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학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
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연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2017.1
- 수록면
- 184 - 193 (10page)
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초록· 키워드
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Background
Through investigating antimicrobial susceptibility patterns of Enterobacteriaceae in community-acquired urinary tract infection (CA-UTI), we provide basic evidence for the use of empirical antibiotics in CA-UTI.
Materials and Methods
We retrospectively reviewed the medical records of patients over the age of 19 years who visited a hospital in Seoul between January 2012 and December 2016 for a CA-UTI. Urine cultures were used to identify causative organisms. We investigated extended-spectrum β-lactamase (ESBL) production and the antimicrobial susceptibility of Enterobactereiaceae. We evaluated recommended empirical antibiotics numerically by calculating the syndrome-specific likelihood of inadequate therapy (LIT) for the last 2 years (interpretation of the LIT A value: 1 out of A people is likely to receive inadequate empirical antibiotics).
Results
Urine cultures were performed in 1,605 out of 2,208 patients who were diagnosed with CA-UTI, and causative pathogens were identified in 1,134 (70.7%) cases. There were 998 (88.0%) cases of Enterobacteriaceae and Escherichia coli was the most common pathogen, accounting for 80.3% of cases (911 cases). The overall resistance rates to trimethoprim-sulfamethoxazole, fluoroquinolones, and cefotaxime were 31.7%, 23.2%, and 13.5%, respectively. There were 128 (10.8%) cases of ESBL-producing Entererobacteriaceae with an increasing but non-significant trend (P = 0.255). The LIT for CA-UTI in the past two years was highest for ertapenem and imipenem. Fluoroquinolones ranked 11th, with a LIT of 8.2, and cefotaxime ranked higher, at 10.5. In ESBL-producing Enterobacteriaceae, except for carbapenems, amikacin and piperacillin-tazobactam showed the highest susceptibility rates at 99.2% and 94.3%, respectively.
Conclusion
Empiric treatment with fluoroquinolones in CA-UTI should be carefully considered, given the high resistance rate. The proportion of ESBL-producing Entererobacteriaceae in CA-UTI has increased to a high level in Korea. Amikacin and piperacillin-tazobactam could be considered for empiric treatment in patients at risk for ESBL-producing Entererobacteriaceae when considering alternatives to carbapenems.
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참고문헌 (34)
참고문헌 신청
Rodríguez‐Baño J / 2008 / Extended‐spectrum β‐lactamases in ambulatory care: a clinical perspective / Clin Microbiol Infect 14(Suppl 1):104~110
Friedman ND / 2002 / Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections / Ann Intern Med 137:791~797
Frakking FN / 2013 / Appropriateness of empirical treatment and outcome in bacteremia caused by extended- spectrum β-lactamase producing bacteria / Antimicrob Agents Chemother 57:3092~3099
Gradel KO / 2017 / Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study / BMC Infect Dis 17:122
Esparcia A / 2014 / Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections / Eur J Intern Med 25:523~527
Friedman ND / 2002 / Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections / Ann Intern Med 137:791~797
Frakking FN / 2013 / Appropriateness of empirical treatment and outcome in bacteremia caused by extended- spectrum β-lactamase producing bacteria / Antimicrob Agents Chemother 57:3092~3099
Gradel KO / 2017 / Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study / BMC Infect Dis 17:122
Esparcia A / 2014 / Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections / Eur J Intern Med 25:523~527
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