糖尿病伴发尿路感染细菌耐药性及抗菌药物应用合理性分析

Analysis of bacterial resistance in diabetes complicated with urinary tract infection and rational use of antimicrobial application

目的:了解糖尿病伴发尿路感染尿培养检出细菌类别,分析抗菌药物使用合理性。方法:收集2018年1月-2019年10月中山医院青浦分院内分泌科收治的糖尿病伴发尿路感染者381例,采用回顾性分析方法对尿培养情况及药敏结果进行分析,同时对抗菌药物使用情况进行整理分析。结果:检出121株阳性细菌,主要为大肠埃希菌、屎肠球菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌、粪肠球菌,各种细菌对抗菌药物不同程度耐药。抗菌药物使用种类以喹诺酮类居首,其次是三代头孢与b内酰胺酶抑制剂复合制剂,联合用药多为b内酰胺酶抑制剂复合制剂+喹诺酮,抗菌药物使用能覆盖主要检出病原菌,但检出菌对抗菌药物使用均有一定程度的耐药情况。结论:糖尿病伴发尿路感染病原菌构成多样,对医院抗菌药物耐药,喹诺酮类经验用药需谨慎,应尽可能根据药敏结果使用抗菌药物。

Objective:To understand the types of bacteria detected in urine culture of diabetic patients with urinary tract infection and analyze the rationality of the use of antibiotics.Methods:Three hundred and eighty-one diabetic patients complicated with urinary tract infection admitted to the Department of Endocrinology of Qingpu Branch of Zhongshan Hospital from January 2018 to October 2019 were collected,the retrospective analysis method was used to analyze urine culture and drug sensitivity results,and at the same time,the use of antibacterial drugs was sorted and analyzed.Results:One hundred and twenty-one strains of positive bacteria were detected,mainly Escherichia coli,Enterococcus faecium,Klebsiella pneumoniae,Streptomonas maltophilia,and Enterococcus faecalis,and all kinds of bacteria were resistant to antimicrobial drugs to varying degrees.The use of antibacterial drugs was led by quinolones,followed by the combination of third-generation cephalosporins and lactamase inhibitors.The combination medication was mostly lactamase inhibitor compound preparation+quinolone,the use of antibacterial drugs could cover the main detected pathogens,but the detected bacteria had a certain degree of resistance to the use of antibacterial drugs.Conclusion:The pathogenic bacteria of diabetes mellitus associated with urinary tract infection are diverse,which are resistant to hospital antibacterial drugs,and the empirical use of quinolones should be cautious,and antibacterial drugs should be used as far as possible based on the results of drug sensitivity.