印度社区获得性尿路致病性大肠埃希菌对抗菌药敏感性的地区差异:一项多中心研究的结果凸显了当地抗生素图谱的重要性

IF 1.5 Q4 INFECTIOUS DISEASES
Meher Rizvi , Shalini Malhotra , Jyotsna Agarwal , Areena H. Siddiqui , Sheela Devi , Aruna Poojary , Bhaskar Thakuria , Isabella Princess , Hiba Sami , Aarti Gupta , Asfia Sultan , Ashish Jitendranath , Balvinder Mohan , Gunjiganur Shankarappa Banashankari , Fatima Khan , Juri Bharat Kalita , Mannu Jain , Narendra Pal Singh , Renu Gur , Sarita Mohapatra , David M. Livermore
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引用次数: 0

摘要

目标以证据为基础的处方对于优化膀胱炎患者的治疗效果至关重要。这需要了解当地的抗生素耐药率。诊断和抗菌药物管理(DASH)以保护抗生素(https://dashuti.com/)是一项多中心指导计划,指导各中心准备、分析和传播当地抗生素图谱,以促进社区泌尿道感染中的抗菌药物管理。在此,我们绘制了来自 22 个印度中心的大肠埃希菌药敏谱。我们整理了门诊部尿液中大肠埃希菌的抗生素图谱。通过地区在线培训实现标准化;异常情况通过咨询研究专家解决。结果在全国范围内,福斯霉素的敏感率为 94%(中心间范围为 83-97%),硝基呋喃妥因的敏感率为 85%(中心间范围为 61-97%),这两种药物保持了最广泛的活性。共三唑类(49%)、氟喹诺酮类(31%)和口服头孢菌素类(26%)的药敏率较低。第三代和第四代头孢菌素的药敏率分别为 46% 和 52%,广谱 β-内酰胺酶感染率为 54%(33%-58%)。哌拉西林-他唑巴坦(81%)、阿米卡星(88%)和美罗培南(88%)保留了较好的活性;然而,德里的一家中心记录的美罗培南敏感率仅为 42%。印度南部、西部和东北部的敏感率大多较高;印度北部和西北部人口稠密的恒河平原的中心耐药性较强。结论磷霉素和硝基呋喃妥因是印度治疗无并发症大肠杆菌膀胱炎的首选口服经验性药物,但某些地区的耐药性升高令人担忧。不鼓励经验性使用氟喹诺酮类和第三代头孢菌素,而哌拉西林/他唑巴坦和氨基糖苷类仍是碳青霉烯类稀释肠外用药。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms

Objectives

Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers.

Methods

These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed.

Results

Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices.

Conclusions

Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.

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IJID regions
IJID regions Infectious Diseases
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