中段尿培养1348份标本病原菌分布及其耐药性分析

Analysis on distriution and drug resistance of pathogenic bacteria by midstream urine culture among 1348 cases

目的分析了解尿路感染患者中段尿培养标本中病原菌分布及其耐药性,为临床用药提供参考和依据。方法对2015年6月至2016年5月期间,南京金域医学检验所收集的来自江苏全省13个地市州的500多家基层医院送检的尿路感染患者1 348份标本,采用血琼脂平皿和麦康凯平皿35℃培养箱培养方法进行中段尿培养;然后,用VITEK COMPACT全自动微生物分析系统和API鉴定板条对菌落计数〉10^5 cfu/ml的革兰阴性菌和菌落计数〉10^4 cfu/ml革兰阳性菌进行菌种鉴定,并根据2015年美国临床实验室标准化协会标准判断药敏结果。结果从1 348份中段尿培养标本的450份标本中分离出病原菌,阳性率为33.38%。其中革兰阴性菌358株,占79.56%;革兰阳性菌76株,占16.89%;真菌16株,占3.56%。选取全部菌种中6类主要菌（大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌、凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌）进行药敏分析,其中大肠埃希菌对氨苄西林、哌拉西林、头孢唑林、头孢呋辛的耐药率分别为84.16%、80.37%、87.12%、93.98%;粪肠球菌对四环素、利福平、奎奴普汀-达福普汀、米诺环素的耐药分别为81.40%、86.67%、100%、83.33%。结论大肠埃希菌和粪肠球菌是尿路感染的主要致病菌。病原菌对青霉素、头孢类、四环素类和利福霉素类耐药严重。分析尿路感染病原菌抗菌药物敏感性试验结果对指导临床合理使用抗菌药物有着重要意义。

Objective To investigate the distribution and drug resistance of microbial pathogens in midstream specimen of urine of patients with urinary tract infection, provide reference and basis for clinical medication. Methods A total of 1 348 urine specimens were in this study. These specimens were collected from more than 500 basic level hospitals in June 2015 to May 2016. These hospitals distributed in 13 cities of Jiangsu province. The urine specimens were cultured on blood agar and MacConkey Agar respectively. VITEK COMPACT automatic microbial analysis system and API identification strip for bacterial identification were utilized. Strain identification were carried out when the isolated gram negative bacteria was more 105 cfu/ml and gram positive bacteria was more than 104 cfu/ml. Drug sensitivity test results were determined by CLSI（2015）. Results Microbial pathogens were isolated from 450 specimens accounted 33.38% of the all （450/1 348）. Three hundred fifty-eight strains of gram negative bacteria was isolated, account for 79.56% of all strains （358/450）. Seventy-six strains of gram positive bacteria were isolated. Sixteen strains of fungi were also isolated, only account for 3.56% of all （16/450）. Drug sensitivity test showed that the resistance rates of E. coli to ampicillin, piperacillin, cefazolin, cefuroxime were 84.16%, 80.37%, 87.12% and 93.98% respectively; the resistance rates of Enterococcus to tetracycline, rifampin, quinupristin-dalfopristin, minocycline were 81.40%, 86.67%, 100% and 83.33% respectively. Conclusions E.coli and Enterococcus faecalis are the the main pathogens of urinary tract infections. Drug resisitance to penicillin, cephalosporins, tetracyclines and rifamycin is greater. These results provide instructional significance to rational use of antimicrobial agents