiotic therapy for treatment of a urinary tract infection (UTI).
METHODS
Following IRB approval menopausal women presenting with a symptomatic UTI to a single urology clinic were prospectively assigned to one of the two treatment groups based on day of presentation: culture-based treatment (CB) (Monday, Tuesday, Wednesday) or empiric treatment (ET) (Thursday, Friday) and started on nitrofurantoin (NF) pending culture results. Both groups were contacted at 7 and 14 days following treatment. Side effects and answers to a standardized questionnaire (UTISA) were recorded. Success was defined as a total UTISA score < 3. Any NF retreatment, use of another antibiotic therapy, or extension of the original antibiotic course was considered treatment failures.
RESULTS
From July 2020 to March 2022, 65 women with 80 UTI events were included in the study, with CB treatment used for 60 UTIs and ET used for 23 UTIs. At 7 days after start of treatment, questionnaire failure rate was 44% (20/45) for the CB group and 16% (3/19) for the ET group (P = 0.076). At 14 days following start of treatment, questionnaire failure rate was 31% (13/42) for the CB group and 17% (3/18) for the ET group (P = 0.3). In the ET group, 11% of cultures were found to be resistant to NF.
CONCLUSION
Outcomes for the empiric treatment of uncomplicated UTI with NF at both 7 and 14 days are not significantly different than outcomes with culture-based treatment.
目的
评估经验性处方抗生素治疗尿路感染（UTI）的获益和风险。
方法
经机构审查委员会批准后，前瞻性地将因有症状 UTI 就诊于一家泌尿科诊所的绝经后女性根据就诊日分为两组：基于培养的治疗（CB）组（周一、周二、周三）或经验性治疗（ET）组（周四、周五），并根据培养结果开始使用呋喃妥因（NF）治疗。两组患者在治疗后第 7 天和第 14 天分别进行联系。记录不良反应和标准化问卷（UTISA）的答案。治疗成功定义为 UTISA 总评分<3。任何 NF 重复治疗、使用另一种抗生素治疗或延长初始抗生素疗程均被视为治疗失败。
结果
2020 年 7 月至 2022 年 3 月，研究共纳入 65 例女性的 80 次 UTI 事件，其中 CB 治疗用于 60 次 UTI，ET 治疗用于 23 次 UTI。治疗开始后第 7 天，CB 组问卷失败率为 44%（20/45），ET 组为 16%（3/19）（P=0.076）。治疗开始后第 14 天，CB 组问卷失败率为 31%（13/42），ET 组为 17%（3/18）（P=0.3）。在 ET 组中，11%的培养物对 NF 耐药。
结论
NF 经验性治疗单纯性 UTI 在第 7 天和第 14 天的治疗结局与基于培养的治疗无显著差异。
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