Zusammenfassung
Harnwegsinfektionen (HWI) sind meist monomikrobielle, endogene Infektionen, hervorgerufen v. a. durch gramnegative Bakterien wie Escherichia coli , seltener durch grampositive wie Enterokokken. Dies ermöglicht eine empirische Therapie unkomplizierter HWI, wobei eine möglichst kurze Therapiedauer das Risiko der Resistenzentwicklung minimiert. Diese beruht häufig auf Mutationen der Zielstruktur (Sulfonamide, Trimethoprim, Fluorchinolone, Fosfomycin) oder dem Erwerb von Resistenzgenen (β-Laktame). Letztere sind oft mit weiteren Resistenzgenen auf mobilen genetischen Elementen assoziiert und vermitteln so Multiresistenz. Bei Escherichia-coli-Isolaten der klonalen Gruppe A (CgA) finden sich diese Gene sogar als Teil des Chromosoms.
Die Prävalenz der Resistenz gegen Fosfomycin oder Nitrofurantoin liegt unter 6%, variiert gegen Sulfonamide/Trimethoprim in Europa zwischen 15 und 50% und erreicht gegen Fluorchinolone inzwischen fast 15%, gegen Amoxicillin durchschnittlich sogar 30%. Übersteigt der Wert lokal 20%, ist bei empirischer Therapie unkomplizierter HWI vermehrt mit einer Verlängerung der Therapiedauer zu rechnen, weshalb alternative Antibiotika angeraten sind.
Abstract
Urinary tract infections (UTI) usually are monoinfections caused by the endogenous microflora including gram-negatives, such as Escherichia coli, or gram-positives, like enterococci. This allows for an empiric treatment of uncomplicated UTIs and a short duration of therapy to minimize the probability for the development of resistance. Resistance often is based upon mutations altering the drug target (sulfonamides, trimethoprim, fluoroquinolones, fosfomycin) or acquisition of resistance genes (β-lactams). The latter can be collocated with other resistance genes on mobile genetic elements mediating multiple drug resistance. Such elements are part of the chromosome of the Escherichia coli clonal group A (cgA).
The prevalence of resistance to nitrofurantoin and fosfomycin is below 6%, while that of sulfonamide/trimethoprim varies between 15 and 50% all over Europe. Resistance to fluoroquinolones and amoxycillin approximates 15 and over 30%, respectively. A value of >20% for the empiric treatment of uncomplicated UTIs is associated with a significantly increased duration of therapy suggesting alternative antibiotic regimens.
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Der korrespondierende Autor weist auf folgende Beziehungen hin: Beratende Tätigkeit für Bayer Healthcare, Lohmann Animal Health, Novartis, Merlion Pharma, Wyeth.
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Heisig, P. Harnwegsinfektionen und Antibiotikaresistenz. Urologe 49, 612–617 (2010). https://doi.org/10.1007/s00120-010-2259-y
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DOI: https://doi.org/10.1007/s00120-010-2259-y