Prevalence and risk factor analysis of resistant Escherichia coli urinary tract infections in the emergency department.
Prevalence and risk factor analysis of resistant Escherichia coli urinary tract infections in the emergency department.
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DOI：
10.4321/s1886-36552013000200006
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发表时间：
2013-04
期刊：
影响因子：
--
通讯作者：
Baker SN
中科院分区：
文献类型：
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作者：
Bailey AM;Weant KA;Baker SN
大肠杆菌（E.大肠杆菌）是泌尿道感染（UTI）中常见的病原体。已经认识到这些分离株对磺胺甲恶唑-甲氧苄啶（SMX-TMP）的广泛耐药性和对氟喹诺酮类药物的耐药性增加。有限的数据表明SMX-TMP和氟喹诺酮类耐药的风险因素。本研究旨在评估大肠杆菌群体抗药性的流行情况。目的：探讨SMX-TMP和左氧氟沙星对艾德出院患者大肠埃希菌的耐药性。成人提出的评价和出院的艾德与诊断E。大肠杆菌UTI进行回顾性分析。利用人口统计学和临床资料，E。大肠埃希菌耐药性和与SMX-TMP和氟喹诺酮类耐药感染相关的危险因素。222例患者中E.大肠埃希菌对左氧氟沙星和SMX-TMP的敏感率分别为82.4%和72.5%。SMX-TMP耐药的显著风险因素包括既往抗生素使用（p=0.04）和既往UTI诊断（p= 0.01）。左氧氟沙星耐药的重要危险因素包括：男性、年龄、高血压、糖尿病、慢性呼吸道疾病、疗养院居民、既往抗生素使用、既往UTI诊断、存在肾脏或泌尿生殖系统异常和既往手术史（所有比较p <0.05）。初次艾德评估前的住院天数（p<0.001）被确定为住院和艾德再入院的预测因素。这些结果表明，传统的方法来监测模式的易感性可能是不够的。从业者必须开发新的方法来识别具有耐药风险因素的患者。从这次评估中识别出的风险因素应该促使提供者在ED中出现无并发症UTI的患者的情况下仔细检查这些药物的使用。
Escherichia coli (E. coli) is a frequent uropathogen in urinary tract infections (UTI). Widespread resistance to sulfamethoxazole-trimethoprim (SMX-TMP) and increasing resistance to fluoroquinolones amongst these isolates has been recognized. There are limited data demonstrating risk factors for resistance to both SMX-TMP and fluoroquinolones. This study was conducted to assess for the prevalence of community resistance amongst E. coli isolates to SMX-TMP and levofloxacin in ambulatory patients discharged from the emergency department (ED). Adults presenting for evaluation and discharged from the ED with a diagnosis of an E. coli UTI were retrospectively reviewed. Utilizing demographic and clinical data the prevalence of E. coli resistance and risk factors associated with SMX-TMP- and fluoroquinolone-resistant infection were determined. Among the 222 patients, the mean rates of E. coli susceptibility to levofloxacin and SMX-TMP were 82.4% and 72.5%, respectively. Significant risk factors for resistance to SMX-TMP included prior antibiotic use (p=0.04) and prior diagnosis of UTI (p= 0.01). Significant risk factors for resistance to levofloxacin included: male gender, age, presence of hypertension, diabetes, chronic respiratory disease, nursing home resident, previous antibiotic use, previous diagnosis of UTI, existence of renal or genitourinary abnormalities, and prior surgical procedures (p <0.05 for all comparisons). The number of hospital days prior to initial ED evaluation (p<0.001) was determined to be a predictive factor in hospital and ED readmission. These results suggest that conventional approaches to monitoring for patterns of susceptibility may be inadequate. It is imperative that practitioners develop novel approaches to identifying patients with risk factors for resistance. Identification of risk factors from this evaluation should prompt providers to scrutinize the use of these agents in the setting of patients presenting with an uncomplicated UTI in the ED.