소변배양검사에서 광범위 베타락탐 분해효소 생산균에 의한 급성단순방광염 환자에서 경험적 항생제 사용의 치료효과 및 비용에 따른 항생제 선택

Abstract

Purpose: The usage of antibiotics on urinary tract infection is high, thus, there is a high chance of acquiring resistance towards antibiotics. Followed by the usage of restricted antibiotics, the emergence of multiple drug resistant pathogens, such as ESBL producing pathogens, is frequently being reported, and the increase of resistant pathogens leads to the increase of medical treatment costs. An effective system of management and observation is needed for this. ESBL is an enzyme produced by gram-negative bacterium,which has beta-lactam rings, that restricts the effectiveness of penicillins and cephalosporins. Such antibiotics have been used as empirical antibiotics for acute cystitis. The effects of ESBL producing pathogens in patients on the curative effectiveness of empirical antibiotics are to be identified and appropriate antibiotics will be selected, according to the results with consideration to the cost. Materials and Methods: From the 4727 patients who have been diagnosed with cystitis between January 2000 and 2011 March, through urine culture test, 81 acute uncomplicated cystitis patients with ESBL producing pathogens were confirmed and their medical records were examined for this study. For 3~7 days empirical antibiotics, such as quinolone (ciprofloxacin / levofloxacin), cephalosporin (1st generation- cefroxadine / 2nd generation- cefprozil / 3rd generation- cefpodoxim, cefdinir), penicillin (amoxicillin-clavulanic acid), trimethoprim-sulfamethoxazole, were used and the curative effects were confirmed through urine culture test,with the improvements on the initial symptoms. For each antibiotic, the average medical insurance cost of domestic market as of May 2011 was applied and calculation was done after averaging for 3 days. Results: In urinalysis of 81 patients (age 44.89±17.42, 17~64), pyuria was confirmed in the urine of 79 patients (97.5%) and microscopic hematuria was confirmed in the urine of 17 patients (21.0%). In urine culture test, Escherichia coli was cultured in the urine of 79 patients (97.5%) and Klebsillea pneumonia was cultured in the urine of 2 patients (2.5%). Thirty three patients (40.7%) complained of suprapubic pain, 55 patients (67.9%) of urodynia, 69 patients (85.2%) of frequent urination and 37 patients (45.7%) of urgent urination. After taking antibiotics, not including 6 patients who have not returned, there were improvements in urine culture test and symptoms in all patients. In the reexamination of urine culture test, no significant pathogens were found. According to the cost, the cost was the cheapest in the order of trimethoprim-sulfamethoxazole (160/800mg, twice a day, 3 day therapy, 378 won), amoxicillin-clavulanic acid (250/125mg, three times a day,3 day therapy, 3019.5 won), and ciprofloxacin (250mg, once a day, 3 day therapy, 3563.4 won). Conclusions: Even if ESBL producing pathogens were found in urine culture test of acute uncomplicated cystitis patient, curative effectiveness can be expected by just taking empirical antibiotic. In concerning the objective of this study as well as the efficacy and the cost, the most appropriate primary antibiotic is trimethoprim/sulfamethoxazole. The acute uncomplicated cystitis caused by ESBL producing pathogen has the same curative effects of antibiotics of the study, having no relations with the antibiotic sensitiveness. Therefore, the empirical antibiotic with no abnormal reactions, cheap cost and short duration of treatment should be selected for the therapy.