Schmitz L, Yepiskoposyan L, Bouteille A, Wybo I, Allard S D, Pauwels S, Hubloue I, Van Honacker E, Van Laethem J
Internal Medicine department, Vrije Universiteit Brussel, UZ Brussel, Brussels, Belgium.
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Acta Clin Belg. 2024 Oct;79(5):332-340. doi: 10.1080/17843286.2024.2446684. Epub 2025 Jan 3.
Urinary tract infections (UTIs) are an important cause of empiric antibiotic (over)treatment at the emergency department (ED). To enhance empiric antibiotic choices, mapping the national and local microbiology and antimicrobial resistance (AMR) patterns is crucial. This study aims to examine resistance patterns at a Brussels ED and to identify risk factors for AMR to evaluate current treatment guidelines and help combat AMR.
Adult patients undergoing urinalysis at the ED of a Brussels tertiary care hospital with positive urine cultures were included. Descriptive microbiological mapping of UTI or asymptomatic bacteriuria (ASB) micro-organisms was performed. Potential risk factors of antibiotic resistance in Gram-negative bacteria were assessed by using logistic regression analysis.
Out of 96 patients with Gram-negative bacteria in urinary culture, the predominant uropathogen was Escherichia coli (58.3%), with 8.6% being extended spectrum beta-lactamase (ESBL)-producing strains. Overall, fosfomycin (29.2%) and nitrofurantoin (28.6%) showed the highest resistance rates. Ceftriaxone revealed lower resistance rates (13.1%) compared to ciprofloxacin (17.0%) and cefuroxime (18.4%). Temocillin exhibited the lowest resistance rate (8.2%) especially against ESBLs (0%). Ciprofloxacin resistance increased with age (OR 1.05 [1.01-1.10]) and recurrent UTIs (OR 4.79 [1.18-19.42]). Male gender was associated with higher odds of temocillin resistance (OR 5.79 [1.18-28.34]).
In the studied Belgian ED setting, ceftriaxone seems slightly safer than ciprofloxacin, especially for recurrent UTI patients. However, overall, and especially in patients at risk for ESBL-producing bacteria, temocillin would be an even better choice in our setting. National microbiological data should be reviewed to support recommending temocillin as a first-line antibiotic in patients presenting with upper UTI.
尿路感染（UTIs）是急诊科经验性抗生素（过度）治疗的重要原因。为了优化经验性抗生素的选择，描绘国家和地方的微生物学及抗菌药物耐药性（AMR）模式至关重要。本研究旨在调查布鲁塞尔一家急诊科的耐药模式，并确定AMR的风险因素，以评估当前的治疗指南并助力对抗AMR。
纳入在布鲁塞尔一家三级护理医院急诊科进行尿液分析且尿培养呈阳性的成年患者。对UTI或无症状菌尿（ASB）微生物进行描述性微生物学分析。通过逻辑回归分析评估革兰氏阴性菌抗生素耐药的潜在风险因素。
在96例尿培养中有革兰氏阴性菌的患者中，主要的尿路病原体是大肠杆菌（58.3%），其中8.6%为产超广谱β-内酰胺酶（ESBL）菌株。总体而言，磷霉素（29.2%）和呋喃妥因（28.6%）显示出最高的耐药率。与环丙沙星（17.0%）和头孢呋辛（18.4%）相比，头孢曲松的耐药率较低（13.1%）。替莫西林的耐药率最低（8.2%），尤其是对ESBLs的耐药率为0%。环丙沙星耐药率随年龄增长（比值比1.05 [1.01 - 1.10]）和复发性UTIs（比值比4.79 [1.18 - 19.42]）而增加。男性与替莫西林耐药的较高几率相关（比值比5.79 [1.18 - 28.34]）。
在本研究的比利时急诊科环境中，头孢曲松似乎比环丙沙星稍安全，尤其是对于复发性UTI患者。然而，总体而言，特别是在有产ESBL细菌风险的患者中，替莫西林在我们的环境中会是更好的选择。应审查国家微生物学数据，以支持推荐替莫西林作为上尿路感染患者的一线抗生素。
