Objective To analyze clinical characteristics, risk factors, drug resistances, treatments and prognosis of patients with urinary tract infections (UTI) caused by extended spectrum P-lactamase producing E. Coli and provides suggestions for rational use of antibiotics. Methods Retrospectively analysis on the relevant clinical data and laboratory data from patients with UTI caused by ESBLs positive E. Coli in West China Hospital of Sichuan University from March 2009 to March 2010. Results A total of 70 cases were enrolled. The clinical manifestations included fever, urinary tract irritation, lower back pain, lower limbs edema, nausea, vomiting and pain in the kidney area rap. Many patients had a variety of underlying diseases and predisposing factors, especially for older women. ESBL-producing E. Coli strains were 100% sensitive to imipenem. Piperacillin/tazobactam, cefoxitin and amikacin retained higher activities against ESBL positive strains than fluoroquinolones and other commonly used antibiotics. Empirical therapeutic effectiveness of the drug resistant in vitro is not satisfied. Conclusion UTI due to ESBLs producing E. Coli easily be found in patients with underlying diseases and risk factors, and had no specific clinical features. Prompt urine pathogenic cultures for patients suspected to have UTI should be done as soon as possible so as to aid rational antibacterial chemotherapy. Fluoroquinolones, aminoglycosides and sulfonamides were not recommended in empirical therepy for UTI by suspected ESBL producing strain.%目的 分析产超广谱β-内酰胺酶大肠埃希菌尿路感染临床特点、危险因素、耐药情况以及治疗转归,为临床合理使用抗菌药提供参考.方法 收集四川大学华西医院2009年3月到2010年3月尿培养为产ESBLs大肠埃希菌尿路感染70例,回顾分析相关临床与实验室数据.结果 70例产ESBLs大肠埃希菌尿路感染者中,临床表现主要为发热、尿路刺激征、腰背部酸痛、下肢水肿,恶心呕吐和肾区叩击痛等,老年女性多见,多有基础疾病及易感因素,产ESBL大肠埃希菌对亚胺培南100％敏感,对哌拉西林/三唑巴坦、头孢西丁、阿米卡星等的耐药率较低,对氟喹诺酮类等其它常用抗菌药耐药率较高,体外耐药者经验用药疗效不佳.结论 产ESBLs大肠埃希菌尿路感染临床表现无特异性,其发生与患者基础疾病和危险因素等有关,对疑有尿路感染且伴有基础疾病及危险因素者应尽早做尿培养,经验选择能覆盖ESBL菌感染的药物,应慎用氟喹诺酮类、氨基糖苷类及磺胺类治疗产ESBL细菌尿路感染.
展开▼
