Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection
Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection
复制标题
DOI：
10.1093/jac/dkq465
复制
发表时间：
2011-03-01
影响因子：
5.2
通讯作者：
van Dissel, Jaap T.
中科院分区：
文献类型：
--
作者：
van der Starre, Willize E.;van Nieuwkoop, Cees;van Dissel, Jaap T.
目的评估社区发病发热性大肠杆菌尿路感染（UTI）患者氟喹诺酮类药物耐药的危险因素。在2004年1月至2009年12月期间在初级卫生保健中心或急诊科就诊的连续成人发热尿路感染队列中进行的巢式病例对照研究。采用EUCAST标准（环丙沙星MIC > 1.0 mg/L）确定耐药性。病例为氟喹诺酮耐药大肠杆菌，对照组为氟喹诺酮敏感菌株。采用多变量logistic回归分析确定氟喹诺酮类药物耐药的潜在危险因素。在787例连续患者中，420例尿培养大肠杆菌阳性。其中51例（12%）对氟喹诺酮类药物耐药。氟喹诺酮类药物耐药的独立危险因素为尿导管[比值比（OR） 3.1；95%可信区间（CI） 0.9-11.6]、近期住院（OR 2.0; 95% CI 1.0-4.3）和过去6个月内使用氟喹诺酮类药物（OR 17.5; 95% CI 6.0-50.7）。环境因素（如与动物接触或住院的家庭成员）与氟喹诺酮类药物耐药性无关。氟喹诺酮耐药菌株中，33%对阿莫西林/克拉维酸耐药，65%对甲氧苄啶/磺胺甲恶唑耐药；14%的菌株广谱β -内酰胺酶（ESBL）阳性，而氟喹诺酮类药物敏感菌株的阳性率< 1%。社区发病发热性大肠杆菌尿路感染中近期住院、导尿和6个月内使用氟喹诺酮类药物是氟喹诺酮类药物耐药的独立危险因素。与动物或住院家庭成员的接触与氟喹诺酮类药物耐药性无关。氟喹诺酮类药物耐药性可能是更广泛耐药性的标志，包括ESBL阳性。
To assess risk factors for fluoroquinolone resistance in community-onset febrile Escherichia coli urinary tract infection (UTI).A nested case-control study within a cohort of consecutive adults with febrile UTI presenting at primary healthcare centres or emergency departments during January 2004 through December 2009. Resistance was defined using EUCAST criteria (ciprofloxacin MIC > 1.0 mg/L). Cases were subjects with fluoroquinolone-resistant E. coli, and controls those with fluoroquinolone-susceptible isolates. Multivariable logistic regression analysis was used to identify potential risk factors for fluoroquinolone resistance.Of 787 consecutive patients, 420 had E. coli-positive urine cultures. Of these, 51 (12%) were fluoroquinolone resistant. Independent risk factors for fluoroquinolone resistance were urinary catheter [odds ratio (OR) 3.1; 95% confidence interval (CI) 0.9-11.6], recent hospitalization (OR 2.0; 95% CI 1.0-4.3) and fluoroquinolone use in the past 6 months (OR 17.5; 95% CI 6.0-50.7). Environmental factors (e.g. contact with animals or hospitalized household members) were not associated with fluoroquinolone resistance. Of fluoroquinolone-resistant strains, 33% were resistant to amoxicillin/clavulanate and 65% to trimethoprim/sulfamethoxazole; 14% were extended-spectrum beta-lactamase (ESBL) positive compared with < 1% of fluoroquinolone-susceptible isolates.Recent hospitalization, urinary catheter and fluoroquinolone use in the past 6 months were independent risk factors for fluoroquinolone resistance in community-onset febrile E. coli UTI. Contact with animals or hospitalized household members was not associated with fluoroquinolone resistance. Fluoroquinolone resistance may be a marker of broader resistance, including ESBL positivity.