尿培养菌群阳性输尿管结石病人的药敏分析及临床意义

Drug sensitivity analysis and clinical significance of calculus cases with positive urinary culture

目的多层面对比分析46例尿培养菌群阳性输尿管结石病人的药敏结果,为临床提供有价值的术前经验性单药用药或配伍用药方案。方法分析2016年1月~2017年12月于我院泌尿外科因"输尿管结石"接受手术治疗病人的临床资料,自402例输尿管结石病人中筛选出术前尿培养阳性病人46例,尤以大肠埃希菌为主,分别从菌群构成、药物敏感性、抗菌效能、各类头孢菌素用药价值等方面进行分析,以确定更合理的术前抗生素用药方案。结果不同性别病人的尿培养中大肠埃希菌(E.coli)是主要的菌群类型,E.coli阳性者共25例(54%);男性E.coli在所有菌群的构成中较女性占比更低,但差异无统计学意义(RR=0.68,95%CI:0.344~1.185,P>0.05);肠杆菌属对β-内酰胺类抗生素单药具有很高的耐药性,然而配伍用药,联合β内酰胺酶抑制剂(舒巴坦/他唑巴坦)后显著提高了药物敏感性,同时显著降低了耐药性(OR=0.058,95%CI:0.022~0.151,P<0.05)。将临床中可能及较多使用到的7种头孢菌素类抗生素的药敏结果(敏感、中介、耐药)分组统计,结果显示各头孢菌素的药敏结果存在明显差异;并筛选出具有理想抗菌性的二代头孢西丁、三代头孢哌酮联合舒巴坦。结论对于本中心合并尿路感染的输尿管结石病人,我们推荐术前经验性用药中在对头孢菌素的选择上以头孢西丁或头孢哌酮联合舒巴坦为主,头孢他啶和头孢吡肟作为可供选择药物,建议减少对环丙沙星及左旋氧氟沙星的使用频率。

Objective Purpose Making a multi-perspective analysis of the drug sensitivity result of 46 patients with ureteral calculus and concomitant urinary infection so as to offer valuable medication instruction.Methods Respectively analyzing clinical information of patients diagnosed with ureteral calculus in our hospital from January,2016 to December,2017,and selecting out 46 cases from all 402 cases with ureteral calculus.To compare the populations of the microbial community,drug sensitivity,anti-bacterial effects and effectiveness of cephalosporins in order to confirm the more rational choice of drugs.Results It had been showed that E.coli was the major bacterial of both genders and 25(54%)samples were positive;while men had a relatively lower percentage of E.coli to all bacteria compared to women,but no statistical significance(RR=0.68,95%CI:0.344~1.185,P>0.05).Enterubacterium had a high resistance rate for single beta-lactam antibiotics while significantly improved sensitivity and decreased resistance were acquired when combined with Beta-lactamase inhibitors(sulbactam/tazobactam)(OR=0.058,95%CI:0.022~0.151,P<0.05).According to drug sensitivity results(sensitive、intermediary、resistant)of 7 different cephalosporins,it had notable distinction.So Cefoxitin and Cefoperazone combined with sulbactam as the major antibiotics for empirical medication were screen out as the ideal anti-bacterial drugs.Conclusion We recommend Cefoxitin or Cefoperazone combined with sulbactam as the first choice,Ceftazidime and Cefepime as the second choice,meanwhile decreasing the application of Ciprofloxacin and Levofloxacin.