Abstract：
Urinary tract infections (UTIs) are one of the most common infectious diseases at the community level. The continue misuse of antimicrobials is leading to an increase in bacterial resistance, which is a worldwide problem. The objective of this work was to study the incidence and pattern of antimicrobial resistance of the main bacteria responsible for UTI in the community of central and northern Portugal, and establish an appropriate empirical treatment. The urine samples were collected in Avelab—Laboratório Médico de Análises Clínicas over a period of 5 years (2015−2019). The urine cultures were classified as positive when bacterial growth was equal to or higher than 105 CFU/mL, and only for these cases, an antimicrobial susceptibility test was performed. Of the 106,019 samples analyzed, 15,439 had a urinary infection. Urinary infections were more frequent in females (79.6%) than in males (20.4%), affecting more elderly patients (56.9%). Escherichia coli (70.1%) was the most frequent uropathogen, followed by Klebsiella pneumoniae (8.9%). The bacteria responsible for UTI varied according to the patient’s sex, with the greatest differences being observed for Enterococcus faecalis and Pseudomonas aeruginosa, these being more prevalent in men. In general, there was a growth in bacterial resistance as the age of the patients increased. The resistance of bacteria in male patients was, in most cases, statistically different (Chi-Square test, p < 0.05) from that observed for bacteria isolated from female patients, showing, in general, higher resistance in male patients. Although E. coli was the most responsible uropathogen for UTI, it was among the bacteria most susceptible to antibiotics. The isolates of K. pneumoniae, Proteus vulgaris and Enterobacter showed high resistance to the tested antimicrobials. The most common multidrug-resistant (MDR) bacteria implicated in UTI were K. pneumoniae (40.4%) and P. aeruginosa (34.7%), but E. coli, the most responsible bacteria for UTI, showed a MDR of 23.3%. When we compared our results with the results from 10 years ago for the same region, in general, an increase in bacterial resistance was observed. The results of this study confirmed that urinary tract infections are a very common illness, caused frequently by resistant uropathogens, for which the antibiotic resistance profile has varied over a short time, even within a specific region. This indicates that periodically monitoring the microbial resistance of each region is essential in order to select the best empirical antibiotic therapy against these infections, and prevent or decrease the resistance among uropathogenic strains.
摘要：
尿路感染（UTI）是社区一级最常见的传染病之一。抗菌药物的持续滥用导致细菌耐药性增加，这是一个世界性的问题。这项工作的目的是研究葡萄牙中部和北部社区中导致UTI的主要细菌的抗生素耐药性的发生率和模式，并建立适当的经验处理方法。尿液样本收集在Avelab-LaboratórioMédicodeAálisesClínicas，为期5年（2015-2019年）。当细菌生长等于或高于105CFU/mL时，尿液培养物被分类为阳性。只有在这些情况下，进行了抗菌药物敏感性试验.在分析的106,019个样本中,15,439患有尿路感染。女性尿路感染(79.6%)多于男性(20.4%),影响更多老年患者(56.9%)。大肠埃希菌(70.1%)是最常见的尿路病原菌,其次是肺炎克雷伯菌(8.9%)。导致UTI的细菌因患者性别而异，观察到粪肠球菌和铜绿假单胞菌的最大差异，这些在男性中更为普遍。总的来说,随着患者年龄的增加，细菌耐药性也在增加。男性患者的细菌耐药性,在大多数情况下,统计学上不同(卡方检验，p<0.05)与从女性患者中分离出的细菌相比，显示,总的来说,男性患者的耐药性较高。尽管大肠杆菌是UTI最负责任的尿路病原体，它是对抗生素最敏感的细菌之一。肺炎克雷伯菌的分离株，普通变形杆菌和肠杆菌对所测试的抗微生物剂显示出高抗性。与UTI有关的最常见的多药耐药（MDR）细菌是肺炎克雷伯菌（40.4％）和铜绿假单胞菌（34.7％）。但是大肠杆菌,对UTI最负责任的细菌，MDR为23.3%。当我们将我们的结果与10年前同一地区的结果进行比较时，总的来说,观察到细菌耐药性增加。这项研究的结果证实，尿路感染是一种非常常见的疾病，经常由耐药性尿路病原体引起，抗生素耐药性在短时间内发生变化，甚至在一个特定的地区。这表明，定期监测每个地区的微生物耐药性对于选择针对这些感染的最佳经验性抗生素治疗至关重要。并防止或降低尿路致病菌株之间的耐药性。
