Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin; Department 1: Healthcare Research, Institute for Public Health and Nursing Research, University of Bremen; Institute for General Medicine, University Hospital Würzburg.
Dtsch Arztebl Int. 2024 Mar 22;121(6):175-181. doi: 10.3238/arztebl.m2023.0267.
Uncomplicated bacterial urinary tract infections(uUTIs) are commonly seen in outpatient practice. They are usuallytreated empirically with antibiotics. The pertinent German ClinicalPractice Guideline contains recommendations on antibiotic selection,with the additional advice that the local resistance situationshould be considered as well. However, up-to-date information onlocal resistance is often unavailable, because microbiological testingis mainly recommended for complicated UTIs. Resistance ratesare often higher in recurrent uUTIs than in single episodes. In thisstudy, we aimed to determine the resistance rates of Escherichiacoli (E. coli) in patients with community-acquired uUTIs and tomake these data available to the treating physicians.
In a nationwide cross-sectional study in Germany (DRKS00019059), we determined the percentages of resistance to antibioticsrecommended for uUTIs (first choice: fosfomycin, nitro -xoline, mecillinam, nitrofurantoin, trimethoprim; second choice:cefpodoxime, ciprofloxacin, cotrimoxazole, levofloxacin, norfloxacin,ofloxacin) over the period 2019-2021. The data were stratified bysingle episodes vs. recurrent UTIs (rUTIs).
Data from 2390 subjects were analyzed. E. coli was foundin 75.4% of the samples with positive urine cultures (1082 out of1435). The resistance rate of E. coli in single episodes (n = 725)was less than 15% for all antibiotics tested. In rUTIs(n = 357), resistance rates were also less than 15%for the most part; the only exceptions were trimethoprim(21.4%) and cotrimoxazole (19.3%).
For single episodes of uUTI, all of theantibiotics studied can be recommended, at least asfar as their resistance profiles are concerned. Forrecurrent UTI, all but trimethoprim and cotrimoxazolecan be recommended. The second-choice antibioticsexamined do not have a more favorable resistanceprofile than the first-choice antibiotics.
单纯性细菌性尿路感染（uUTI）在门诊实践中很常见。它们通常通过经验性使用抗生素进行治疗。相关的德国临床实践指南包含了抗生素选择的建议，此外还建议考虑当地的耐药情况。然而，由于微生物学检测主要推荐用于复杂性尿路感染，因此关于当地耐药情况的最新信息往往不可用。耐药率在复发性 uUTI 中通常高于单发性发作。在这项研究中，我们旨在确定社区获得性 uUTI 患者中大肠杆菌（E. coli）的耐药率，并将这些数据提供给治疗医生。
在德国的一项全国性横断面研究（DRKS00019059）中，我们确定了在 2019-2021 年期间，用于 uUTI 的抗生素（首选：磷霉素、呋喃妥因、美西林、复方磺胺甲噁唑；次选：头孢泊肟、环丙沙星、复方磺胺甲噁唑、左氧氟沙星、诺氟沙星、氧氟沙星）的耐药率。数据按单发性和复发性尿路感染（rUTI）进行分层。
对 2390 名受试者的数据进行了分析。在 1435 份尿液培养阳性样本中，发现 75.4%的样本为 E. coli（1082 份）。在单发性发作（n=725）中，所有测试的抗生素的大肠杆菌耐药率均低于 15%。在 rUTI（n=357）中，大部分情况下耐药率也低于 15%；唯一的例外是复方磺胺甲噁唑（21.4%）和复方磺胺甲噁唑（19.3%）。
对于单发性 uUTI，至少就其耐药谱而言，可以推荐所有研究的抗生素。对于复发性 UTI，可以推荐除复方磺胺甲噁唑和复方磺胺甲噁唑以外的所有抗生素。所检查的二线抗生素的耐药谱并不优于一线抗生素。
