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社区获得性尿路感染的致病微生物及产超广谱β-内酰胺酶菌株感染发生的危险因素

Causative Microorganisms in Community-Acquired Urinary Tract Infections and Risk Factors for the Development of Infection with Extended-Spectrum β-Lactamase-Producing Species.

作者信息

Korkmazer Rüveyda, Kayaaslan Bircan, Kaya-Kalem Ayşe, Oktay Zeynep, Eser Fatma, Hasanoğlu İmran, Güner Rahmet

机构信息

Department of Infectious Disease and Clinical Microbiology, Yıldırım Beyazıt University School of Medicine, Ankara City Hospital, Ankara, Türkiye.

出版信息

Infect Dis Clin Microbiol. 2024 Jun 28;6(2):112-122. doi: 10.36519/idcm.2024.340. eCollection 2024 Jun.

Abstract

OBJECTIVE

This study aimed to determine the microorganisms grown in the urine cultures of patients followed up with the diagnosis of community-acquired urinary tract infection (CA-UTI), their antibiotic susceptibility, and the risk factors that cause extended-spectrum β-lactamase (ESBL) production in microorganisms.

MATERIALS AND METHODS

Patients diagnosed with CA-UTI in the Yıldırım Beyazıt University City Hospital Infectious Diseases and Clinical Microbiology Clinic between February 2019 and February 2020 were prospectively analyzed. The microorganisms grown in the urine cultures and antibiotic susceptibility rates were examined. The clinical and demographic characteristics of the patients were compared in terms of the isolated agent producing ESBL.

RESULTS

(63.8%) and (22.0%) were the most common microorganisms detected in the urine cultures; the rate of those producing ESBL was 46.6%. Antibiotics with high resistance rates were ampicillin (74.2%), cefuroxime (49.6%), and ceftriaxone (49%). Male gender, complicating factors, immunosuppression, kidney transplantation and history of antibiotic use were determined as significant risk factors for ESBL production. Male gender, immunosuppression, and history of antibiotic use were also independent risk factors. ROC analysis of risk factors showed ESBL-producing bacteria were isolated at a high rate in patients having ≥3 risk factors.

CONCLUSION

The resistance rates in our study are quite high. Male gender, history of antibiotic use and immunosuppression status were found to be independent risk factors for ESBL positivity in patients with CA-UTI, and the more risk factors a patient has, the higher the risk of ESBL positivity.

摘要

目的

本研究旨在确定被诊断为社区获得性尿路感染(CA-UTI)并接受随访的患者尿液培养物中生长的微生物、它们的抗生素敏感性,以及导致微生物产生超广谱β-内酰胺酶(ESBL)的危险因素。

材料与方法

对2019年2月至2020年2月间在耶尔德勒姆·贝亚泽特大学城市医院传染病与临床微生物学诊所被诊断为CA-UTI的患者进行前瞻性分析。检查尿液培养物中生长的微生物及抗生素敏感性率。根据分离出的产ESBL病原体,比较患者的临床和人口统计学特征。

结果

尿液培养物中检测到的最常见微生物为(63.8%)和(22.0%);产ESBL的比例为46.6%。耐药率较高的抗生素为氨苄西林(74.2%)、头孢呋辛(49.6%)和头孢曲松(49%)。男性、并发症因素、免疫抑制、肾移植和抗生素使用史被确定为产生ESBL的重要危险因素。男性、免疫抑制和抗生素使用史也是独立危险因素。危险因素的ROC分析显示,有≥3个危险因素的患者中分离出产ESBL细菌的比例较高。

结论

我们研究中的耐药率相当高。男性、抗生素使用史和免疫抑制状态被发现是CA-UTI患者ESBL阳性的独立危险因素,患者的危险因素越多,ESBL阳性的风险越高。

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Drug-resistant gram-negative uropathogens: A review.耐药革兰阴性尿路病原体:综述。
Biomed Pharmacother. 2017 Oct;94:982-994. doi: 10.1016/j.biopha.2017.08.006. Epub 2017 Aug 12.

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