摘要
目的:评估男性发热性尿路感染(FUTI)患者大肠杆菌分离株对喹诺酮类药物的耐药性和临床危险因素。方法:通过患者临床表现及尿细菌涂片检查确诊的大肠杆菌感染的FUTI患者123例,采集患者清洁中段尿或经膀胱穿刺获取尿液标本,进行尿细菌培养及药敏试验。观察大肠杆菌对各种抗生素的耐药反应,并评估与大肠杆菌耐药性相关的临床危险因素。结果:34%的大肠杆菌菌株对喹诺酮类药物产生耐药性,且对其他抗生素的耐药性也较高,尤其是对阿莫西林(P<0.001)和复方新诺明(P<0.001)。大肠杆菌菌株对喹诺酮类药物的耐药性与年龄、既往尿路感染史、尿道异常、既往使用抗生素(特别是氟喹诺酮类)、卫生保健相关的尿路感染(HA-UTI)等因素有关,其中HA-UTI(OR 4.34,95%CI 1.62～12.13,P<0.001)、既往尿路感染史(OR 6.27,95%CI 2.71～15.32,P<0.001)、既往使用氟喹诺酮史(OR 14.37,95%CI 2.14～73.26,P<0.001)是大肠杆菌对喹诺酮类药物耐药的危险因素。结论:男性FUTI患者的耐喹诺酮类药物的大肠杆菌对其他抗生素也存在较高的耐药性,尤其是对阿莫西林和复方新诺明;HA-UTI、既往尿路感染史和既往使用氟喹诺酮类是男性FUTI患者大肠杆菌耐药的高危因素,因此,应避免在男性FUTI患者中使用喹诺酮类抗菌药物治疗泌尿系感染。
Objective： To evaluate the prevalence and clinical risk factors for quinolone resistance in E.coli strains from males with febrile urinary tract infection（FUTI）.Methods： We diagnosed that patients by clinical manifestations and urinary bacterial smears in 123 males with a community FUTI caused by E.coli,and collected clean-catch midstream urine or urine samples from bladder puncture for bacterial culture and sensitivity test of urine.We observed the response of E.coli resistance to various antibiotics,and evaluated the clinical risk factors for quinolone resistance in E.coli.Results： Among the 123 FUTI episodes,34% of E.coli strains resistant to quinolones,and it also higher frequency resistance to other antibiotics,especially amoxicillin（P0.001） and cotrimoxazole（P0.001）.In the multivariate analysis,HA-UTI（OR 4.34,95%CI 1.62-12.13,P0.001） and use of antimicrobials in the previous month,mainly with fluoroquinolone resistance（OR 14.37,95%CI 2.14-73.26,P0.001） were risk factors for quinolone resistance E.coli.Conclusion： To have a HA-UTI and previous urinary tract infection and use of fluoroquinolone resistance in the preceding month are strong risk factors for quinolone resistance E.coli,and thus empirical antimicrobial treatment with quinolones should be avoided in these patients.
出处
《现代医学》
2012年第2期145-148,共4页
Modern Medical Journal
关键词
尿路感染
喹诺酮
大肠杆菌
耐药性
urinary tract infection
quinolone
Escherichia coli
resistance
