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目的:评估男性发热性尿路感染(FUTI)患者大肠杆菌分离株对喹诺酮类药物的耐药性和临床危险因素。方法:通过患者临床表现及尿细菌涂片检查确诊的大肠杆菌感染的FUTI患者123例,采集患者清洁中段尿或经膀胱穿刺获取尿液标本,进行尿细菌培养及药敏试验。观察大肠杆菌对各种抗生素的耐药反应,并评估与大肠杆菌耐药性相关的临床危险因素。结果:34%的大肠杆菌菌株对喹诺酮类药物产生耐药性,且对其他抗生素的耐药性也较高,尤其是对阿莫西林(P<0.001)和复方新诺明(P<0.001)。大肠杆菌菌株对喹诺酮类药物的耐药性与年龄、既往尿路感染史、尿道异常、既往使用抗生素(特别是氟喹诺酮类)、卫生保健相关的尿路感染(HA-UTI)等因素有关,其中HA-UTI(OR 4.34,95%CI 1.62～12.13,P<0.001)、既往尿路感染史(OR 6.27,95%CI 2.71～15.32,P<0.001)、既往使用氟喹诺酮史(OR 14.37,95%CI 2.14～73.26,P<0.001)是大肠杆菌对喹诺酮类药物耐药的危险因素。结论:男性FUTI患者的耐喹诺酮类药物的大肠杆菌对其他抗生素也存在较高的耐药性,尤其是对阿莫西林和复方新诺明;HA-UTI、既往尿路感染史和既往使用氟喹诺酮类是男性FUTI患者大肠杆菌耐药的高危因素,因此,应避免在男性FUTI患者中使用喹诺酮类抗菌药物治疗泌尿系感染。
OBJECTIVE: To evaluate the resistance of quinolones to clinical isolates of Escherichia coli in patients with febrile urinary tract infection (FUTI) and their clinical risk factors. Methods: One hundred and three patients with FUTI were diagnosed by clinical manifestations and urinary bacterial smear. Urinary samples were collected from patients with central cleansing or urinary bladder punctures, urine culture and drug sensitivity test. The E. coli response to various antibiotics was observed and the clinical risk factors associated with E. coli resistance were evaluated. RESULTS: 34% of E. coli strains developed resistance to quinolones and were more resistant to other antibiotics, particularly amoxicillin (P <0.001) and cotrimoxazole (P <0.001) . The resistance of E. coli strains to quinolones was related to age, previous history of urinary tract infection, abnormal urinary tract, previous antibiotics (especially fluoroquinolones) and health-related urinary tract infections (HA-UTI) (OR 4.34, 95% CI 1.62-12.13, P <0.001), history of previous urinary tract infection (OR 6.27, 95% CI 2.71-15.32, P <0.001), and history of fluoroquinolone (OR 14.37, 95% CI 2.14-73.26, P <0.001) was a risk factor for E. coli resistance to quinolones. CONCLUSIONS: The quinolone-resistant Escherichia coli in FUTI patients is also resistant to other antibiotics, especially to amoxicillin and cotrimoxazole; HA-UTI, previous history of urinary tract infection, and previous use of fluoride Quinolones are a high risk factor for E. coli resistance in male patients with FUTI and therefore, the use of quinolone antibiotics in male patients with FUTI should be avoided in the treatment of urinary tract infections.