Prevalence, etiology and antibiotic resistance patterns of community-acquired urinary tract infections in Dhaka, Bangladesh.
Prevalence, etiology and antibiotic resistance patterns of community-acquired urinary tract infections in Dhaka, Bangladesh.
复制标题
DOI：
10.1371/journal.pone.0274423
复制
发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Riley, Lee W.
中科院分区：
文献类型：
--
作者：
Islam, Mohammad Aminul;Islam, Md Rayhanul;Khan, Rizwana;Amin, Mohammed Badrul;Rahman, Mahdia;Hossain, Muhammed Iqbal;Ahmed, Dilruba;Asaduzzaman, Muhammad;Riley, Lee W.
泌尿道感染（UTI）占世界范围内的显著发病率和死亡率，并且是社区尤其是发展中国家抗生素处方的主要原因。经验性选择抗生素治疗尿路感染往往是不一致的药物敏感性的病原体。本研究旨在评估社区获得性尿路感染的抗生素耐药微生物引起的患病率。这是一项横断面研究，在2016-2018年期间，在孟加拉国达卡的icddr，B诊断诊所前瞻性收集了4，500例患者的尿液样本。尿液样本采用标准培养法进行分析，分离出的细菌采用纸片扩散法和VITEK-2进行抗生素敏感性测试。采用描述性统计方法，按不同年龄组、性别和感染病因估计社区获得性UTI（CA-UTI）的患病率。采用二分类Logistic回归分析CA-UTI病因与患者年龄、性别的关系。还分析了CA-UTI、多药耐药（MDR）病原体和MDR大肠杆菌患病率的季节趋势。约81%的患者为成人（≥ 18岁）。在3，200份（71%）有细菌生长的尿液样本中，920份（29%）的细菌计数≥1.0x105 CFU/ml，表明UTI。与男性相比，女性更容易患UTI（OR：1.48，CI：1.24-1.76）。E.大肠埃希菌（51.6%）为主要致病菌，其次为链球菌; (15.7%）、克雷伯氏菌属（Klebsiella spp.）(12.1%）、肠球菌属（Enterococcus spp.）(6.4%）、假单胞菌属（Pseudomonas spp.）(4.4%）、凝固酶阴性葡萄球菌属（Staphylococcus spp.）(2.0其他病原体占7.8%。E.大肠杆菌和克雷伯氏菌属（Klebsiella spp.）对青霉素类抗生素的耐药率分别为85%和95%，其次为大环内酯类抗生素（70%和76%）、第三代头孢菌素类抗生素（69%和58%）、氟喹诺酮类抗生素（69%和53%）和碳青霉烯类抗生素（5%和9%）。约65%的患者检测出多重耐药（MDR）尿路病原体阳性。MDR病原体检测阳性的男性患者数量高于女性患者（p = 0.015）。总体而言，71%的革兰氏阴性菌和46%的革兰氏阳性菌为MDR。在研究人群中，由MDR微生物引起的社区获得性UTI的负担很高。该研究的结果将指导临床医生在经验性治疗UTI时对抗生素的选择更具选择性，并减少社区中抗生素的滥用/过度使用。
Urinary tract infection (UTI) accounts for a significant morbidity and mortality across the world and is a leading cause for antibiotic prescriptions in the community especially in developing countries. Empirical choice of antibiotics for treatment of UTI is often discordant with the drug susceptibility of the etiologic agent. This study aimed to estimate the prevalence of community-acquired UTI caused by antibiotic resistant organisms. This was a cross-sectional study where urine samples were prospectively collected from 4,500 patients at the icddr,b diagnostic clinic in Dhaka, Bangladesh during 2016–2018. Urine samples were analyzed by standard culture method and the isolated bacteria were tested for antibiotic susceptibility by using disc diffusion method and VITEK-2. Descriptive statistics were used to estimate the prevalence of community acquired UTI (CA-UTI) by different age groups, sex, and etiology of infection. Relationship between the etiology of CA-UTI and age and sex of patients was analyzed using binary logistic regression analysis. Seasonal trends in the prevalence of CA-UTI, multi-drug resistant (MDR) pathogens and MDR Escherichia coli were also analyzed. Around 81% of patients were adults (≥18y). Of 3,200 (71%) urine samples with bacterial growth, 920 (29%) had a bacterial count of ≥1.0x105 CFU/ml indicating UTI. Women were more likely to have UTI compared to males (OR: 1.48, CI: 1.24–1.76). E. coli (51.6%) was the predominant causative pathogen followed by Streptococcus spp. (15.7%), Klebsiella spp. (12.1%), Enterococcus spp. (6.4%), Pseudomonas spp. (4.4%), coagulase-negative Staphylococcus spp. (2.0%), and other pathogens (7.8%). Both E. coli and Klebsiella spp. were predominantly resistant to penicillin (85%, 95%, respectively) followed by macrolide (70%, 76%), third-generation cephalosporins (69%, 58%), fluoroquinolones (69%, 53%) and carbapenem (5%, 9%). Around 65% of patients tested positive for multi-drug resistant (MDR) uropathogens. A higher number of male patients tested positive for MDR pathogens compared to the female patients (p = 0.015). Overall, 71% of Gram-negative and 46% of Gram-positive bacteria were MDR. The burden of community-acquired UTI caused by MDR organisms was high among the study population. The findings of the study will guide clinicians to be more selective about their antibiotic choice for empirical treatment of UTI and alleviate misuse/overuse of antibiotics in the community.
登录
查看更多内容
DOI：
10.1038/nrmicro3432
发表时间：
2015-05
期刊：
Nature reviews. Microbiology
影响因子：
--
作者：
Flores-Mireles AL;Walker JN;Caparon M;Hultgren SJ
通讯作者：
Hultgren SJ
影响因子：
3.7
作者：
Leski, Tomasz A;Taitt, Chris R;Vora, Gary J
通讯作者：
Vora, Gary J
DOI：
10.4103/0976-9668.210012
发表时间：
2017-07-01
期刊：
Journal of natural science, biology, and medicine
影响因子：
--
作者：
Kulkarni, Sudheendra Ramesh;Peerapur, Basavaraj V;Sailesh, Kumar Sai
通讯作者：
Sailesh, Kumar Sai
影响因子：
14.2
作者：
Magiorakos, A. -P.;Srinivasan, A.;Monnet, D. L.
通讯作者：
Monnet, D. L.
DOI：
10.1136/bmj.i939
发表时间：
2016-03-15
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bryce A;Hay AD;Lane IF;Thornton HV;Wootton M;Costelloe C
通讯作者：
Costelloe C