摘要

由于抗菌素耐药性增加，我们的目的是确定初级保健中的抗生素敏感性和尿路致病菌中耐药基因的存在，与对常用抗生素耐药性相关的因素以及治疗对早期症状缓解的影响。我们对2015年至2016年在新加坡进行的具有尿路感染（UTI）症状和经培养证实的UTI的基层护理患者进行了一项前瞻性研究。分析了培养分离株的队列特征和抗菌药敏性。在肠杆菌科细菌中，评估了根据抗生素规定的早期症状消退（3天内）和分离物的药敏性以及与抗生素耐药性相关的因素。在695名有症状的患者中，有299名尿培养阳性；在这299名患者中，有259名（87％）是女性。大肠杆菌是最常见的尿路致病菌（76％）。肠杆菌科分离株（n = 283）对阿莫西林-克拉维酸盐（86％），呋喃妥因（87％）和磷霉素（98％）高度敏感，但> 20％对环丙沙星和复方新诺明耐药。进一步测试了对合适的指示性抗生素具有抗性的分离株，以确定blaCTX-M（14/26，54％），质粒介导的ampC（12/24，50％），qnr（7/69，10％）和fos（1/6，17％）抗性基因。总共有67％的患者使用易感菌株的抗生素报告了早期解决方案，而45％的患者使用了不易感菌株的抗生素（P = 0.001）和27％未治疗（P = 0.018）。在多变量分析中，印度种族和糖尿病与阿莫西林-克拉维酸耐药有关。泌尿生殖系统异常，过去12个月的尿路感染和过去6个月的住院与环丙沙星和复方新诺明耐药有关。给予活性经验性抗生素的患者最有可能报告早期症状缓解，但与体外药敏性的相关性并不完善。与抵抗力相关的因素可以指导获得初始尿培养的决定。

Given increasing antimicrobial resistance, we aimed to determine antibiotic susceptibility and presence of resistance genes in uropathogens in primary care, factors associated with resistance to commonly prescribed antibiotics, and effect of treatment on early symptom resolution. We conducted a prospective study of primary care patients with urinary tract infection (UTI) symptoms and culture-confirmed UTI in Singapore from 2015 to 2016. Cohort characteristics and antimicrobial susceptibility of cultured isolates were analyzed. Among Enterobacteriaceae isolates, early symptom resolution (within 3 days) according to antibiotic prescribed and isolate susceptibility and factors associated with antibiotic resistance were evaluated. Of 695 symptomatic patients, 299 were urine culture positive; of these 299 patients, 259 (87%) were female. Escherichia coli was the most common uropathogen (76%). Enterobacteriaceae isolates (n = 283) were highly susceptible to amoxicillin-clavulanate (86%), nitrofurantoin (87%), and fosfomycin (98%), but >20% were resistant to ciprofloxacin and co-trimoxazole. Isolates resistant to appropriate indicator antibiotics were further tested to determine proportions positive for blaCTX-M (14/26, 54%), plasmid-mediated ampC (12/24, 50%), qnr (7/69, 10%), and fos (1/6, 17%) resistance genes. A total of 67% of patients given antibiotics with susceptible isolates reported early resolution versus 45% given antibiotics with nonsusceptible isolates (P = 0.001) and 27% not treated (P = 0.018). On multivariable analysis, Indian ethnicity and diabetes mellitus were associated with amoxicillin-clavulanate resistance. Genitourinary abnormalities, UTI in the past 12 months, and hospitalization in the past 6 months were associated with ciprofloxacin and co-trimoxazole resistance. Patients given active empirical antibiotics were most likely to report early symptom resolution, but correlation with in vitro susceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture.

https://jcm.asm.org/content/57/9/e00143-19.abstract