细菌性肺炎合并尿路感染患者的病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria in patients with bacterial pneumonia complicated with UTI

目的总结细菌性肺炎合并尿路感染(UTI)患者病原菌分布及耐药性特点。方法收集91例细菌性肺炎合并UTI患者的痰培养、尿培养结果及药敏试验结果。结果痰培养共分离出病原菌70株,革兰阴性菌60株(85.7%),分离率最高的是铜绿假单胞菌23株(32.9%);革兰阳性菌10株(14.3%),均为金黄色葡萄球菌;尿培养共分离出病原菌100株,革兰阴性菌45株(45.0%),分离率最高的是大肠埃希菌32株(32.0%);革兰阳性菌23株(23.0%),分离率最高的是屎肠球菌14株(14.0%);真菌32株(32.0%)。痰培养革兰阴性菌中铜绿假单胞菌对亚胺培南、美罗培南、左氧氟沙星、环丙沙星的耐药率分别为60.9%、52.2%、52.2%、47.8%,对氨苄西林/舒巴坦、头孢噻肟、头孢曲松、舒普深、哌拉西林的耐药率均为0;革兰阳性菌中金黄色葡萄球菌对氨苄西林耐药率为100%,对青霉素、四环素、庆大霉素、克林霉素的耐药率为90%、70%、60%、60%,对头孢曲松、头孢呋辛、左氧氟沙星、环丙沙星、莫西沙星、奎奴普丁/达福普汀、利奈唑胺、万古霉素的耐药率均为0。尿培养革兰阴性菌中的大肠埃希菌对氨苄西林、复方新诺明、环丙沙星、左氧氟沙星、头孢唑林、头孢吡肟、头孢呋辛、庆大霉素的耐药率分别为81.3%、71.9%、68.8%、68.8%、62.5%、59.4%、56.3%、53.%,对阿米卡星、氨苄西林/舒巴坦、厄他培南、美罗培南、舒普深、哌拉西林的耐药率分别为9.4%、25.0%、3.1%、0、6.3%、12.5%;革兰阳性菌中的屎肠球菌对氨苄西林、环丙沙星、左氧氟沙星、青霉素耐药率为100%,对红霉素、利福平、庆大霉素的耐药率分别为90.9%、81.8%、63.6%,对氯霉素、达托霉素、利奈唑胺、万古霉素的耐药率为0。结论细菌性肺炎合并UTI患者痰培养、尿培养的病原菌均以革兰阴性菌为主,且革兰阴性菌中产超广谱β-内酰胺酶比例较高,其耐药情况较为严重,在临床经验性用药时应注意覆盖革兰阴性菌,其中碳青霉烯类是可供临床选择的方案之一。

Objective To summarize the characteristics of distribution and drug resistance of pathogenic bacteria in patients with bacterial pneumonia complicated with urinary tract infection(UTI).Methods The results of sputum culture,urine culture and drug sensitivity test were collected from 91 patients with bacterial pneumonia complicated with UTI.Results A total of 70 strains of pathogenic bacteria were isolated from sputum culture,among which 60 strains of Gram-negative bacteria(85.7%)were isolated.A total of 23 strains of Pseudomonas aeruginosa were isolated from Gramnegative bacteria,with the highest isolation rate(32.9%).Ten strains of Gram-positive bacteria(14.3%)were isolated from pathogenic bacteria,and all were staphylococcus aureus.A total of 100 strains of pathogenic bacteria were isolated from urine culture,among which 45 strains of Gram-negative bacteria(45.0%)were isolated,and 32 strains of Escherichia coli were isolated from Gram-negative bacteria,with the highest isolation rate(32.0%).Twenty-three strains of Grampositive bacteria(23.0%)were isolated from pathogenic bacteria,and 14 strains of Enterococcus faecium were isolated from Gram-positive bacteria,with the highest isolation rate(14.0%).Thirty-two strains of Fungi were isolated from pathogenic bacteria(32.0%).The drug resistance rates of Pseudomonas aeruginosa to imipenem,meropenem,levofloxacin,ciprofloxacin were 60.9%,52.2%,52.2%and 47.8%,respectively.The drug resistance rates of Pseudomonas aeruginosa to ampicillin/sulbactam,cefotaxime,ceftriaxone,suprusen and piperacillin were all 0.The resistance rates of Staphylococcus aureus to ampicillin were 100%,to penicillin,tetracycline,gentamicin and clindamycin were 90%,70%,60%and 60%,and the resistance rates to ceftriaxone,cefuroxime,levofloxacin,ciprofloxacin,moxifloxacin,quinuprotin/dafoptin,linezolid and vancomycin were all 0.The resistance rates of E.coli included in Gram-negative bacterium in urine culture to ampicillin,compound sulfamethoxazole,ciprofloxacin,levofloxacin,cefazolin,cefepime,cefuroxime,gentamicin were 81.3%,71.9%,68.8%,68.8%,62.5%,59.4%,56.3%and 53%,and to amikacin,ampicillin/sulbactam,ertapenem,meropenem,sulperazone and piperacillin were 9.4%,25.0%,3.1%,0,6.3%,and 12.5%,respectively.The resistance rates of Enterococcus faecium to ampicillin,ciprofloxacin,levofloxacin and penicillin were 100%,to erythromycin,rifampicin,and gentamicin were 90.9%,81.8%and 63.6%,and to chloramphenicol,daptomycin,linezolid,and vancomycin were 0.Conclusions Gram-negative bacteria are the main pathogenic bacteria in sputum culture and urine culture of patients with bacterial pneumonia complicated with UTI,in addition,the proportion of Gram-negative bacteria producing extended spectrumβ-lactamases are higher,and the drug resistance is more serious.Gram-negative bacteria should be covered in clinical empirical medication,and carbapenems are one of the options available for clinical use.