呋喃妥因治疗老年肠球菌下尿路感染的疗效分析

摘要

背景 肠球菌是引起尿路感染(UTI)的重要G.+球菌,其耐药性严重,临床常用万古霉素(VAN)或利奈唑胺(LZD)进行治疗,但二者治疗费用高.呋喃妥因(NIT)是治疗UTI的老药,在其临床应用50年历史中,基本避免了耐药问题,且经济方便,可有效治疗急、慢性UTI,但目前临床鲜有用于治疗肠球菌所致老年下尿路感染(LUTI)的研究报道.目的 评价NIT治疗老年肠球菌LUTI的临床疗效和安全性,为临床用药提供依据.方法 回顾性选取2009年7月-2015年7月攀枝花学院临床医学院、攀枝花市中心医院、攀钢集团总医院门诊和病房符合纳入标准的LUTI患者92例为研究对象.其中单纯性LUTI 52例,复杂性LUTI 40例.记录其尿液细菌培养、药敏试验结果.所有患者给予NIT肠溶片100 mg,口服,4次/d,治疗7~14 d.记录患者临床疗效、细菌学疗效和不良反应.结果 粪肠球菌60例(65.2%),屎肠球菌32例(34.8%).粪肠球菌感染患者与屎肠球菌感染患者对NIT、VAN、LZD均不耐药;粪肠球菌感染患者与屎肠球菌感染患者对氨苄西林(AMP)、青霉素G(PEN)、氨苄西林/舒巴坦(SAM)、红霉素(ERY)、左氧氟沙星(LEV)、高浓度庆大霉素(GEN)耐药率比较,差异无统计学意义(P>0.05).92例患者总有效率为84.8%(78/92).单纯性LUTI患者总有效率(96.2%,50/52)高于复杂性LUTI(70.0%,28/40)(x.2=11.987,P<0.001).92例患者的细菌清除率为81.5%(75/92).单纯性LUTI患者细菌清除率为96.2%(50/52),高于复杂性LUT患者的62.5%(25/40)(x.2=11.256,P=0.027).92例患者中,22例(23.9%)发生恶心、呕吐、轻度腹泻,未停药,予对症治疗后缓解;无咳嗽、气喘、皮疹、周围神经炎等不良反应.结论 NIT临床用于治疗老年肠球菌LUTI,疗效较好,尤其适用于治疗单纯性LUTI,且短期口服不良反应少,加之临床治疗费用低,可作为老年肠球菌非复杂性LUTI的初治首选抗生素.%Background Urinary tract infection(UTI) can be commonly caused by enterococcus which is a type of gram-positive bacteria with high antibiotic resistance.Vancomycin(VAN) or linezolid(LZD) is often used for clinical treatment of UTI,but the economic burden is heavy to the individuals.In contrast,nitrofurantoin(NIT) is an effective,inexpensive and easily available drug for acute and chronic UTI basically without causing the resistance of enterococcus proved by a 50-year history of clinical application.However,there are few reports about using NIT to treat lower urinary tract infection(LUTI) due to enterococcus in old people.Objective To evaluate the clinical efficacy and safety of NIT in the treatment of elderly patients with LUTI due to enterococcus,so as to provide an evidence for clinical treatment of the disease.Methods This retrospective study was conducted between July 2009 and July 2015.The participants recruited were 92 consecutive LUTI outpatients and inpatients meeting the inclusion criteria from the Affiliated Hospital of Clinical Medical College of Panzhihua University,Central Hospital of Panzhihua,and Pangang Group General Hospital,including 52 cases of simple LUTI and 40 cases of complicated LUTI.The results of bacterial culture and drug sensitivity test were recorded.All patients were given the 7-14 d treatment of orally taking NIT enteric coated tablets 100 mg,qid.The clinical treatment response,status of enterococcus eradication and adverse reactions in the patients were recorded.Results It was found that 60 patients(65.2%) were infected by enterococcus faecalis,and other 32(34.8%) were infected by enterococcus faecium.Both kinds of bacteria were not resistant to NIT,VAN,and LZD,and they had no significant difference in the rate of resistance to ampicillin(AMP),penicillin G(PEN),ampicillin/sulbactam(SAM),erythromycin(ERY),levofloxacin(LEV) and high-concentration gentamicin(GEN)(P>0.05).The overall response rate was 84.8%(78/92).Patients with simple LUTI had higher response rate than those with complicated LUTI 〔96.2%(50/52) vs.70.0%(28/40),x.2=11.987,P<0.001〕.The overall enterococcus eradication rate was 81.5%(75/92).Patients with simple LUTI had higher enterococcus eradication rate than those with complicated LUTI 〔96.2%(50/52) vs.62.5%(25/40),x.2=11.256,P=0.027〕.Of the 92 patients,22 cases(23.9%) had nausea,vomiting,and mild diarrhea,but relieved after symptomatic treatment without stopping the NIT treatment.No patients had cough,asthma,rash,peripheral neuritis and other adverse reactions.Conclusion NIT has good clinical efficacy in the treatment of elderly patients with LUTI due to enterococcus without heavy economic burden and many adverse reactions during short-term oral administration.It is especially suitable for elderly patients with simple LUTI and can be used as the first-choice drug for these patients.