University of Missouri School of Medicine, Columbia, MO.
Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO.
Urology. 2023 May;175:96-100. doi: 10.1016/j.urology.2023.02.020. Epub 2023 Feb 27.
To evaluate variability among hospitals in susceptibility of common uropathogens to antimicrobial agents frequently used in transurethral procedures in order to examine whether state-based guidelines might be more appropriate than national prophylactic guidelines.
Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), third-generation cephalosporins, cefazolin, penicillin combinations, gentamicin, and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities.
Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for third-generation cephalosporins for E. coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E. coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E. coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%).
Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen.
评估在经尿道操作中常用抗菌药物治疗常见尿路病原体的敏感性方面，各医院间的变异性，以检验基于州的指南是否比国家预防指南更合适。
从密苏里州所有医院收集医院层面的药敏试验数据。我们研究了大肠埃希菌、克雷伯菌和变形杆菌对包括复方磺胺甲噁唑（TMP-SMX）、三代头孢菌素、头孢唑啉、青霉素类联合用药、庆大霉素和氟喹诺酮类在内的常见指南推荐抗菌药物的敏感性。我们评估了医院特征与抗菌药物敏感性之间的变异性和关联。
从全州 81 家医院中请求数据，其中 38 家医院提供了请求的数据（47%的应答率）。对于大肠埃希菌（平均 94%）、变形杆菌（96%）和克雷伯菌（96%），第三代头孢菌素的敏感性最高。研究中的细菌对庆大霉素也具有较高的敏感性；对于大肠埃希菌和克雷伯菌，其敏感性分别为 94%和 96%。目前推荐的一线药物对大肠埃希菌（头孢唑啉 84%，TMP-SMX 78%）、变形杆菌（头孢唑啉 82%，TMP-SMX 71%）和克雷伯菌（头孢唑啉 90%，TMP-SMX 89%）的覆盖范围则较为适中。
经尿道操作后感染很常见。适当的预防措施可以限制其发生率。在决定经验性治疗覆盖范围时，必须考虑当地的耐药模式。常见尿路病原体的抗菌药物敏感性在州内和州间存在很大差异。在选择抗菌药物预防时，鉴于存在很大的变异性，泌尿科医生应考虑采用局部而非州或国家层面的药敏试验数据，以选择最佳方案。未来的研究应考虑广谱预防的优点以及在选择最佳方案时，分子尿液病原体（和病原体耐药性）检测的潜在作用。
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