Does urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli show same antibiotic resistance when it recurs?
Does urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli show same antibiotic resistance when it recurs?
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DOI：
10.1016/j.jiac.2019.02.006
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发表时间：
2019-07-01
影响因子：
2.2
通讯作者：
Oh, Mi Mi
中科院分区：
文献类型：
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作者：
Ahn, Sun Tae;Kim, Sang Woo;Oh, Mi Mi
本研究旨在评估产超广谱 β-内酰胺酶 (ESBL) 菌株引起的尿路感染 (UTI) 在随访期间与产 ESBL 菌株复发的比例，并评估产 ESBL 大肠杆菌菌株在随后首次复发时复发的危险因素。我们招募了 2012 年 5 月至 2015 年 12 月期间患有产 ESBL 大肠杆菌引起的尿路感染的女性患者，并对这些患者进行了至少 24 个月的纵向随访。在 206 名 ESBL 阳性 UTI 患者中，180 名完成了研究。 60 名（60/180，33.3%）首次发生由产 ESBL 大肠杆菌引起的尿路感染的患者在随访期间经历了复发性尿路感染。在 60 名患者中，43 名（43/60，71.7%）在第一次 UTI 复发时复发了产 ESBL 大肠杆菌。在多变量分析中，复发时间和过去 6 个月的头孢菌素使用史被确定为产 ESBL 大肠杆菌本身复发的危险因素（比值比 [OR] = 0.9，95% 置信区间 [CI] 0.8-1.0，p = 0.030 和 OR = 27.0，95% CI 2.4-299.8，p = 0.007，分别）。这些发现表明，由产 ESBL 大肠杆菌引起的 UTI 患者中，很大一部分在随后的复发发作中会因产 ESBL 大肠杆菌而复发。虽然在就诊当天无法确定抗生素敏感性结果，但对于之前因产生 ESBL 菌株而导致尿路感染的患者，经验性治疗应参考之前的抗生素耐药性情况。 (c) 2019 年日本化疗学会和日本传染病学会。由爱思唯尔有限公司出版。保留所有权利。
This study was performed to evaluate what percentage of urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL)-producing strains recurs with ESBL-producing strains during follow up and to assess the risk factors for recurrence with ESBL-producing Escherichia coli strains on subsequent first recurrence episode. We enrolled female patients with UTIs caused by ESBL-producing E. coli between May 2012 and December 2015, who were longitudinally followed up for at least 24 months. Among the 206 patients with ESBL positive UTI, 180 completed the study. 60 (60/180, 33.3%) of patient with first episode of UTI caused by ESBL-producing E. coli experienced recurrent UTIs during follow up. Of 60 patients, 43 (43/60, 71.7%) recurred with ESBL-producing E. coli on the first UTI recurrence episode. On multivariate analysis, the time to recurrence and history of cephalosporin usage in the last 6 months were identified as risk factors for recurrence with ESBL-producing E. coli per se (odds ratio [OR] = 0.9, 95% confidence interval [CI] 0.8-1.0, p = 0.030 and OR = 27.0, 95% CI 2.4-299.8, p = 0.007, respectively). These findings show that high proportion of patient with UTI caused by ESBL-producing E. coli recurs with ESBL-producing E. coli on subsequent recurrence episode. While result of antibiotic susceptibility cannot be identified on the visit day empirical treatment should be referred to the antecedent antibiotic resistance profile in patients whose previous UTIs were due to ESBL-producing strains. (c) 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.