Étude pilote d’évaluation de l’efficacité et de la tolérance d’un traitement court par céphalosporine de 3e génération dans la prise en charge aux urgences des pyélonéphrites aiguës simples chez la femme

Abstract

Trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in the community: the Vigil'Roc multicenter studies.This study was performed in order to describe the trends and epidemiology of antimicrobial resistance in Enterobacteriaceae isolated in the community.In 1993, 1997 and 2000, 9290 strains of Enterobacteriaceae were isolated in community lab settings and their susceptibility to antibiotics evaluated by the disk method according to the French recommendations (CA-SFM). Epidemiological data concerning medical history of patients were simultaneously collected.Samples are essentially provided from urinary tract (88.7 %) and from women (79.5 %). 88.2%of the strains are Escherichia coli and Proteus mirabilis. Over the three studies, we observe an increasing resistance to penicillins, coamoxiclav and cotrimoxazole for E. coli, to coamoxiclav for P. mirabilis and to penicillins for Salmonella sp. Ceftriaxone, gentamicin and ciprofloxacin retain a very good activity. Producers of extendedspectrum â-lactamase are detected for a rising number of species, but strains remain rare (0.5%). Analysing, by logistic regression, the risk factors for adults to be infected by a resistant strain of E. coli, lead to observe a narrow association of antimicrobial resistance with prior antibiotherapy and a relative specificity between the family of prior antibiotics and the compound affected by bacterial resistance. Prior hospitalisation is preferentially linked to multiresistance and age > 60 years is associated with cefixime and quinolone resistance and with multiresistance. Resistance of E. coli to penicillins is more elevated in children than in adults, and is also linked to a prior antibiotic use by children. Some comparable results are provided in univariate analysis for P. mirabilis and Salmonella sp.