Karlsson Philip A, Pärssinen Julia, Danielsson Erik A, Fatsis-Kavalopoulos Nikos, Frithiof Robert, Hultström Michael, Lipcsey Miklos, Järhult Josef D, Wang Helen
Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Front Med (Lausanne). 2023 Feb 7;10:1087446. doi: 10.3389/fmed.2023.1087446. eCollection 2023.
High frequency of antimicrobial prescription and the nature of prolonged illness in COVID-19 increases risk for complicated bacteriuria and antibiotic resistance. We investigated risk factors for bacteriuria in the ICU and the correlation between antibiotic treatment and persistent bacteria.
We conducted a prospective longitudinal study with urine from indwelling catheters of 101 ICU patients from Uppsala University Hospital, Sweden. Samples were screened and isolates confirmed with MALDI-TOF and whole genome sequencing. Isolates were analyzed for AMR using broth microdilution. Clinical data were assessed for correlation with bacteriuria.
Length of stay linearly correlated with bacteriuria (R = 0.99, ≤ 0.0001). 90% of patients received antibiotics, primarily the beta-lactams (76%) cefotaxime, piperacillin-tazobactam, and meropenem. We found high prevalence of (42%) being associated with increased cefotaxime prescription. Antibiotic-susceptible were found to cause bacteriuria despite concurrent antibiotic treatment when found in co-culture with .
Longer stays in ICUs increase the risk for bacteriuria in a predictable manner. Likely, high use of cefotaxime drives prevalence, which in turn permit co-colonizing Gram-negative bacteria. Our results suggest biofilms in urinary catheters as a reservoir of pathogenic bacteria with the potential to develop and disseminate AMR.
COVID-19中抗菌药物处方的高频率以及病程延长的性质增加了复杂性菌尿症和抗生素耐药性的风险。我们调查了重症监护病房（ICU）中菌尿症的危险因素以及抗生素治疗与持续性细菌之间的相关性。
我们对瑞典乌普萨拉大学医院101名ICU患者留置导管的尿液进行了一项前瞻性纵向研究。样本经基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）和全基因组测序进行筛查和分离株确认。使用肉汤微量稀释法分析分离株的抗菌药物耐药性（AMR）。评估临床数据与菌尿症的相关性。
住院时间与菌尿症呈线性相关（R = 0.99，P≤0.0001）。90%的患者接受了抗生素治疗，主要是β-内酰胺类药物（76%），即头孢噻肟、哌拉西林-他唑巴坦和美罗培南。我们发现肺炎克雷伯菌的高流行率（42%）与头孢噻肟处方增加有关。当在共培养中发现时，尽管同时进行抗生素治疗，但仍发现对多种抗生素敏感的肺炎克雷伯菌会导致菌尿症。
在ICU停留时间延长以可预测的方式增加了菌尿症的风险。可能是头孢噻肟的大量使用导致了肺炎克雷伯菌的流行率上升，这反过来又使得革兰氏阴性菌得以共同定植。我们的结果表明，导尿管中的生物膜是病原菌的一个储存库，具有产生和传播AMR的潜力。
