尿路感染病原菌的分布及耐药趋势

尿路感染是最常见的社区感染性疾病之一,临床往往首先给予经验性抗菌治疗。随着抗生素的广泛应用,多种耐药菌株不断出现、耐药率不断增加。为进一步了解尿路感染病原菌及其对抗生素耐药性的变化,我们对门诊尿路感染病原菌进行药敏结果分析,以指导临床用药。资料与方法1研究对象选择在我院门诊治疗的尿路感染患者150例,其中男29例,女121例,平均年龄为(46.83±18.46)岁。所有患者均符合1985年第二届肾脏病学术会议制订的尿路感染诊断标准[1]。2细菌鉴定和药敏试验尿标本分离株用梅埃里公司Vitek-32型全自动微生物分析仪鉴定菌种后按照KB法进…     

老年女性尿路感染的特点及处理

正尿路感染(urinary tract infections,UTI)是女性常见病,也是下尿路不适的主要原因,且发病率随着年龄的增加而增加,同时增加老年女性的死亡率。对尿路感染进行深入的研究,加强治疗及护理等可以有效控制病情并减少死亡率及住院率。对于老年女性,绝经后内源性的雌激素分泌下降与泌尿生殖道萎缩及下尿路感染增加相关。所以,阴道雌激素     

121例尿路感染病原菌流行趋势分析

目的:观察尿路感染病原菌分布流行趋势及对药物的反应性.方法:用回顾性方法对121例尿病原菌培养结果达标者,分组分别探讨病原菌菌属分布特点、G-杆菌及肠球菌对药物的敏感性及耐药性,并通过计算OR值观察年龄与尿路真菌感染的关系.结果:革兰氏阴性杆菌占所有病原菌的首位,肠球菌占第二位,真菌感染的发生率较文献报道有上升趋势;从药敏试验上得出,氨苄西林对G-杆菌及其中的大肠埃希氏菌耐药率最高,亚胺培南对肠杆菌科保持着高度敏感性.肠球菌对青霉素类有中低度敏感,重症屎肠球菌感染可首选万古霉素.而对于老年患者、长期应用广谱抗生素、糖皮质激素、免疫抑制剂,则应尽早考虑到真菌感染的可能性.结论:尿路感染的主要致病菌仍是革兰氏阴性杆菌,并以大肠埃希氏菌为主.真菌感染有上升趋势,临床中应引起重视.     

2型糖尿病并发尿路感染病原菌特点分析

糖尿病患者常易并发感染,其中又以慢性尿路感染最多见.本研究对我院住院的2型糖尿病患者合并尿路感染的发病率、病原菌菌群分布特点及药物敏感性等进行了总结,现报告如下……     

2型糖尿病并发尿路感染病原菌特点分析

糖尿病患者常易并发感染,其中又以慢性尿路感染最多见.本研究对我院住院的2型糖尿病患者合并尿路感染的发病率、病原菌菌群分布特点及药物敏感性等进行了总结,现报告如下……     

2型糖尿病并发尿路感染病原菌特点分析

糖尿病患者常易并发感染,其中又以慢性尿路感染最多见.本研究对我院住院的2型糖尿病患者合并尿路感染的发病率、病原菌菌群分布特点及药物敏感性等进行了总结,现报告如下……     

2型糖尿病并发尿路感染病原菌特点分析

糖尿病患者常易并发感染,其中又以慢性尿路感染最多见.本研究对我院住院的2型糖尿病患者合并尿路感染的发病率、病原菌菌群分布特点及药物敏感性等进行了总结,现报告如下……     

2型糖尿病并发尿路感染病原菌特点分析

糖尿病患者常易并发感染,其中又以慢性尿路感染最多见.本研究对我院住院的2型糖尿病患者合并尿路感染的发病率、病原菌菌群分布特点及药物敏感性等进行了总结,现报告如下……     

2型糖尿病并发尿路感染病原菌特点分析

糖尿病患者常易并发感染,其中又以慢性尿路感染最多见.本研究对我院住院的2型糖尿病患者合并尿路感染的发病率、病原菌菌群分布特点及药物敏感性等进行了总结,现报告如下……     

女性泌尿系医院与社区感染菌群分布及耐药性分析

泌尿系感染是常见的感染性疾病,在医院感染中仅次于呼吸道感染,由于女性生理结构特殊,更易发生泌尿系感染.为了解医院与社区女性泌尿系感染病原学的特点及菌株耐药情况,为临床合理使用抗菌药物提供依据,我们对2009年5月-2010年5月江苏省泰州市人民医院女性中段尿分离出的181株病原菌进行了回顾性分析.     

女性糖尿病患者泌尿系统感染的尿液菌群特征、血清CRP水平及危险因素分析

目的:分析女性糖尿病患者泌尿系统感染的尿液菌群特征、血清C反应蛋白(CRP)水平,并探讨患者泌尿系统感染发生的危险因素。方法:选择2019年6月至2020年10月本院收治的79例女性糖尿病患者作为研究对象,并依照患者是否并发泌尿系统感染分为感染组(19例)和未感染组(60例);详细收集患者的临床资料,并检测患者的尿液菌...     

一县级医院泌尿道感染的病原菌分布及耐药性分析

为给临床治疗尿路感染提供依据,我们对2007年5月至2010年4月我院中段尿分离菌的分布及耐药性进行回顾分析,现报道如下. 一、对象和方法 1.一般资料:中段尿培养分离的不重复菌株264株,其中205株来源于女性,59株来源于男性.     

Renal concentrating capacity in female outpatients with symptomatic urinary tract infection

OBJECTIVE: Renal concentrating capacity (RCC) has been used as a tool in the diagnosis of the site of urinary tract infection (UTI). In this study, RCC was measured in women with symptoms of UTI in relation to the clinical picture and the bacterial species isolated. MATERIAL AND METHODS: In 633 outpatients aged > or =18 years with symptoms of UTI, a renal concentration test with desmopressin was performed at baseline. The test was repeated after antibiotic treatment in a subset of patients with osmolality values below the reference levels at entry. The bacterial species were identified and patients were classified as having either pyelonephritis or cystitis. RESULTS: RCC was reduced in patients infected with Escherichia coli or Staphylococcus saprophyticus compared to those who had negative urine cultures and increased after antibiotic treatment. Patients with symptoms of both pyelonephritis and cystitis had reduced RCC: 44/68 (65%) and 205/457 (45%), respectively. CONCLUSIONS: These findings demonstrate a considerable overlap in RCC between patients with pyelonephritis and cystitis, making the osmolality test unreliable for the purpose of diagnosis of the site of UTI.     

复杂性尿路感染致病菌的耐药性新趋势

目的 探讨复杂性尿路感染致病菌和耐药性的变化。方法 分析从1995年到2001年住院治疗的260例培养阳性的复杂性尿路感染致病菌分布及其对抗生素敏感性。结果 革兰阴性杆菌占77.3％,其中大肠杆菌占44.2％;革兰阳性球菌占16.9％,其中肠球菌占11.6％;真菌占5.8％。大肠杆菌对氨苄西林耐药率最高,达84.1％;对羟氨苄西林/克拉维酸耐药率(21.3％)明显低于对氨苄西林的耐药率(P<0.05);对阿米卡星耐药率明显低于对庆大霉素的耐药率(4.9％比54.3％,P<0.01);致病大肠杆菌对喹诺酮耐药,耐药率为50％-78％;对SMZ/TMP耐药性也高达62.3％。结论 大肠杆菌仍是住院复杂性尿路感染的主要致病菌,但肠球菌、克雷白杆菌、阴沟肠杆菌常见等细菌的比例有所增加。这些细菌耐药性高,部分呈多重耐药,应尽量根据细菌药敏试验调整抗生素。     

National S3 guideline on uncomplicated urinary tract infection: recommendations for treatment and management of uncomplicated community-acquired bacterial urinary tract infections in adult patients

Background

Urinary tract infections (UTI) belong to the most frequent bacterial infections in outpatients. Increasing antibiotic resistance rates and a new appreciation of the epidemiological side effects of antibiotics (??collateral damage??) have warranted an update of the guidelines on uncomplicated UTI as an S3 clinical guideline.

Methods

The guideline was developed by the Deutsche Gesellschaft für Urologie (DGU) in collaboration with the Deutsche Gesellschaft für Allgemein- und Familienmedizin (DEGAM), Deutsche Gesellschaft für Gyn?kologie und Geburtshilfe (DGGG), Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Deutsche Gesellschaft für Infektiologie (DGI), Deutsche Gesellschaft für Nephrologie (DGfN), Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG) and a patient representative. The systematic review of the literature on the topics of the guideline was performed for the time period of 1 January 1998 to 30 April 2008 in the databases of the Cochrane Library and MEDLINE. International guidelines of the years 1999?C2007 were included.

Results

Uncomplicated UTI comprise uncomplicated cystitis and uncomplicated pyelonephritis. The leading uropathogen is Escherichia coli. The choice of the antbiotic substance follows the five primary aspects: (1) individual patient risk and antibiotic pretreatment; (2) bacterial spectrum and antibiotic susceptibility; (3) effectivity of the antimicrobial substance demonstrated in clinical studies; (4) epidemiological effects (??collateral damage??); and (5) adverse effects. If antibiotics such as trimethoprim/sulfamethoxazole or fluoroquinolones have previously been given, the risk for pathogens to become resistant against these substances is increased. Because of increasing resistance rates of E. coli against trimethoprim/sulfamethoxazole also in uncomplicated UTI, trimethoprim alone or in combination with sulfamethoxazole is no longer regarded as the first-line agent in the empiric treatment of uncomplicated cystitis, unless the regional resistance rate is below 20%. The antibiotic resistance rates of fluoroquinolones in uncomplicated UTI are still below 10% in Germany, but there is a significant emergence of resistance compared to earlier years. Moreover, fluoroquinolones and group 3 cephalosporins exhibit negative epidemiological effects resulting in selection of multi-resistant pathogens. Because these antibiotic classes are needed in therapy of life-threatening infections, such effects should be taken seriously. For substances like fosfomycin, nitrofurantoin or mecillinam??collateral damage?? has not been documented or only to a lesser degree. Therefore, for empiric therapy of frequent uncomplicated cystitis fosfomycin-trometamol, nitrofurantoin or pivmecillinam (not listed in Germany) are recommended as first-line antibiotics. For oral first-line treatment of uncomplicated pyelonephritis, fluoroquinolones are still recommended in sufficiently high dosage due to the resistance rates of E. coli still being below 10% and the superior effectivity compared to other antibiotics. Asymptomatic bacteriuria (ASB) should only be treated in exceptional cases such as pregnant women or prior to expected mucocutaneous traumatising interventions of the urinary tract.

Conclusion

The S3 guideline on uncomplicated urinary tract infections is a comprehensive set of evidence- and consensus-based recommendations dealing with epidemiology, diagnosis, therapy and management of uncomplicated bacterial UTI of adult outpatients. A broad implementation in all disciplines taking care of patients with UTI is necessary in order to ensure a prudent antibiotic policy in these frequent infections and thus improve patient care.