留置导尿致泌尿系感染的常见菌群耐药分析及预防对策

Clinical Isolates from Urinary Tract Infection Patients with Indwellng Catheter: Analysis of Drug Tolerance and Preventive Strategy

目的了解留置导尿致泌尿系感染的常见菌群及其对抗生素的耐药性,以采取易行实用的预防对策,减少医院感染的发生率。方法对2002年5月～2004年5月,因留置导尿致泌尿系感染分离的193株病原菌进行回顾性调查分折。结果分离出193株病菌中,革兰阴性杆菌118株(61.1%)、革兰阳性菌49株(25.3%),真菌26株(13.5%);主要病原菌依次为大肠埃希菌(35.8%)、白色念珠菌(10.9%)、粪肠球菌(9.3%)、肺炎克雷伯菌(8.3%)、铜绿假单胞菌(5.7%)和表皮葡萄球菌(5.7%);药敏试验结果提示除真菌外大多数病原菌出现多重耐药性;革兰阴性杆菌对亚胺培南、头孢哌酮/舒巴坦、头孢西丁和阿米卡星较为敏感;革兰阳性球菌对替考拉宁和万古霉素高度敏感;16株大肠埃希菌超广谱β内酰胺酶(ESBLs)阳性产酶率23.2%。结论留置导尿致泌尿系感染的病原菌以大肠埃希菌为最常见,其次为白色念珠菌、粪肠球菌和肺炎克雷伯菌;合理使用各种侵袭性诊疗技术及抗生素,对有效控制泌尿系统感染和避免耐药菌株的产生尤为重要。

OBJECTIVE To investigate the common pathogens in urinary tract infection （UTI） patients with indwelling catheter and their drug tolerance. METHODS One hundred and ninety-three strains of pathogens were isolated from UTI patients with indwelling catheter from May 2002 to May 2004. RESULTS Among 193 isolates, 118 strains （61.1%） were Gram-negative bacilli, 49 （25.3%） were Gram-positive cocci and 26 （13.5%） of fungi. The most common pathogens were Escherichia coli （35.8 %）, Candida albicans （10.9 %）, Enterococcus faecalis （9.3 %）, K lebsiella pneumoniae （8. 3 % ） , Pseudomonas aeruginosa （5.7 %） and Staphylococcus e pidermidis （5.7%）. Most strains were multidrug resistant. Most strains of Gram-negative bacilli were highly susceptible to imipenem, cefoperazone-sulbactam, cefoxitin and amikacin, while most strains of Gram-ositive cocci were highly susceptible to teicoplanin and vancomycin. 23.2% of E. coli strains produced extended-spectrum 13-1actamases. CONCLUSIONS The most common pathogens of UTI patients with indwelling catheter are E. coll. followed by C. albicans, E. faecalis and P. aeruginosa. Prudential use of urinary catheter and rational use of antibiotics are important for the treatment of oatients with UTI and reduce the development of resistant strains.