2016~2018年泌尿外科患者尿路感染病原菌分布及耐药性分析

Analysis of pathogenic bacterium distribution and antibiotic resistance among urologic patients with urinary infection in 2016-2018

目的:对泌尿外科患者尿路感染的病原菌分布及耐药性进行分析,给临床治疗提供依据。方法:收集2016年1月~2018年12月我院泌尿外科患者尿路感染病原菌2597株,使用MALDI-TOF飞行质谱仪进行菌株的鉴定,采用纸片扩散法进行药敏试验,采用WHONET 5.6软件进行耐药率分析,使用SPSS统计软件进行χ~2检验和统计分析。结果:分离革兰阴性菌1860株,革兰阳性菌520株,念珠菌217株,分别占71.6%、20%和8.4%。大肠埃希菌、屎肠球菌、念珠菌属、粪肠球菌和肺炎克雷伯菌排在前5位,分别占总菌株数的46.5%、8.7%、8.4%、7.9%和7.5%。大肠埃希菌和肺炎克雷伯菌的ESBLs发生率分别为59.4%和43.3%。与2016年相比,2018年分离的大肠埃希菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、庆大霉素、妥布霉素和呋喃妥因的耐药率显著降低。肺炎克雷伯菌、铜绿假单胞菌、屎肠球菌和粪肠球菌对各种抗菌药物的耐药率在3年之间未显示出显著性差异。大肠埃希菌及肺炎克雷伯菌对哌拉西林、头孢噻肟、头孢唑啉、头孢吡肟、环丙沙星、左旋氧氟沙星等耐药率多在60%以上。粪肠球菌对环丙沙星和左氧氟沙星的耐药率分别为24.0%和22.4%,屎肠球菌对环丙沙星和左氧氟沙星的耐药率分别为97.7%和96.8%。结论:泌尿外科患者尿路感染的主要病原菌为肠杆菌科细菌中的大肠埃希菌和肺炎克雷伯菌,且产超广谱β内酰胺酶菌株检出率较高。此外,屎肠球菌、粪肠球菌、念珠菌也是常见分离菌。临床医生要密切关注分离菌的变迁及耐药性情况,合理使用抗菌药物。

Objective:To analyze pathogenic bacterium distribution and antibiotic resistance among urologic patients with urinary infection to provide evidence for clinical treatment.Method:A total of 2597 uropathogens were collected in our hospital from January 2016 to December 2018.Identification of strains and drug sensitivity test were performed by MALDI-TOF flight mass spectrometer and paper diffusion method respectively.Statistical analysis was performed using WHONET 5.6 software.Chi-square test was performed by SPSS software.Result:The uropathogens comprised 1860(71.6%)gram-negative bacteria,520(20%)gram-positive bacteria and 217(8.4%)Candida.The five most common bacteria were Escherichia coli(46.5%),Enterococcus faecium(8.7%),Candida spp.(8.4%),Enterococcus faecalis(7.9%)and Klebsiella pneumoniae(7.5%).The incidence rate of ESBLs in Escherichia coli and Klebsiella pneumoniae were 59.4%and 43.3%respectively.Compared with 2016,the antibiotic resistance rate of Escherichia coli isolated in 2018 to cefoperazone/sulbactam,piperacillin/tazobactam,imipenem,gentamicin,tobramycin and nitrofurantoin was much lower.The antibiotic resistance rates of Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterococcus faecium and Enterococcus faecalis to various antibiotics did not show significant difference among three years.The antibiotic resistance rates of Escherichia coli and Klebsiella pneumoniae to piperacillin,cefotaxime,cefazolin,cefepime,ciprofloxacin and levofloxacin were more than 60%.The antibiotic resistance rates of Enterococcus faecalis to ciprofloxacin and levofloxacin were 24.0%and 22.4%,while Enterococcus faecium were as high as 97.7%and 96.8%.Conclusion:The main pathogens of urinary infection in urological patients are Escherichia coli and Klebsiella pneumoniae in Enterobacteriaceae,and the detection rate of ESBLs strain is high.Besides,Enterococcus faecium,Enterococcus faecalis and Candida spp.are also common pathogens.Clinicians should pay close attention to the changes and antibiotic resistance of isolated bacteria and reasonably use antibiotics.