坦桑尼亚姆万扎地区引起尿路感染的病原体的流行病学及抗菌药物耐药性趋势：一项在《国家抗菌药物耐药性行动计划》（2017 - 2022年）实施期间及之后的对比研究。

Epidemiology and antimicrobial resistance trends of pathogens causing urinary tract infections in Mwanza, Tanzania: A comparative study during and after the implementation of the National Action Plan on Antimicrobial Resistance (2017-2022).

作者信息

Silago Vitus, Oravcova Katarina, Matthews Louise, Mshana Stephen E, Claus Heike, Seni Jeremiah

机构信息

Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany.

Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.

出版信息

Int J Infect Dis. 2024 Oct;147:107208. doi: 10.1016/j.ijid.2024.107208. Epub 2024 Aug 10.

DOI:10.1016/j.ijid.2024.107208

PMID:39128601

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11442316/

Abstract

OBJECTIVES

To delineate the epidemiology and antimicrobial resistance (AMR) trends of pathogens causing urinary tract infections (UTIs) during (June 2019-June 2020) and after (March-July 2023) the implementation of the National Action Plan on AMR 2017-2022 in Mwanza, Tanzania.

METHODS

This cross-sectional study was conducted among 2097 patients with clinical symptoms of UTIs during (n = 1144) and after (n = 953) the National Action Plan on AMR 2017-2022. Quantitative urine culture was done to isolate significant bacteria causing UTI, which were then identified to the species level and tested for antimicrobial susceptibility. Tabulations, descriptive, and logistic regression analyses were used to analyze categorical and continuous variables, as well as the association between outcome and independent variables. Statistical significance was defined as P ≤0.05 at a 95% confidence interval (CI).

RESULTS

The overall prevalence of culture-positive UTIs was 22.8% (479 of 2097; 95% CI: 21.1-24.7%), with no significant difference between the study periods (21.8% [249 of 1144; 95% CI: 19.5-24.3%]) vs 24.1% (230 of 953; 95% CI: 21.5-26.9%), P = 0.274). We observed a significant increase in resistance to ciprofloxacin (32.0% vs 45.8%, P = 0.0481) and third-generation cephalosporins (marked by extended-spectrum β-lactamase-producing Enterobacterales [ESBL-PE], 38.7% vs 56.9%, P = 0.0307). Additionally, UTIs caused by ESBL-PE is significantly common among patients in higher-tier hospitals (58.4% vs 34.0%; OR [95% CI]: 2.51 [1.41-4.48], P = 0.002).

CONCLUSIONS

There was a significant increase in bacterial resistance to ciprofloxacin and third-generation cephalosporins, as well as ESBL-PE. These results emphasize the critical need to enhance AMR surveillance, improve infection prevention and control measures, and strengthen antimicrobial stewardship programs.

摘要

目的

描绘在坦桑尼亚姆万扎实施2017 - 2022年国家抗菌药物耐药性行动计划期间（2019年6月至2020年6月）及之后（2023年3月至7月）引起尿路感染（UTI）的病原体的流行病学和抗菌药物耐药性（AMR）趋势。

方法

这项横断面研究在2097例有UTI临床症状的患者中进行，其中在2017 - 2022年国家抗菌药物耐药性行动计划实施期间有1144例，之后有953例。进行定量尿培养以分离引起UTI的重要细菌，然后将其鉴定到种水平并测试抗菌药物敏感性。使用列表、描述性和逻辑回归分析来分析分类变量和连续变量，以及结果与自变量之间的关联。统计学显著性定义为在95%置信区间（CI）下P≤0.05。

结果

培养阳性UTI的总体患病率为22.8%（2097例中的479例；95%CI：21.1 - 24.7%），研究期间之间无显著差异（21.8%[1144例中的249例；95%CI：19.5 - 24.3%]）与24.1%（953例中的230例；95%CI：21.5 - 26.9%），P = 0.274）。我们观察到对环丙沙星的耐药性显著增加（32.0%对45.8%，P = 0.0481）和对第三代头孢菌素的耐药性增加（以产超广谱β-内酰胺酶的肠杆菌科细菌[ESBL-PE]为标志，38.7%对56.9%，P = 0.0307）。此外，由ESBL-PE引起的UTI在上级医院的患者中显著更常见（58.4%对34.0%；OR[95%CI]：2.51[