Abstract：
To evaluate variability among hospitals in susceptibility of common uropathogens to antimicrobial agents frequently used in transurethral procedures in order to examine whether state-based guidelines might be more appropriate than national prophylactic guidelines.
Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), third-generation cephalosporins, cefazolin, penicillin combinations, gentamicin, and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities.
Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for third-generation cephalosporins for E. coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E. coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E. coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%).
Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen.
Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), third-generation cephalosporins, cefazolin, penicillin combinations, gentamicin, and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities.
Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for third-generation cephalosporins for E. coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E. coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E. coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%).
Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen.
摘要：
目的：评估医院间常见尿路病原菌对经尿道手术常用抗菌药物敏感性的差异，以研究基于国家的指南是否比国家预防指南更合适。
方法：密苏里州所有医院都要求提供医院级别的抗菌药物。我们研究了大肠杆菌，克雷伯菌属,和变形杆菌敏感性来评估常用指南推荐的抗菌药物，包括甲氧苄啶磺胺甲恶唑（TMP-SMX），第三代头孢菌素，头孢唑啉,青霉素组合，庆大霉素和氟喹诺酮。我们评估了医院特征与抗菌药物敏感性之间的差异和关联。
结果：全州81家医院要求提供数据，38家提供了要求的数据（47％的反应率）。第3代头孢菌素对大肠杆菌的敏感性最高（平均94%），变形杆菌（96%），和克雷伯菌(96%)。庆大霉素对所研究的细菌也有很高的敏感性；大肠杆菌为94％，克雷伯菌为96％。目前一线推荐的药物对大肠杆菌的覆盖率较低(头孢唑林84%，TMP-SMX78%)，变形杆菌(头孢唑啉82%，TMP-SMX71%)，和克雷伯菌(头孢唑林90%，TMP-SMX89%）。
结论：经尿道手术后感染是常见的。可以通过适当的预防来限制比率。决定经验覆盖范围必须考虑到当地的阻力模式。常见尿路病原体的抗微生物剂敏感性在各州之间和内部存在很大差异。选择抗菌预防措施时，泌尿科医师应该考虑本地而不是州或国家级抗生素，考虑到相当大的可变性。在选择最佳方案时，未来的研究应考虑广谱预防的优点以及分子尿病原体（和病原体抗性）测试的潜在作用。
方法：密苏里州所有医院都要求提供医院级别的抗菌药物。
结果：全州81家医院要求提供数据，38家提供了要求的数据（47％的反应率）。
结论：经尿道手术后感染是常见的。
