石家庄市2005～2007年不同来源沙门菌的耐药性比较研究

目的:通过比较不同来源沙门菌株的耐药性差异,探讨耐药性的产生与抗菌药物压力之间的关系,为预防和控制食源性疾病,指导临床合理用药提供一定的理论依据.方法:从石家庄市3家医疗卫生机构收集133株沙门菌,其中健康从业人员肠道内分离菌株(携带株)111株,食品中毒标本中分离菌株(食品株)8株,临床标本分离菌株(感染株)14株.采用K-B法对收集菌株进行6大类共15种抗菌药物的敏感性测定.结果:携带株、食品株和感染株对2种或2种以上抗菌药物的耐药比例分别为9.91%、12.50%和57.14%.结论:感染株对各种抗菌药物耐药率明显高于携带株和食品株,提示沙门菌耐药性的产生与其生存环境中的抗菌药物压力大小有直接关系.     

2007-2011年血流感染金黄色葡萄球菌的临床分布及耐药性分析

目的:分析我院血流感染金黄色葡萄球菌(SAU)的临床分布及对常用抗菌药物的耐药性,为预防控制和临床治疗SAU血流感染提供指导.方法:应用WHONET 5.4软件对本院2007年1月至2011年12月确诊为SAU血流感染的患者临床资料和菌株的耐药性进行分析,采用SPSS16.0软件进行统计学分析.结果:临床分离的167株SAU广泛分布于全院各科室,分离率最高为ICU占16.17％,其次为儿科病区和心内病区分离率分别为10.78％和10.18％；167株SAU中,70株为耐甲氧西林金黄色葡萄球菌(MRSA),占41.90％;金黄色葡萄球菌对多种抗菌药物呈普遍耐药,对青霉素G的耐药率为99.10％,利福平的耐药 率＜ 15.00％,未分离到对利奈唑胺、喹奴普汀/达福普汀、替考拉宁及万古霉素耐药的菌株.对大多数抗菌药物MRSA的耐药率显著高于甲氧西林敏感金黄色葡萄球菌(MSSA) (P＜ 0.01).结论:血流感染的SAU对常用抗菌药物显示多药耐药,没发现耐万古霉素的MRSA,MRSA耐药性比MSSA严重,医院应大力加强抗菌药物的监控和管理力度,根据药敏合理选用抗菌药物,延缓细菌耐药性的产生并积极做好各项防治措施,防止MRSA的暴发流行.     

鲍曼不动杆菌感染分布及耐药性分析

目的了解鲍曼不动杆菌的感染分布及其耐药性变化。方法对达州市中心医院2007年1月至2009年12月从临床患者标本中分离的377株鲍曼不动杆菌进行耐药性分析,并用WHONET软件进行数据处理。结果分离的鲍曼不动杆菌主要分布在重症监护病房(ICU)(38.5%),痰标本中分离的鲍曼不动杆菌最多见(74.3%)。鲍曼不动杆菌除对亚胺培南和多黏菌素敏感率较高外,对临床常用的头孢3代和氟喹诺酮类抗菌药物的耐药率大于55.0%。ICU分离株耐药率明显高于普通病房。结论鲍曼不动杆菌对多种抗菌药物耐药,且以ICU分离株最为明显,应加强细菌耐药性监测,合理使用抗菌药物,有效预防和控制感染。     

2010年中国CHINET铜绿假单胞菌耐药性监测

目的了解2010年我国不同地区铜绿假单胞菌临床分离株的耐药性和耐药特征,指导临床合理使用抗菌药物。方法对全国14所医院临床分离的5 080株铜绿假单胞菌按照统一的方案,采用统一的材料、方法(K-B法)和判断标准(CLSI 2010年版),进行铜绿假单胞菌的耐药性监测,并用WHONET5.4软件进行数据分析。结果 2010年14所医院共收集5 080株临床分离的铜绿假单胞菌,其中91.2%分离自住院患者;69.9%分离自呼吸道标本。铜绿假单胞菌对阿米卡星的耐药率最低,平均为15.3%,对其他抗菌药物的耐药率均高于18%。昆明一医院的分离株对各种抗菌药物的耐药率均高于28%,对其中13种抗菌药物的耐药率是14所医院中最高者;北京一医院分离的菌株对大多数抗菌药物的耐药率在40%左右,甘肃省一医院的分离株对抗菌药物(除头孢哌酮和氨曲南外)耐药率均低于20%;上海一儿童医院的分离株对各抗菌药物的耐药率均低于5%。从ICU分离菌对各种抗菌药物的耐药率均高于门诊、内科、外科和整体分离菌的耐药率(P=0.001)。各医院泛耐药铜绿假单胞菌的检出率平均为1.7%。结论我国临床分离的铜绿假单胞菌对常用抗菌药物的耐药性仍处于较高水平,但本次有轻微下降趋势。不同地区、不同医院的分离株对抗菌药物的耐药性相差较大,ICU仍应是监控重点。医疗机构应加强细菌耐药监测,指导临床合理使用抗菌药物。同时要加强感染控制措施,预防和控制耐药菌株的医院内流行。     

2007年中国CHINET铜绿假单胞菌耐药性监测

目的 了解2007年我国不同地区铜绿假单胞菌临床分离株的耐药性和耐药特征,指导临床合理使用抗菌药物.方法 对全国12所教学医院临床分离的3 988株铜绿假单胞菌采用纸片扩散法(K-B法)进行药敏试验,按CLSI 2007年标准判定药敏结果,并用WHONET 5.4软件进行数据分析.结果 2007年12所医院从临床标本中共分离出3 988株铜绿假单胞菌,其中 94.3% 自住院患者中分离,76.2%的菌株分离自呼吸道标本.铜绿假单胞菌对阿米卡星的耐药率最低,为18.7%,对其他抗菌药物的耐药率均高于20%.上海华山医院的临床分离株除头孢哌酮-舒巴坦外,对其他抗菌药物的耐药率均高于30%,北京医院除对阿米卡星和环丙沙星外,对其他各抗菌药物的耐药率均高于39%,上海儿科医院对各抗菌药物的耐药率均低于10%,甘肃省人民医院除庆大霉素和环丙沙星外,对其他各抗菌药物的耐药率均低于10%. 泛耐药铜绿假单胞菌的检出率为3.2%.结论 我国铜绿假单胞菌的耐药性仍处于较高水平,不同医院抗菌药物的耐药性相差较大,应加强监测,指导临床合理使用抗菌药物并控制医院耐药菌感染的流行.     

血流感染中产CTX-M型ESBLs大肠埃希菌的分子流行病学和危险因素研究

目的研究血流感染中产CTX-M型超广谱β-内酰胺酶(ESBLs)-大肠埃希菌(E.coli)的分子流行病学和危险因素。方法收集该院2014年1月至2017年12月血流感染标本中分离的204株E.coli,其中49株产CTX-M型ESBLs-E.coli作为CTX-M组,44株非产CTX-M型ESBLs-E.coli作为非CTX-M组,111株非产ESBLs-E.coli作为对照组。分析产CTX-M型ESBLs-E.coli的耐药率;采用脉冲场凝胶电泳(PFGE)进行产CTX-M型ESBLs-E.coli菌株的同源性分析;分析产CTX-M型ESBLs-E.coli感染的独立危险因素。结果204株E.coli中产ESBLs率为45.6%,产ESBLs-E.coli中共检出blaCTX-M 49株,占52.7%。CTX-M组对庆大霉素、环丙沙星、左氧氟沙星、头孢他啶和头孢吡肟的耐药率高于非CTX-M组(P0.05)。PFGE结果显示,29株产CTX-M型ESBLs-E.coli菌株属于不同的型别,来源不同,未发现克隆传播。多因素Logistic回归分析结果显示,与非CTX-M组比较,年龄≥60岁、粒细胞减少症、内置引流管和头孢菌素类抗菌药物使用是CTXM组患者感染产CTX-M型ESBLs-E.coli的独立危险因素(P0.05);与对照组比较,转院、尿路感染、置入导尿管和头孢菌素类抗菌药物使用是CTX-M组患者感染产CTX-M型ESBLs-E.coli的独立危险因素(P0.05)。结论产CTX-M型ESBLs-E.coli血流感染的发生率及菌株耐药率均较高,临床应关注产CTX-M型ESBLs-E.coli的流行情况和感染的相关危险因素,并进行早期预防。     

鲍曼不动杆菌耐药性变迁分析及临床对策

目的了解鲍曼不动杆菌(ABA)感染的菌群分布及其对抗菌药物耐药性的变迁趋势,为临床抗感染的预防、诊断、治疗及合理应用抗菌药物提供实验室依据。方法回顾性分析2011年1月至2014年12月本院临床送检的各类标本中分离的ABA的分布及耐药状况,使用VITEK2compact全自动细菌分析仪鉴定菌株及药敏试验,并对其进行统计分析。结果4年间从各类标本中共分离出病原菌7 136株,其中ABA 300株,分离率为4.2%,多药耐药鲍曼不动杆菌(MDR-AB)117株,分离率为39.0%;泛耐药鲍曼不动杆菌(PDR-AB)13株,分离率为4.3%,分离率总体呈上升趋势。ABA临床分布以ICU为主(31.7%),其次为呼吸科(29.3%),其他科室散在分布。感染分布以呼吸道标本为主,其次为分泌物,分别占89.7%和4.3%。ABA对常用抗菌药物的耐药率大部分在40%以上,对青霉素类、头孢菌素和β-内酰胺类抗菌药物均表现为较高耐药性。对丁胺卡那霉素的耐药率最低(3.0%),对头孢替坦和头孢呋辛钠完全耐药(100%)。结论 ABA对多种抗菌药物产生了较高的耐药性,并且多药耐药及泛耐药现象比较严重,应加强其耐药性的动态监测,规范合理应用抗菌药物,严格无菌操作,控制及延缓MDR-AB及PDR-AB的产生,预防和控制ABA的感染与暴发流行。     

肺炎支原体23SrRNA基因突变位点与耐药表型的分析

目的 了解本地区社区呼吸道感染肺炎支原体(Mycoplasma pneumoniae,Mp)感染状况,探讨肺炎支原体对大环内酯类抗菌药物的耐药分子机制,并分析肺炎支原体耐药菌株23SrRNA基因突变位点与耐药表型之间的关系.方法 对400例社区获得性呼吸道感染患儿咽拭子标本进行分离培养,应用巢式聚合酶链反应(PCR)对临床分离株进行分子鉴定;通过体外药物敏感试验测定Mp临床分离株对大环内酯类抗菌药物的最小抑菌浓度(MIC),并筛选出耐药株;检测耐药株23SrRNA基因序列,并与标准菌株M129基因序列对比分析,分析突变位点与耐药表型的关系.结果 400例咽拭子标本中分离Mp 50株.其中敏感株32株,耐药株18株.18株耐药株分别出现A2063G、A2064G、A2067G 位点突变.A2063G突变株表现出对14元环大环内酯类抗菌药物耐药,A2064G突变株表现为对14、16元环大环内酯类抗菌药物的耐药,A2067G突变株表现出对交沙霉素耐药.结论 Mp对大环内酯类抗菌药物耐药现象严重,23SrRNA基因位点突变是耐药性产生的主要机制.通过对23SrRNA基因突变位点与耐药表型的分析研究,初步了解临床肺炎支原体耐药现状,并且为抗菌药物的合理选择和应用提供理论指导.     

2011年中国CHINET铜绿假单胞菌耐药性监测

目的了解2011年中国不同地区铜绿假单胞菌临床分离株的耐药性和耐药特征,指导临床合理使用抗菌药物。方法对全国15所医院临床分离的6012株铜绿假单胞菌按照统一方案,采用统一材料、方法(K-B法或自动化仪器)和判断标准(CLSI 2011年版),进行铜绿假单胞菌的耐药性监测,并用WHONET5.6软件进行数据分析。结果 2011年15所医院从临床标本中共分离6 012株铜绿假单胞菌,其中92.9%分离自住院患者,73.7%的菌株分离自呼吸道标本。铜绿假单胞菌对阿米卡星的耐药率最低,为14.3%。耐药性最高的医院分离株对大多数抗菌药物的耐药率均高于30%,而耐药性最低的成人医院分离的菌株对大多数抗菌药物的耐药率均低于20%,2所儿童医院分离菌株对各种抗菌药物的耐药率均低于17%;分离自门诊的菌株对各种抗菌药物的耐药率均低于25%,而分离自ICU的菌株除了对阿米卡星的耐药率为16.1%外,对其他各种抗菌药物的耐药率均高于23%。各医院泛耐药铜绿假单胞菌的检出率平均为1.8%。结论我国不同地区、不同医院临床分离的铜绿假单胞菌对抗菌药物的耐药率仍处于较高水平,但近年耐药性增长趋势稳定。各地区、各医院、各科室患者的分离株对抗菌药物的耐药性相差较大,医疗机构应加强细菌耐药监测,指导临床合理使用抗菌药物。     

金黄色葡萄球菌医院感染分布及耐药性调查

目的调查医院临床分离的金黄色葡萄球菌的耐药性,为临床医生合理使用抗菌药物提供科学依据。方法对166株金黄色葡萄球菌的分布和耐药性进行调查分析,使用WHONET5.4软件进行数据的统计学分析。结果医院耐甲氧西林金黄色葡萄球菌分离率为62.0%;耐甲氧西林金黄色葡萄球菌(MRSA)对抗菌药物的耐药率均高于甲氧西林敏感金黄色葡萄球菌。未发现对万古霉素和利奈唑胺耐药的金黄色葡萄球菌株。结论加强金黄色葡萄球菌耐药性的监控工作,是预防医院感染的有效措施。     

Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey

OBJECTIVES: To determine the risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection (UTI). METHODS: The study was performed with isolates from community-acquired UTIs collected from 15 centres representing six different geographic regions of Turkey. All microbiological procedures were carried out in a central laboratory. Multivariate analysis was performed for detection of risk factors for resistance. Use of quinolones more than once within the last year, living in a rural area, having a urinary catheter, age >50 and complicated infections were included in the model as variables and logistic regression was performed. RESULTS: A total of 611 gram-negative isolates were studied: 321 were isolated from uncomplicated UTI and 290 were isolated from complicated UTI. E. coli was the causative agent in 90% of the uncomplicated UTIs and in 78% of the complicated UTIs (P < 0.001). Seventeen percent of E. coli strains isolated from uncomplicated cases and 38% of E. coli strains isolated from complicated UTI were found to be resistant to ciprofloxacin. In multivariate analysis, age over 50 [odds ratio (OR): 1.6; confidence interval (CI): 1.08-2.47; P = 0.020], ciprofloxacin use more than once in the last year (OR: 2.8; CI: 1.38-5.47; P = 0.004) and the presence of complicated UTI (OR: 2.4; CI: 1.54-3.61; P < 0.001) were found to be associated with ciprofloxacin resistance. Detection of strains of E. coli producing extended-spectrum beta-lactamase (ESBL) enzymes was two times more common in the patients who received ciprofloxacin than those who did not (15% versus 7.4%). CONCLUSIONS: The increasing prevalence of infections caused by antibiotic-resistant bacteria makes the empirical treatment of UTIs more difficult. One of the important factors contributing to these high resistance rates might be high antibiotic use. Urine culture and antimicrobial susceptibility testing are essential in Turkey for patients with UTI who have risk factors for resistance, such as previous ciprofloxacin use. Fluoroquinolone-sparing agents such as nitrofurantoin and fosfomycin should be evaluated as alternative therapies by further clinical efficacy and safety studies.     

Urinary tract infections and antibiotic resistance

Urinary tract infections (UTI) are diseases which differ considerably regarding pathogenesis, natural history and management. Complicated UTI as well as uncomplicated acute pyelonephritis in women are managed with pretherapy urine and, possibly, blood culture. This is not the case, however, with the most frequent UTI, acute uncomplicated cystitis in women. Empirical management strategies, without pretherapy culture, are well established and widely used. The treatment of choice is trimethoprim-sulfamethoxazole (TMP-SMZ) and fluoroquinolones. E. coli cause the vast majority of these infections, and resistance to TMP-SMZ has been observed to increase considerably during the last decade. Data from Europe and Switzerland regarding resistance of etiologic agents causing acute uncomplicated cystitis are very limited. Indeed, these empirical management strategies have resulted in poor microbiological information, since only selected groups of women with UTI undergo urine culture. Data derived from laboratory isolates usually lack the necessary clinical and epidemiological correlations. Preliminary data allow some estimates of the clinical and microbiological success rates when treating TMP-SMZ resistant uropathogens with TMP-SMZ. TMP-SMZ should probably no longer be used if the prevalence of TMP-SMZ resistance among uropathogens causing acute uncomplicated cystitis is 20% or higher. In these cases, a fluoroquinolone during three days, amoxicillin-clavulanate during three to five days or nitrofurantoin during seven days should be given empirically. Non-antibiotic means of preventing UTI, such as increasing colonization resistance with lactobacilli, or the use of vaccines which provide inhibition of adherence of uropathogens to uroepithelial cells, show very promising experimental results. In order to survey and correct the value of our empirical strategies, more appropriate data on antimicrobial resistance and risk factors in the community are needed. This data can only be produced by a strong collaboration effort with networks of general practitioners.     

Predictive value of Escherichia coli susceptibility in strains causing asymptomatic bacteriuria for women with recurrent symptomatic urinary tract infections receiving prophylaxis

A significant proportion of women develop a recurrence following an initial urinary tract infection (UTI). In women with recurrent UTI, the predictive value of asymptomatic bacteriuria (ASB) for the development of a subsequent UTI has not yet been established and it is not known whether information from an asymptomatic sample is useful in guiding antimicrobial therapy. To address these questions, we used data that originated from the 'Non-antibiotic prophylaxis for recurrent urinary tract infections' (NAPRUTI) study: two randomized controlled trials on the prevention of recurrent UTI in non-hospitalized premenopausal and postmenopausal women (n=445). During 15months of follow-up, no difference was observed in the time to a subsequent UTI between women with and without ASB at baseline (hazard ratio: 1.07, 95% CI 0.80-1.42). The antimicrobial susceptibility and pulsed-field gel-electrophoresis (PFGE) pattern of 50 Escherichia coli strains causing a UTI were compared with those of the ASB strain isolated 1month previously. The predictive values of the susceptibility pattern of the ASB strain, based on resistance prevalence at baseline, were ≥76%, except in the case of nitrofurantoin- and amoxicillin-clavulanic acid-resistance. Asymptomatic and symptomatic isolates had similar PFGE patterns in 70% (35/50) of the patients. In the present study among women with recurrent UTI receiving prophylaxis, ASB was not predictive for the development of a UTI. However, the susceptibility pattern of E. coli strains isolated in the month before a symptomatic E. coli UTI can be used to make informed choices for empirical antibiotic treatment in this patient population.     

Exposure to co-amoxiclav as a risk factor for co-amoxiclav-resistant Escherichia coli urinary tract infection

The objective of the study was to define whether individual exposure to co-amoxiclav is a risk factor for selecting co-amoxiclav-resistant Escherichia coli in vivo. One hundred and eight patients were included in our study as soon as they were found to have a urinary tract infection (UTI) due to E. coli. Stool probes were also undertaken for some of these patients. Co-amoxiclav administration in the month before diagnosing the UTI, and any treatment to cure the current UTI were recorded for all patients. When co-amoxiclav-resistant E. coli was detected in the stools after diagnosis of E. coli UTI, isolates were compared with urinary E. coli isolates in terms of clonal relatedness, beta-lactam susceptibility and mechanisms of beta-lactam resistance. The patients who had taken co-amoxiclav in the month before the reported E. coli UTI had a significantly higher risk of being infected with co-amoxiclav-resistant E. coli. Those patients treated with amoxicillin for a current infection were at greater risk of intestinal carriage of co-amoxiclav-resistant E. coli; those treated with co-amoxiclav had a greater risk of intestinal carriage of co-amoxiclav-resistant Gram-negative bacilli than patients treated with third-generation cephalosporins or fluoroquinolones. Hence, individual exposure to co-amoxiclav is a risk factor for UTIs caused by co-amoxiclav-resistant E. coli or for carrying co-amoxiclav-resistant Gram-negative bacilli in the digestive tract.     

某医院2013-2017年细菌耐药性趋势分析

目的分析医院2013-2017年临床常见分离菌对抗菌药物的耐药特点及变迁趋势,为临床合理使用抗菌药物提供参考依据。方法采用VITEK-2 Compact全自动细菌鉴定仪进行菌科鉴定,纸片扩散(K-B)法测定细菌对受试抗菌药物的敏感性,使用WHONET 5.6软件收集耐药性数据,分析临床常见分离菌的耐药特点。结果2013-2017年大肠埃希菌占比始终位于首位,鲍曼不动杆菌占比明显下降,肺炎克雷伯菌、屎肠球菌和粪肠球菌占比有所上升。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌耐药率主要呈下降趋势,肠球菌耐药率处于波动中;其中大肠埃希菌耐药率普遍高于肺炎克雷伯菌,鲍曼不动杆菌耐药率普遍高于铜绿假单胞菌,屎肠球菌对多数抗菌药物耐药率高于粪肠球菌。结论肠球菌耐药率控制效果不佳,临床应进一步发挥抗菌药物科学化管理团队的作用,促进抗菌药物合理使用,延缓细菌耐药。     

Association between antibiotic resistance and the expression of Dr adhesin among uropathogenic Escherichia coli

BACKGROUND: Urinary tract infections (UTIs) are a significant health problem and Escherichia coli has been exported to be the primary pathogen in approximately 80% of cases. E. coli express structures called adhesins, fimbriae or pili that help them bind to specific tissue receptors. One such adhesin is Dr, which binds to the complement decay-accelerating factor (CD55) on the host cell. The purpose of the present study was to review the epidemiology and antimicrobial sensitivity spectrum of Dr adhesin-bearing E. coli isolates in women with UTI. METHODS AND RESULTS: A total of 337 uropathogenic E. coli isolates were collected, and mannose-resistant hemagglutination was observed in 43%, while 12.4% expressed Dr adhesin. All 337 uropathogenic E. coli isolates were found to be resistant to penicillin, oxacillin, bactericin and cloxacillin. None of the isolates was resistant to quinolones. The resistance to sulfamethoxazole was most common (90%), followed by nalidixic acid (51%) and ampicillin (41%). Interestingly, uropathogenic E. coli expressing Dr adhesin had a high incidence of ampicillin resistance (83%), and only 17% of the Dr-bearing isolates were found to be resistant to an ampicillin/sulbactum combination. CONCLUSION: These results indicate that UTIs may be successfully treated with ampicillin in combination with a beta-lactamase inhibitor, so that selective colonization by Dr adhesin-bearing uropathogenic E. coli is prevented, which is probably promoted by treating these patients with ampicillin alone.     

无菌体液与非无菌体液细菌耐药监测对比分析

目的探讨该院2014年无菌体液与非无菌体液来源细菌的菌种分布及耐药性的差异。方法采用回顾性分析方法,应用BD Phoenix~(TM)100全自动细菌鉴定药敏系统进行细菌鉴定与药敏检测,应用Whonet5.6软件和SPSS19.0统计软件对细菌耐药率进行统计分析。结果无菌体液分离率最高的细菌为大肠埃希菌(43%),非无菌体液分离率最高的细菌为铜绿假单胞菌(21%)。无菌体液来源的大肠埃希菌对氨苄西林、氨曲南、环丙沙星、氯霉素等11种抗菌药物耐药率低于非无菌体液来源的菌株,无菌体液来源的金黄色葡萄球菌对阿米卡星、阿莫西林/克拉维酸、环丙沙星等6种抗菌药物耐药率低于非无菌体液来源的菌株,无菌体液来源的铜绿假单胞菌对氨曲南耐药率低于非无菌体液来源的菌株,无菌体液来源的肺炎克雷伯菌对氨苄西林/舒巴坦、复方新诺明、氯霉素等6种抗菌药物耐药率低于非无菌体液来源的菌株,差异均有统计学意义(P0.05)。结论无菌体液与非无菌体液来源细菌的菌种分布及耐药性存在差异,加强无菌体液细菌耐药性监测尤为重要。     

Urinary tract infection trends in Latin American hospitals: report from the SENTRY antimicrobial surveillance program (1997-2000)

Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed in outpatients as well as in hospitalized patients. The objective of this study was to report the frequency of occurrence and antimicrobial susceptibility of uropathogens collected in Latin America between 1997 to 2000 through the SENTRY Antimicrobial Surveillance Program. Antimicrobial susceptibility testing was performed and results interpreted using reference broth microdilution methods. In the 4 year period, a total of 1961 urine isolates from hospitalized patients were included. The patients' mean age was 51.3 years and most of the infections occurred among women (65.6%). Esherichia coli was the most frequent pathogen isolated followed by Klebsiella spp., Pseudomonas aeruginosa, and Proteus mirabilis. Among the E. coli isolates, piperacillin/tazobactam, aztreonam, extended-spectrum cephalosporins, carbapenems and amikacin constitute reasonable therapeutic options for treatment of serious UTI in Latin America (91.0-100.0% susceptible). High resistance rates to fluoroquinolones (17.5-18.9%) and trimethoprim/sulfamethoxazole (>45.0%) were observed among the E. coli. In contrast, nitrofurantoin displayed susceptibility rate of > 87.0%. Against Klebsiella spp. infections, the only effective therapeutic option would be the carbapenems due to the high number of isolates (>30.0%) producing extended-spectrum beta-lactamases (ESBL). Even the new fluoroquinolones showed limited activity against Klebsiella spp. (72.1-88.6% susceptible) and the P. aeruginosa isolates showed high resistance rates to most antimicrobial agents tested. The results of this survey endorse the importance of Enterobacteriaceae as cause of UTI in Latin America. Our results also demonstrate that the uropathogens isolated in the Latin American medical centers exhibit high resistance to various classes of antimicrobial agents. Carbapenem-resistant P. aeruginosa, ciprofloxacin-resistant E. coli, ESBL-producing K. pneumoniae constitute serious problem in this geographic region.     

Susceptibility patterns of orally administered antimicrobials among urinary tract infection pathogens from hospitalized patients in North America: comparison report to Europe and Latin America. Results from the SENTRY Antimicrobial Surveillance Program (2000)

Urinary tract infections (UTIs) remain a worldwide nosocomial infection problem. Geographic variations in pathogen occurrence and susceptibility profiles require monitoring to provide information to guide new (garenoxacin [BMS284756]) therapeutic options. Two thousand seven hundred-eighty UTI isolates from Europe (n = 783), Latin America (531), and North America (1,466) were tested and compared against 44 agents by reference methods in the SENTRY Antimicrobial Surveillance Program. The top seven pathogens accounted for 90% of all isolates and the rank order for all regions was: Escherichia coli (1,316; 47%), Enterococcus spp. (351; 13%), Klebsiella spp. (306; 11%), Pseudomonas aeruginosa (210; 8%), Proteus mirabilis (145; 5%), Enterobacter spp. (97; 4%), and Citrobacter spp. (78; 3%). The pathogen rank order was similar among regions except for the rarer occurrence of Enterococcus spp. (Rank #6, 4%) in Latin America. E. coli ampicillin resistance was highest in Europe and Latin America (51-55%). Ampicillin (37%), ciprofloxacin or garenoxacin (4%), and trimethoprim/sulfamethoxazole (23%) resistance remained lowest in North America. Nitrofurantoin susceptibility in E. coli was still at acceptable levels and ranged from 91 to 96% across regions. The regional ciprofloxacin-resistant rank order for P. aeruginosa by region was: Latin America (55%) > Europe (41%) > North America (29%). Vancomycin-resistant enterococci (VRE) were only detected in North America (7%). Garenoxacin possessed a 34 to 44% wider spectrum compared to ciprofloxacin against enterococci UTI isolates. Extended spectrum beta-lactamase rates for E. coli and Klebsiella spp. were 4 and 19%, respectively. These results emphasized the need to assess the often striking differences in pathogen occurrence and resistance rates among the commonly encountered UTI pathogens.