舟山海岛341例慢性前列腺炎病原学分布及耐药性分析

Distribution and antibacterial resistance of chronic prostatitis:an investigation of 341 cases in Zhoushan islands

目的：研究慢性前列腺炎的病原学分布及对临床常用药物的耐药性。方法：对341例慢性前列腺炎患者的前列腺液进行细菌培养和药敏试验，同时检测解脲脲原体、人支原体和沙眼衣原体。结果：341例慢性前列腺炎患者中201例（58．9％）常规细菌培养阳性，共分离出细菌18种共204株，阳性球菌占82．4％，阴性杆菌占17．6％，又以溶血葡萄球菌为主（46．6％）；154株葡萄球菌中MRS139株（90．3％），对β-内酰胺酶类抗菌药物的耐药率与MRS检出率一致，对庆大霉素、红霉素、环丙沙星、左氧氟沙星和四环素等均表现出50％～90．9％的高耐药率，对呋喃妥因和利福平较敏感。12株粪肠球菌中，万古霉素耐药（VRE）3株（25％）；高浓度链霉素耐药（HLSR）5株（41．7％）；高浓度庆大霉素耐药（HLGR）7株（58．3％）；对红霉素、环丙沙星、四环素、利福平耐药率较高（58．3％～100．0％）。14株大肠埃希菌中8株ESBLs阳性（57．1％），除对哌拉西彬他唑巴坦、亚胺培南和阿米卡星较敏感外，对其他常用药物的耐药率均在4｜D％以上。支原体或（和）衣原体检测阳性50例（14．7％），在140例细菌培养阴性和201例细菌培养阳性病例中，支原体或（和）衣原体感染检出率分别为20例（14．3％）和30例（14．9％）（χ^2=0．03，P〉0．05）。结论：慢性前列腺炎病原菌以细菌感染占主导地位，分离菌株对常用药物耐药严重。支原体、衣原体感染也应加以重视。适时监测前列腺液病原菌及药敏试验对临床诊断和治疗慢性前列腺炎具有重要意义。

Objective：To study the distribution and antibacterial resistance of chronic prostatitis. Methods：Bacterial culture and antimicrobial agents sensitivity tests were applied to prostatic fluid in 341 patients with chronic prostatitis. Meanwhile, Ureaplasma urealyticum （Uu） , Mycoplasma hominis （ Mh ） and Chlamydia traehomatis （Ct） were detected. Results： A total of 204 strains from 18 kinds of bacteria were found in 201 patients out of 341 （ 58. 9% ）. Gram - positive bacteria were about 82.4% and Gram - negative bacteria were about 46. 6%. Staphylococcus haemolyticus was the most predominant accounted for 46.6%. The ratio of meticillin - resistant staphlococci was 90. 3%. The ratio of resistance staphylococci to gentamicin, erythromycin, ciprofloxacin, Levofloxacin and tetracycline ranged from 50% to 90.9% ,but was low to nitrofurantoin and rifampin. In 12 strains of Enterococcus faecalis,3 strains were VRE;5 resisted to high -level streptomycin;7 resisted to high -level gentamicin; the resistance rate to erythromycin, ciprofloxacin, tetracycline and rifarhpin ranged from 58. 3% to 100.0%. In E. coli,8 of 14 strains were positive for ESBLs. The resistance was all above 40% to usual antibiotics except Piperacillin/tazobactam, imipenem and amikacin. Uu and/or Mh and/or Ct were found out in 50 patients, from them 20 cases were from 140（ 14. 3% ） patients non - infected with bacteria and 30 cases were from 201 （ 14. 9% ） patients infected with bacteria（χ^2 =0. 03 ,P 〉0. 05）. Conclusion： Bacteria are the main pathogens of chronic prostatitis and terribly resist to clinical usual antibiotics. Infection with Uu, Mh and Ct should be taken seriously. It is very important to apply bacterial culturing and sensitivity test to the diagnosis and therapy of chronic prostatitis.