Asymptomatic Bacteriuria Treatment Is Associated With a Higher Prevalence of Antibiotic Resistant Strains in Women With Urinary Tract Infections
Asymptomatic Bacteriuria Treatment Is Associated With a Higher Prevalence of Antibiotic Resistant Strains in Women With Urinary Tract Infections
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DOI：
10.1093/cid/civ696
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发表时间：
2015-12-01
影响因子：
11.8
通讯作者：
Bartoletti, Riccardo
中科院分区：
文献类型：
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作者：
Cai, Tommaso;Nesi, Gabriella;Bartoletti, Riccardo
背景患有复发性尿路感染（rUTIs）的妇女通常接受无症状菌尿（AB）治疗，但这种治疗对抗生素耐药性的影响尚不完全清楚。本研究的目的是评估AB治疗对rUTIs女性抗生素耐药性的影响。研究人群包括2组先前参加过随机临床试验的女性：A组未接受治疗，B组接受治疗。所有女性都计划每6个月进行一次随访，如果出现症状，则更频繁。仅在有症状的女性中进行微生物学评价。所有妇女随访平均38.8个月，分析尿培养和尿沉渣分析数据。先前的研究人群包括673名女性，但123名女性没有参加整个随访期。对于最终分析，剩余550例患者中的257例被分配到A组，293例被分配到B组。随访结束时，复发率差异具有统计学意义（P <0.001）：A组97例（37.7%），B组204例（69.6%）。B组分离的大肠埃希菌对阿莫西林-克拉维酸（P = .03）、甲氧苄啶-磺胺甲恶唑（P = .01）和环丙沙星（P = .03）的耐药性高于A组。这项研究表明，AB治疗与耐药细菌的发生率较高有关，表明AB治疗rUTIs女性有潜在危险。
Background. Women suffering from recurrent urinary tract infections (rUTIs) are routinely treated for asymptomatic bacteriuria (AB), but the consequences of this procedure on antibiotic resistance are not fully known. The aim of this study was to evaluate the impact of AB treatment on antibiotic resistance among women with rUTIs.Methods. The study population consisted of 2 groups of women who had previously been enrolled in a randomized clinical trial: group A was not treated, and group B was treated. All women were scheduled for follow-up visits every 6 months, or more frequently if symptoms arose. Microbiological evaluation was performed only in symptomatic women. All women were followed up for a mean of 38.8 months to analyze data from urine cultures and antibiograms.Results. The previous study population consisted of 673 women, but 123 did not attend the entire follow-up period. For the final analysis, 257 of the remaining 550 patients were assigned to group A, and 293 to group B. At the end of follow-up, the difference in recurrence rates was statistically significant (P < .001): 97 (37.7%) in group A versus 204 (69.6%) in group B. Isolated Escherichia coli from group B showed higher resistance to amoxicillin-clavulanic acid (P = .03), trimethoprim-sulfamethoxazole (P = .01), and ciprofloxacin (P = .03) than that from group A.Conclusions. This study shows that AB treatment is associated with a higher occurrence of antibiotic-resistant bacteria, indicating that AB treatment in women with rUTIs is potentially dangerous.