Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients
Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients
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DOI：
10.1093/jac/dku282
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发表时间：
2014-12-01
影响因子：
5.2
通讯作者：
Bordon, J. M.
中科院分区：
文献类型：
--
作者：
Sanchez, G. V.;Baird, A. M. G.;Bordon, J. M.
为了解多药耐药(MDR)尿大肠埃希菌在美国门诊患者中的流行情况，评估治疗尿路感染(UTI)常用口服抗生素对MDR分离株的抗菌活性，对美国监测网络(TSN)数据库中门诊患者尿培养的药敏数据进行分析。包括6个不同药物类别的6种抗菌药：氨苄西林、头孢氨丁、环丙沙星、呋喃妥因、甲氧苄氨嘧啶/磺胺甲恶唑和阿莫西林/克拉维酸。分离株被归类为对1、2、3、4、5和6种药物的抗药性，并在2001年和2010年进行了比较。耐多药大肠埃希菌的患病率从2001年的9.1%(nEuroS=aEuroS29aEuroS198)上升到2010年的17.0%(nEuroS=aEuroS32aEuroS742)(PaEuroS<；aEuroS0.0001)。在2010年表现出对三种、四种或五种抗菌剂耐药的菌株中，分别只有2.1%、7.5%和24.1%的菌株对呋喃妥因耐药。对甲氧苄氨嘧啶/磺胺甲恶唑的耐药率分别为62.6%、88.6%和97.9%，对环丙沙星的耐药率分别为48.9%、84.3%和98.2%。由于呋喃妥因对多药耐药大肠埃希菌具有一致的抗菌活性，因此呋喃妥因仍是经验性治疗急性非复杂性膀胱炎的可靠一线药物。
To examine the prevalence of multidrug-resistant (MDR) urinary Escherichia coli among US outpatients and to assess the antimicrobial activity of oral antibiotics commonly used to treat urinary tract infections (UTIs) against MDR isolates.Antimicrobial susceptibility testing data from outpatient urine cultures in The Surveillance Network (TSN) Database USA were analysed. Six antimicrobial agents from six separate drug classes were included: ampicillin, cefalotin, ciprofloxacin, nitrofurantoin, trimethoprim/sulfamethoxazole and amoxicillin/clavulanate. Isolates were categorized as resistant to one, two, three, four, five and six agents and compared for the years 2001 and 2010. Phenotypes of MDR isolates were assessed to determine antimicrobial activity of recommended therapy for UTIs.Prevalence of MDR E. coli increased from 9.1% in 2001 (naEuroS=aEuroS29aEuroS198) to 17.0% in 2010 (naEuroS=aEuroS32aEuroS742) (PaEuroS < aEuroS0.0001). In isolates that demonstrated resistance to three, four or five antimicrobial agents in 2010, resistance to nitrofurantoin was observed in only 2.1%, 7.5% and 24.1% of isolates, respectively. Conversely, widespread resistance was observed for trimethoprim/sulfamethoxazole (62.6%, 88.6% and 97.9% for isolates resistant to three, four and five agents, respectively) and ciprofloxacin (48.9%, 84.3% and 98.2% for isolates resistant to three, four and five agents, respectively).Because of its consistent antimicrobial activity against MDR E. coli, nitrofurantoin remains a reliable first-line agent for the empirical treatment of acute uncomplicated cystitis.