埃塞俄比亚南部阿尔巴米琴地区性活跃女性社区获得性尿路感染：危险因素、细菌谱及其抗菌药敏模式
Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia.
作者信息
Seid Mohammed, Markos Mesafint, Aklilu Addis, Manilal Aseer, Zakir Abdurezak, Kebede Teshome, Kulayta Kebede, Endashaw Gessila
机构信息
Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Arba Minch General Hospital, Arba Minch, Ethiopia.
出版信息
Infect Drug Resist. 2023 Apr 18;16:2297-2310. doi: 10.2147/IDR.S407092. eCollection 2023.
BACKGROUND
Globally, urinary tract infections (UTIs) are a common health issue among women. Investigating risk factors associated with culture-proven UTIs and the antimicrobial resistance profile of uropathogens would provide insight into planning prevention and control measures.
OBJECTIVE
To identify the risk factors associated with UTIs among sexually active women and determine antimicrobial susceptibility patterns of uropathogenic bacterial isolates.
METHODS
A case-control study was conducted from February to June 2021, involving 296 women (62 case group and 234 control group in a ratio of 4:1). Cases were defined as culture-confirmed UTIs, and controls were non-UTIs. A semi-structured questionnaire was used to collect demographic, clinical, and behavioral data. The antimicrobial susceptibility test was done by the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were used to identify risk factors, and the strength of association was measured by adjusted odds ratios and a 95% confidence interval used at P-values < 0.05.
RESULTS
The results revealed that recent coitus and frequency of coitus more than three times per week (P=0.001) were independent predictors of UTIs. Swabbing from back to front, a history of UTI and a delay in voiding were also independent predictors (P < 0.05). On the other hand, a daily water intake of 1 to 2 litres reduced the risk of UTI (P= 0.001). The predominant uropathogenic isolate was (35.48%). Over 60% of isolates were resistant to cotrimoxazole, penicillin, cephalosporin, and fluoroquinolones. The most effective antibiotics included piperacillin-tazobactam, aminoglycosides, carbapenem, and nitrofurantoin. 85% and 50% of isolates were MDR and ESBL producers, respectively.
CONCLUSION
The finding indicates the importance of public intervention targeting the identified risk factors and the resistance phenotype to reduce the burden of UTIs with antimicrobial resistance in the study area.
背景
在全球范围内，尿路感染（UTIs）是女性中常见的健康问题。调查与经培养证实的UTIs相关的危险因素以及尿路病原体的抗菌药物耐药情况，将有助于制定预防和控制措施。
目的
确定性活跃女性中与UTIs相关的危险因素，并确定尿路致病性细菌分离株的抗菌药物敏感性模式。
方法
于2021年2月至6月进行了一项病例对照研究，涉及296名女性（病例组62名，对照组234名，比例为4:1）。病例定义为经培养确诊的UTIs，对照组为非UTIs。使用半结构化问卷收集人口统计学、临床和行为数据。采用 Kirby-Bauer 纸片扩散法进行抗菌药物敏感性试验。使用SPSS 25版对数据进行分析。采用双变量和多变量逻辑回归来识别危险因素，并通过调整后的比值比和95%置信区间（P值<0.05）来衡量关联强度。
结果
结果显示，近期性交以及每周性交频率超过三次（P=0.001）是UTIs的独立预测因素。从后向前擦拭、UTIs病史和排尿延迟也是独立预测因素（P<0.05）。另一方面，每日饮水量1至2升可降低UTIs风险（P=0.001）。主要的尿路致病性分离株是 （35.48%）。超过60%的分离株对复方新诺明、青霉素、头孢菌素和氟喹诺酮耐药。最有效的抗生素包括哌拉西林-他唑巴坦、氨基糖苷类、碳青霉烯类和呋喃妥因。分别有85%和50%的分离株是多重耐药菌和超广谱β-内酰胺酶产生菌。
结论
该研究结果表明，针对已确定的危险因素和耐药表型进行公共干预对于减轻研究地区具有抗菌药物耐药性的UTIs负担具有重要意义。
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