目的:这项多中心研究旨在分析氟喹诺酮(FQ)耐药的危险因素,并阐明日本急性细菌性前列腺炎(ABP)的临床特征。
方法:回顾性分析了2017年1月至12月参加日本尿路感染研究小组的13家医疗机构的124例临床诊断为ABP的患者。
结果:本研究纳入的124例患者中,37人是门诊病人,87名住院病人。ABP发病前的主要基础医疗条件是严重的排尿困难,尿潴留,经尿道手术,留置导尿管,经直肠前列腺活检(TRBx)。主要症状为发热(≥37.5°C),前列腺压痛,排尿困难,排尿痛,尿潴留,和巨大血尿。14例患者出现菌血症。在3例患者中观察到前列腺脓肿。大肠杆菌是主要的生物,占48%(51/106)。在33%(17/51)中检测到FQ抗性大肠杆菌,和产超广谱β-内酰胺酶的大肠杆菌占12%(6/51)。TRBx(比值比[OR]=48.60,95%置信区间[CI]:5.49-430.00,p<0.001)和住院状态(OR=29.00,95%CI:1.95-430.00,p=0.014)是FQ耐药菌检测的危险因素。
结论:在TRBxABP和住院状态下,FQ耐药菌检出率明显较高。这些发现对ABP和抗菌治疗的管理具有重要意义。特别是对于TRBxABP,这应该被视为一个单独的类别。
OBJECTIVE: This multicenter study aimed to analyze the risk factors for fluoroquinolone (FQ) resistance and to clarify the clinical characteristics of acute bacterial prostatitis (ABP) in Japan.
METHODS: A total of 124 patients clinically diagnosed with ABP at 13 medical institutions participating in the Japanese Research Group for Urinary Tract Infection between January and December 2017 were retrospectively reviewed.
RESULTS: Of the 124 patients included in this study, 37 were outpatients, and 87 were inpatients. The main underlying medical conditions before the onset of ABP were severe dysuria, urinary retention, transurethral manipulation, indwelling urinary catheter, and transrectal prostate biopsy (TRBx). The main symptoms were fever (≥37.5 °C), prostate tenderness, dysuria, micturition pain, urinary retention, and macrohematuria. Bacteremia was observed in 14 patients. Prostatic abscess was observed in three patients. Escherichia coli was the predominant organism, accounting for 48 % (51/106). FQ-resistant E. coli was detected in 33 % (17/51), and extended-spectrum beta-lactamase-producing E. coli in 12 % (6/51). TRBx (odds ratio [OR] = 48.60, 95 % confidence interval [CI]: 5.49-430.00, p < 0.001) and inpatient status (OR = 29.00, 95 % CI: 1.95-430.00, p = 0.014) were risk factors for the detection of FQ-resistant bacteria.
CONCLUSIONS: The detection rate of FQ-resistant bacteria was significantly higher with TRBx ABP and inpatient status. These findings have important implications for the management of ABP and antimicrobial treatment, especially for TRBx ABP, which should be considered a separate category.