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Klinik und Epidemiologie der unkomplizierten Zystitis bei Frauen

Deutsche Ergebnisse der ARESC-Studie

Clinical aspects and epidemiology of uncomplicated cystitis in women

German results of the ARESC Study

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Zusammenfassung

Hintergrund und Fragestellung

Die unkomplizierte Zystitis bei der Frau gehört zu den häufigsten ambulant erworbenen Infektionen. Hier wird über die deutschen Ergebnisse der internationalen ARESC-Studie hinsichtlich Klinik, Epidemiologie und Antibiotikaempfindlichkeit der Erreger berichtet.

Patienten und Methoden

Es wurden Patientinnen im Alter von 18–65 Jahren mit den Symptomen einer unkomplizierten Zystitis konsekutiv eingeschlossen. Die klinische Untersuchung wurde durch eine Urinanalyse und -kultur ergänzt. Die Erreger wurden identifiziert und ihre Empfindlichkeit für 9 Antibiotika bestimmt.

Ergebnisse

In Deutschland wurden insgesamt 442 Patientinnen eingeschlossen, davon waren 412 auswertbar. Eine positive Urinkultur (Keimzahl ≥104/ml) fand sich bei 335 (81,3%); 325 (97,1%) hatten ein Monoinfektion. 317 Isolate wurden weiter in einem Zentrallabor (Genua) analysiert. Escherichia coli war der häufigste Erreger (76,7%), gefolgt von Proteus mirabilis (4,7%), Staphylococcus saprophyticus (2,8%), Klebsiella pneumoniae (2,5%), Enterokokken (2,5%) und Staphylococcus aureus (2,2%). Die höchste Empfindlichkeitsrate für Escherichia coli fand sich bei Fosfomycin (97,9%) gefolgt von Mecillinam (97,5%), Nitrofurantoin (95,4%) und Ciprofloxacin (95,4%). Die niedrigste Empfindlichkeitsrate fand sich bei Ampicillin (59,2%), gefolgt von Cotrimoxazol (74,0%). Für das gesamte Spektrum lag die Reihenfolge bei: Fosfomycin (96,1%), Mecillinam (97,5%), Ciprofloxacin (92,3%) und Nitrofurantoin (86,3%). Die niedrigsten Raten fanden sich für Ampicillin (56,6%) und Cotrimoxazol (73,9%).

Schlussfolgerungen

Fosfomycin, Mecillinam (in Deutschland nicht im Handel) und Nitrofurantoin haben ihre gute In-vitro-Aktivität erhalten und eignen sich für die empirische Therapie. Wegen der bereits hohen Resistenzraten bzw. der Gefahr weiterer Resistenzselektion sollten Cotrimoxazol (Trimethoprim) und Fluorchinolone generell nicht mehr als Mittel der ersten Wahl zur empirischen Therapie der unkomplizierten Zystitis bei der Frau empfohlen werden.

Abstract

Objective

Uncomplicated cystitis in women is among the most frequent infections in the community setting. The German results of the international ARESC Study are reported concerning clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens.

Patients and methods

Patients between 18 and 65 years of age with symptoms of uncomplicated cystitis were consecutively enrolled and investigated clinically including urinalysis and urine culture. Uropathogens were identified and their susceptibility was tested for nine antimicrobials

Results

In Germany a total of 442 patients were enrolled and 412 were eligible. A positive urine culture (cfu≥104/ml) was found in 335 (81.3%); 325 (97.1%) of them had a monoinfection. A total of 317 uropathogens were further analyzed in a central laboratory (Genua). Escherichia coli was the most frequent (76.7%), followed by Proteus mirabilis (4.7%), Staphylococcus saprophyticus (2.8%), Klebsiella pneumoniae (2.5%), enterococci (2.5%), and Staphylococcus aureus (2.2%). E. coli showed the highest rate of susceptibility to fosfomycin (97.9%) followed by mecillinam (97.5%), nitrofurantoin (95.4%), and ciprofloxacin (95.4%). The lowest rate was found for ampicillin (59.2%) followed by cotrimoxazole (74.0%). For the total spectrum the order was fosfomycin (96.1%), mecillinam (97.5%), ciprofloxacin (92.3%), and nitrofurantoin (86.3%). The lowest rates were found again for ampicillin (56.6%) and cotrimoxazole (73.9%).

Conclusions

Fosfomycin, mecillinam (not available in Germany), and nitrofurantoin have preserved their in vitro activity and are suitable for empiric therapy. Because of increasing resistance rates cotrimoxazole (trimethoprim) and fluoroquinolones are generally not recommended as first-choice drugs for empiric therapy of female patients with uncomplicated cystitis.

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Danksagung

Die Autoren danken Antonio Colantoni für die statistischen Analysen, Cordula Lebert für die Mithilfe bei der Manuskripterstellung, sowie den übrigen Mitgliedern der Studienleitung, Teresita Mazzei, Henry Botto, Joan Palou für die gute Kooperation und allen Beteiligten in den deutschen Zentren für die Teilnahme an der Beobachtungsstudie. Patientenzahl (n): (23) Thorsten Bruns, Hamburg; (2) Wolfgang Weidner, Gießen; (36) Florian M.E. Wagenlehner, Straubing; (11) Catalin Becheru, Straubing; (8) Harald Schumacher, Straubing; (66) Jürgen Jessberger, Bogen; (16) Michaela Well, Deggendorf; (17) Mitschitzky, Dingolfing; (2) Bernhard Muschol, Landshut; (20) Martin Ludwig, Marburg/L; (9) Marion Weigand, Lich; (40) Andreas Clad, Freiburg; (20) Klaus Bürger, München; (32) Christoph Antwerpen, Eggenfelden; (10) Klaus Rüdiger, Freiburg; (130) Orlin Savov, Nürnberg.

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Studie wurde durch eine Forschungsbeihilfe von Zambon Group Spa (Hersteller von Fosfomycin Trometamol), Bresso (MI), Italien, unterstützt. Außerdem führte der korrespondierende Autor klinische Studien mit Unterstützung von Sanofi-Aventis (Hersteller von Levofloxacin), Deutschland, durch. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg - Standort Gießen, Gießen, Deutschland

    F.M.E. Wagenlehner

  2. Evangelisches Krankenhaus, Gießen, Deutschland

    C. Wagenlehner

  3. Facharzt für Urologie, Nürnberg, Deutschland

    O. Savov

  4. Mikrobiologisches Institut, Universität, Genua, Italien

    L. Gualco & G. Schito

  5. Technische Universität, München, Deutschland

    K.G. Naber

  6. Karl-Bickleder-Straße 44c, 94315, Straubing, Deutschland

    K.G. Naber

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  1. F.M.E. Wagenlehner
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  2. C. Wagenlehner
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  3. O. Savov
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  4. L. Gualco
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  5. G. Schito
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  6. K.G. Naber
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Correspondence to K.G. Naber.

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Wagenlehner, F., Wagenlehner, C., Savov, O. et al. Klinik und Epidemiologie der unkomplizierten Zystitis bei Frauen. Urologe 49, 253–261 (2010). https://doi.org/10.1007/s00120-009-2145-7

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  • DOI: https://doi.org/10.1007/s00120-009-2145-7

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