The impact of resistance on the management of urinary tract infections

Urinary tract infections requiring treatment are extremely common. It is estimated that between 20 and 50% of adult women will have had at least one symptomatic urinary tract infection. When considering the optimal therapy of any infection, patient factors, organism factors, drug factors (e.g. pharmacokinetics), side-effects and cost as well as antimicrobial resistance all need to be considered. This paper deals with the impact of increasing antibiotic resistance on the management of urinary tract infections.     

Clinical experience with indanyl carbenicillin in urinary tract infections

Summary

A trial was carried out in 30 patients to assess the effectiveness of indanyl carbenicillin in acute or chronic urinary tract infections, many of which were complicated by a pathological urological or medical condition. In all patients, infection was due to a single species of pathogen: E. coli (19), Proteus (6), and Pseudomonas (5). Oral doses of 1 g indanyl carbenicillin were given 6-hourlyfor an average of 10 days.

Results showed a clinical and bacteriological cure in 13 {43.8 %)patients. In 6 patients, although there was initial clinical improvement, the pathogen developed resistance during therapy. In 7 patients, there was super-infection with another organism. Four patients were withdrawn early in treatment because of side-effects, mainly gastrointestinal in origin. Indanyl carbenicillin proved very effective in eradicating all strains of Proteus and Pseudomonas and 12 (70.6%) of the 17 strains of E. coli in patients completing the full course of treatment.     

Spectrum and antibiotic resistance of uropathogens from hospitalized patients with urinary tract infections: 1994-2000

During the period 1994–2000 all uropathogens cultured from urine of hospitalized urological patients were identified and susceptibility was tested against 11 antibacterials. Duplicated isolates were eliminated. There was no general trend of increased of resistance apart from E. coli to ciprofloxacin (10.4% in 2000). Vancomycin-resistant staphylococci or enterococci was not significant. The lowest overall rates of resistance were found with piperacillin/tazobactam followed by ciprofloxacin and trimethoprim/sulphamethoxazole. Ciprofloxacin was the best oral antibiotic for the empirical treatment of urinary tract infection (UTI) due to Gram-negative rods and ampicillin/sulbactam for the treatment of UTI with Gram-positive cocci.     

小儿泌尿道感染常见病原菌及耐药性分析

目的了解小儿泌尿道感染的常见病原菌及体外对常用抗生素敏感情况。方法对2000年1月至2003年2月诊断为尿路感染的306例病人,常规进行中段尿培养,并对鉴定的致病菌Kirby-Bauer琼脂扩散法进行药物敏感试验。结果163例分离到致病菌,阳性率53.75%,最常见者为肠杆菌科细菌,构成比达67.5%(110株,包括大肠杆菌46株,肺炎克雷伯菌21株,阴沟肠杆菌13株,变形杆菌7株、绿脓杆菌6株,等);肠球菌达16.0%(共26株);葡萄球菌15.3%(25株)。药敏试验结果几乎所有的肠杆菌科细菌都对亚胺培南敏感,大肠杆菌、肺炎克雷伯菌、阴沟肠杆菌、变形杆菌和绿脓杆菌等5种主要致病肠杆菌对复方新诺明的敏感率也在50～91.3%不等,但对青霉素类和一代、二代头孢菌素的耐药率高达71.4～100%。肠球菌对万古霉素的敏感性达96.2%,而葡萄球菌对环丙沙星、万古霉素和利福平的敏感率较高,分别为80%、100%和100%。结论肠杆菌科细菌、肠球菌和葡萄球菌是小儿尿路感染的三大类常见致病菌。除了大肠杆菌和变形杆菌,其它主要致病菌耐药现象都较严重。治疗上复方新诺明是治疗大多数细菌感染的价廉而有效的药物,而亚胺培南则是治疗耐药细菌感染的最终选择。     

真菌性尿路感染的发病机制与诊断标准

本文根据多年的临床观察经验,并参考相关文献资料,系统论述了真菌性尿路感染的流行病学、发病机制、病理、临床表现、检查及诊断标准,对进一步研究该疾病的发病机制,更好地治疗该疾病提供了理论依据。     

Antimicrobial activity of imipenem against isolates from complicated urinary tract infections

Antimicrobial activity of imipenem was measured using 4725 strains isolated from patients with complicated urinary tract infections (CUTIs) between 1988 and 2000. Imipenem was inactive against methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis, Enterococcus faecium and some non-fermenting Gram-negative rods. Resistant strains (MIC>16 mg/l) were observed in Staphylococcus haemolyticus (22%), Enterococcus faecalis (4%), Enterococcus avium (8%), Serratia marcescens (5%) and Pseudomonas aeruginosa (7%). Although the prevalence of imipenem-resistant strains of S. aureus, S. epidermidis and P. aeruginosa was sporadically high in some years, no steady increase was seen over the period. Resistant strains were rare in other major uropathogenic species. These results suggest that imipenem is still one of the most reliable antimicrobial drugs.     

加替沙星联合阿奇霉素治疗泌尿系统感染的临床研究

目的 分析加替沙星联合阿奇霉素治疗泌尿系统感染的临床疗效,总结治疗泌尿系统感染的有效方法及安全性.方法 选择94例泌尿系统感染患者,随机分为两组,观察组47例采用加替沙星联合阿奇霉素治疗,对照组47例仅使用加替沙星治疗,两组疗程均为7～10d,对两组的有效率、细菌清除率及不良反应进行比较.结果 观察组总有效率为100.00％,对照组总有效率为82.98％,两组总有效率比较差异有统计学意义(P＜0.05).观察组细菌清除率为100.00％,对照组细菌清除率为82.98％,两组细菌清除效果比较差异有统计学意义(P＜0.05).观察组不良反应发生率为6.37％,对照组不良反应发生率为4.26％,两组不良反应发生情况比较差异无统计学意义(P＞0.05).结论 加替沙星联合阿奇霉素治疗泌尿系统感染效果显著,且不良反应少,使用安全,可作为泌尿系统感染的首选药物.     

New 4-quinolones in the treatment of urinary tract infections

The new fluorinated quinolones norfloxacin, ciprofloxacin and pefloxacin were evaluated in urinary infections. Bacteriological cure rates in both uncomplicated and complicated urinary tract infections ranged from 85% to 99%. Clinical cure rates were often lower due to the underlying conditions in the urinary tract. Patients with neurological bladder disease were cured in a relatively high percentage of theirPseudomonas infection after three months treatment with norfloxacin. Pharmacokinetics of ciprofloxacin in prostatic tissue and fluid will probably offer an advance in the treatment of chronic urinary infections due to an infectious prostatic focus. Definitely drug related side effects (of gastro-intestinal, neurological or allergic nature) were mild in most cases. The new 4-quinolones should be followed with interest concerning their activity in urological infections in general as well as specifically. The minor influence on the natural human flora and the possibility to decrease plasmid-mediated resistance are of major importance.     

宜昌地区泌尿道感染病原菌构成及抗菌药物敏感性分析

目的为指导临床医师合理使用抗菌药物提供理论依据。方法回顾性分析宜昌市中心人民医院2012年至2018年尿培养阳性的门诊及住院患者,按时间分为A组(2012—2014年)与B组(2015—2018年),对比分析两组主要病原菌分布情况,以及各病原菌抗菌药物敏感趋势。结果①共培养出6596株病原菌,其中A组1857株,B组4739株。A组与B组排名前5位细菌均为大肠埃希菌、粪肠球菌、屎肠球菌、肺炎克雷伯菌和铜绿假单胞菌。②B组中大肠埃希菌对常见抗菌药物敏感性均高于A组,且具有统计学意义。③A组中粪肠球菌对环丙沙星的敏感率高于B组,分别为45.2%和30.6%,B组粪肠球菌对其他抗菌药物敏感率均高于A组,且其中四环素、氨苄西林、万古霉素具有统计学意义。④B组中屎肠球菌对四环素的敏感率略高于A组,分别为42.4%和42.8%,B组屎肠球菌对其他抗菌药物敏感率则更低。结论泌尿道感染最常见病原菌为大肠埃希菌及肠球菌,占病原菌的70%～80%。常用抗菌药物的敏感率呈上升趋势,临床上规范合理使用抗菌药物对减少病原菌耐药、治疗泌尿道感染具有重要意义。     

宜昌地区泌尿道感染病原菌构成及抗菌药物敏感性分析

目的 为指导临床医师合理使用抗菌药物提供理论依据。方法 回顾性分析宜昌市中心人民医院2012年至2018年尿培养阳性的门诊及住院患者,按时间分为A组(2012—2014年)与B组(2015—2018年),对比分析两组主要病原菌分布情况,以及各病原菌抗菌药物敏感趋势。结果 ①共培养出6596株病原菌,其中A组1857株,B组4739株。A组与B组排名前5位细菌均为大肠埃希菌、粪肠球菌、屎肠球菌、肺炎克雷伯菌和铜绿假单胞菌。②B组中大肠埃希菌对常见抗菌药物敏感性均高于A组,且具有统计学意义。③A组中粪肠球菌对环丙沙星的敏感率高于B组,分别为45.2%和30.6%,B组粪肠球菌对其他抗菌药物敏感率均高于A组,且其中四环素、氨苄西林、万古霉素具有统计学意义。④B组中屎肠球菌对四环素的敏感率略高于A组,分别为42.4%和42.8%,B组屎肠球菌对其他抗菌药物敏感率则更低。结论 泌尿道感染最常见病原菌为大肠埃希菌及肠球菌,占病原菌的70%~80%。常用抗菌药物的敏感率呈上升趋势,临床上规范合理使用抗菌药物对减少病原菌耐药、治疗泌尿道感染具有重要意义。     

重庆小儿下呼吸道感染的细菌耐药性与抗菌药物使用分析

目的：了解重庆地区小儿下呼吸道感染的细菌耐药性与抗菌药物使用情况。指导抗菌药物的合理应用。方法：采用分层随机抽样的方法,回顾性分析2000-2004年我院1200例下呼吸道感染患儿的病原学检查结果与常见细菌的耐药性及抗菌药物应用。结果：重庆地区小儿下呼吸道感染的病原以细菌为主。第一位为肺炎链球菌,它对青霉素的耐药率较高,在55．0％左右,5年中有缓慢增加趋势;80．0％左右的菌株对复方新诺明、红霉素和四环素耐药。肺炎克雷伯菌对儿科常用抗菌药物的耐药性逐渐增加。我院抗菌药物的选用以二联为主,98．0％以上为静脉用药。结论：重庆地区小儿下呼吸道感染的病原以细菌为主,其耐药性不容忽视,应重视小儿下呼吸道感染的病原及耐药性监测,合理应用抗菌药物。     

舒氨新在治疗泌尿系统感染中的应用

自1995年8至10月份,单独使用舒氨新治疗泌尿系统感染患者40例,取得较好疗效。剂量:每日3～6克溶于5％的葡萄糖溶液中分两次静脉滴入,每次60～90分钟,连续用药7～14天。结果:痊愈22例(55％),显效15例(37.5％),进步1例(2.5％),无效2例(5％),总有效率为92.5％。     

加替沙星治疗急性泌尿系统感染疗效研究

目的评价加替沙星注射液治疗急性泌尿系统感染的临床疗效与安全性。方法采用随机单盲对照试验,以左氧氟沙星注射液为对照,两组药物的用量用法均为200mg、ivgtt、q12h、疗程7～14d。治疗前后均行尿液细菌学检查。结果加替沙星组和左氧氟沙星组的临床疗效和细菌清除率分别为84.62%、83.08%;91.8%、90.0%(P>0.05)。且两组药物的临床副反应率分别为9.2%与7.7%。结论加替沙星是治疗急性泌尿系统感染的安全、有效的抗生素。     

氨曲南联合头孢吡肟治疗泌尿系统感染疗效分析

目的 分析氨曲南联合头孢吡肟治疗泌尿系统感染的临床疗效.方法 123例泌尿系统感染患者,采用随机区组分组法分为观察组、对照1组和对照2组三组,每组41例.对照1组给予头孢吡肟治疗,对照2组给予氨曲南治疗,观察组则联合给予氨曲南和头孢吡肟,疗程均为7d.结果 观察组总有效率达95.1％,与对照1组(85.4％)和对照2组(82.9％)相比,差异均有统计学意义(x2=12.89、13.56,均P＜0.05).治疗结束后,观察组细菌清除率达94.3％,较对照1组和对照2组稍高.各组治疗过程中仅发生轻微不良反应,不影响继续用药,并且停药后症状消失.且各组不良反应发生率差异均无统计学意义(P＞0.05).结论 头孢吡肟联合氨曲南用于泌尿系统感染治疗,可提高治疗疗效,且不良反应没有增加.     

呼吸道感染者的细菌培养及抗生素耐药情况分析

目的通过对呼吸道感染细菌培养及抗生素耐药情况分析,以期正确、合理及有效使用抗生素。方法选取180例呼吸道感染者且进行细菌培养和抗生素耐药率统计,然后对所得数据给予相应统计学处理,最后对其结果进行合理分析。结果革兰阳性菌占28.33%、革兰阴性菌占71.67%且革兰阴性菌明显高于革兰阳性菌,同时对常规抗生素存在不同程度的耐药性。结论做好呼吸道感染病原菌的监测及耐药性分析对临床合理选取抗生素至关重要。     

479株尿路感染病原菌分布及其耐药性分析

目的探讨尿路感染的病原菌分布及耐药情况,为临床合理用药提供依据。方法统计分析2008年1月1日至2008年12月31日间,本院门诊及住院患者的尿培养与药敏结果。结果2008年尿路感染病原菌共分离出479株,其中大肠埃希菌占40．3％,肺炎克雷伯菌10．4％,粪肠球菌8．6％,表皮葡萄球菌5．4％;真菌10．0％;药敏结果显示亚胺培南、阿米卡星、头胞他啶、头胞吡肟对革兰阴性菌敏感率较高;呋哺妥因和万古霉素对革兰阳性球菌敏感率较高（几乎100％）。结论泌尿系感染最多见的是大肠埃希氏菌,病原菌耐药严重,临床医生应重视尿培养检测,依据药敏报告合理地选用抗菌药物治疗。     

辽宁锦州地区尿路感染致病菌分布及耐药性分析

目的 了解锦州地区尿路感染患者的致病菌分布及耐药性，指导临床合理用药。方法 分析2005年6月～2006年6月确诊为尿路感染的住院患者尿细菌培养及其对抗生素的耐药性。结果 分离前4位的细菌依次为大肠埃希菌（43．75％）、凝固酶阴性葡萄球菌（9．03％）、肠球菌（6．94％）、肺炎克雷伯菌（5．56％）；超广谱β-内酰胺酶（ESBLs）检出率21．43％；革兰阴性杆菌对头孢西丁、头孢哌酮、头孢他啶、头孢吡肟和亚胺培南的敏感性较好，对哌拉西林、氨苄西林、磺胺类、喹诺酮类抗生素耐药率高；革兰阳性球菌对万古霉素、利福平、呋喃妥因敏感，对头孢菌素类、青霉素类、红霉素等抗生素耐药率高。结论 分离菌株对常用抗生素耐药严重，临床应结合药敏试验和耐药菌株的报告结果，合理选择抗生素。     

Pharmacotherapy of lower urinary tract infections and pyelonephritis in children

This review focuses on the treatment of urinary tract infections (UTI) in children. Acute pyelonephritis (an infection involving the renal parenchyma), acute cystitis (infection limited to the lower urinary tract) and asymptomatic bacteriuria (absence of clinical symptoms) have to be clearly distinguished. Whereas antibiotics are needed in pyelonephritis and cystitis, they should be used only exceptionally in cases of asymptomatic bacteriuria, as they may be potentially harmful and select more virulent bacteria. In case of pyelonephritis, there should be no delay in beginning the treatment in order to decrease the risk of long term complication in particular renal scars. Predisposing conditions for UTI should be evaluated carefully. New concepts concerning analysis of virulence profile or specific host immune response might bring more comprehension to UTI, but yet these concepts do not influence clinical practice. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economical factors in different health systems.     

泌尿系感染的菌群分布及耐药性分析

目的对泌尿系统感染的细菌菌群分布及其耐药性进行统计分析。方法选取2009年2月至2011年2月我院中段尿细菌培养阳性,临床诊断为泌尿系感染的患者200名,对标本进行菌种鉴定及药敏试验,并将实验结果进行统计分析。结果导致泌尿系统感染的主要细菌为：大肠埃希菌（66％）、肺炎克雷伯菌（12．5％）、变形杆菌（6．5％）、不动杆菌（5．5％）及凝固酶阴性葡萄球菌（4．5％）,每种菌对不同药物敏感性及耐药性均有差异。结论对泌尿系统感染患者进行治疗时,应根据患者细菌培养结果和药敏试验结果,进行合理的临床用药,从而有效的控制和避免耐药菌感染的发生。