尿路感染病原菌检测结果分析

Analysis of results in detection of pathogen in urinary tract

目的探讨尿路感染病原菌分布及其耐药特征,为临床合理选用抗菌药物提供依据。方法对2005年1月1日～2006年12月31日间,海南医学院附属医院门诊患者582份尿培养标本及其分离出的285株细菌进行鉴定和耐药分析。结果285株病原菌中,革兰阴性杆菌148株,占51.9%;革兰阳性球菌108株,占37.9%,其它棒状杆菌及真菌等29株,占10.2%。在所有分离菌中,大肠埃希菌检出率最高(102株,35.8%),其余依次为粪肠球菌(52株,18.2%)、凝固酶阴性葡萄球菌(27株,9.5%)、真菌(18株,6.3%)等。革兰阴性杆菌和革兰阳性球菌,对呋喃妥因敏感性最高,而对复方新诺明和喹诺酮耐药率达一半以上。革兰阳性球菌,对美洛培南,万古霉素敏感率高,革兰阴性杆菌对美洛培南,头孢派酮/舒巴坦敏感率高。结论大肠埃希菌、粪肠球菌、凝固酶阴性葡萄球菌是尿路感染的主要病原菌;不同菌种对不同抗菌药物耐药率差别较大;临床医师应结合本地区尿路感染病原菌的分布特征及药敏试验结果合理选用抗菌药物。

Objective To analyze the distribution and features of drug resistance pathogens in urinary tract infection and provide basis for clinical use of antibiotics correctly. Methods The 285 bacterial strains isolated from urine samples between January 2005 and December 2006 in Affiliated Hospital of Hainan Medical College were identified and their resistance to antibiotics were tested. Results Among the 285 isolates, there were 148 strains of gram - negative bacilli （51.9 % ）, 108 strains of gram - positive cocci （37.9 % ） and 29 strains of corynebacterium and fungi （10.2 % ） . The most common pathogens were Escherichia co li, accounting for 35.8 %, followed by Enterococcus faecalis 18.2 %, eoagulase negative Staphylococcus （ CONS ） 9.5 %, fungi 6.3 % . the gram - negative and gram- positive bacilli were most sensitive to nitrofurantoin . and the resistant rate to trimethoprim - sulfamethoxazole and ampicillin were more then 50%. Among gram- positive cocci, the Staphylococcus were still sensitive to meropenem and vancomycin, but gram - negative cocci were also sensitive to meropenem and quinolones. Conclusion Escherichia coli, Enterococcus faecalis and coagulase negative Staphylococcus （CONS） were main pathogens in urinary tract infection. The resistance rate of pathogens to different antibiotics were different. Rational use of antibiotica should be carried out according to the distribution characteristic of pathogens in urinary tract infection and Microbial sensitivity test results.