上海市浦东部分地区尿路感染常见病原菌的耐药性分析

Analysis of drug resistance of pathogens in urinary tract infection in Pudong New District in Shanghai

目的分析2004—2010年上海市浦东部分地区尿路感染患者最常见的病原菌大肠埃希菌和粪肠球菌的耐药性,为临床合理用药提供依据。方法收集2004年10月—2010年9月上海市浦东部分社区医院住院患者、上海交通大学医学院附属仁济医院东部住院及门诊患者临床分离的尿路感染病原菌,用纸片扩散(K-B)法检测并分析其耐药性,采用WHONET 5.3软件和SPSS 13.0统计学软件进行分析。结果从尿路感染患者中段尿标本中分离出4 415株细菌,大肠埃希菌1 968株(45.6%),粪肠球菌736株(16.7%)。耐药率比较:浦东地区社区医院住院患者>仁济医院住院患者>仁济医院门诊患者。大肠埃希菌对氨苄西林和环丙沙星耐药率逐年下降,对头孢噻肟和头孢他啶耐药率及超广谱β内酰胺酶(ESBLs)检出率逐年下降,对庆大霉素、氨苄西林/舒巴坦、哌拉西林、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和头孢吡肟耐药率先升后降;粪肠球菌对左氧氟沙星耐药率逐年上升,对呋喃妥因耐药率先升后降。结论尿路感染最常见病原菌是大肠埃希菌和粪肠球菌;临床经验用药不同可导致耐药性差异;合理有效使用抗生素能改善耐药性产生。

Objective To investigate the drug resistance of Escherichia coli and Enterococcus faecalis in urinary tract infection in Pudong New District in Shanghai from 2004 to 2010,and provide evidence for clinical drug use. MethodsPathogens in urinary tract infection were collected from inpatients in community hospitals and inpatients and outpatients in Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine in Pudong New District in Shanghai from October 2004 to September 2010.Drug resistance was examined by Kirby-Bauer(K-B) method,and was analysed with WHONET 5.3 software and SPSS 13.0 software. Results A total of 4 415 strains were collected from urine of patients with urinary tract infection,among which there were 1 968(45.6%) Escherichia coli strains and 736(16.7%) Enterococcus faecalis strains.The drug resistance rate of strains from inpatients in community hospitals was higher than that in inpatients in Renji Hospital,and that in outpatients in Renji Hospital was the lowest.The drug resistance rates of Escherichia coli to Ampicillin and Ciprofloxacin decreased year by year.The drug resistance rates of Escherichia coli to Cefotaxime and Ceftazidime and the detection rate of extended-spectrum β-lactamases(ESBLs) strains decreased year by year.The drug resistance rates of Escherichia coli to Gentamicin,Ampicillin/Sulbactam,Piperacillin,Cefoperazone/Sulbactam,Piperacillin/Tazobactam and Cefepime displayed a turning up at first and a turning down later.The drug resistance rate of Enterococcus faecalis to Levofloxacin increased year by year,and that to Nitrofurantoin increased before a collapse. Conclusion Escherichia coli and Enterococcus faecalis are the most common pathogens in urinary tract infection.Different clinical use of drugs may lead to different degree of drug resistance.A reasonable and effective antimicrobial therapy can improve the drug resistance.