尿路感染患者1112例中段尿细菌培养结果

Results of Mid-stream Clean-catch Urinary Bacteria Culture from 1112 Patients with Urinary Tract Infection

目的探讨尿路感染患者清洁中段尿致病性细菌检出和耐药情况,以指导临床合理用药。方法对武汉大学人民医院2007年1月—2008年3月1112例尿路感染患者的清洁中断尿的病原体进行鉴定和体外药敏试验,细菌鉴定按照《全国临床检验操作规程》进行;药敏试验采用琼脂扩散法(K-B),对革兰阴性杆菌进行超广谱β内酰胺酶的检测。结果检出大肠埃希菌,占53.2%,其次是肠球菌(15.1%)、真菌(5.3%)、葡萄球菌(4.5%)。产超广谱β内酰胺酶大肠埃希菌检出率为24.0%,呈上升趋势。大肠埃希菌对喹诺酮类、复方新诺明、青霉素,除头孢西丁外的第1、2代头孢的耐药率>40%,对碳青霉烯类、呋喃妥因、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的敏感率>90%。产超广谱β内酰胺酶的大肠埃希菌对青霉素类,喹诺酮类及大多数头孢的耐药率大幅增高(P<0.05),对碳青霉烯类、呋喃妥因、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、复方新诺明、庆大霉素的耐药率没影响(P>0.05)。革兰阳性菌对喹诺酮类、庆大霉素耐药率>50%,对万古霉素(92%)、氯霉素(82%)、呋喃妥因(75%)的敏感率较高。结论泌尿系统感染仍以肠杆菌科细菌为主,且病原菌耐药性较强,临床医生加强对泌尿系统感染病人的病原菌的检测及耐药性的监测,对指导合理使用抗生素有重要意义。

[ Objective ] To investigate the detection of pathological bacteria and their drug resistance of urinary tract infection, so as to guide clinical rational drug use. [Methods] The mid-stream clean-catch urine of 1112 patients with urinary tract infection in Peopleg hospital of Wuhan University from January 2007 -- March 2008 were identified pathogens by national clinical testing proce- dures, and drug sensitivity test in vitro were performed by Kirby Bauer （ KB } method. Gram-negative bacilli were detected by ex- tended spectrum β lactamases （ ESBLs） detection. [ Results ] Escherichia coli were detected, occupied 53.2%, followed by enterococcus （15.1% } , epiphyte （5.3%） , and staphylococcus （4.5%）. The detection of Escherichia coli which produced ESBLs was 24.0% , with an increasing tendency. Drug resistance of Escherichia coli to the 1,2-generation cepbalosporins including quinolones, cotrimoxazole, penicillin, with the exception of cefoxitin, was more than 40% , the sensitive rate of Eschericbia coli to carbapenem, nitrofurantoin, piperacillin / tazobactam, cefoperazone / sulbactam, cotrimoxazole; gentamicin was more than 90%. Drug resistance rate of Escheriehia coli which produced ESBLs to penicillins, quinolones, and most of the cephalosporin increased significantly （P 〈0.05）, whereas to carbapenem, nitrofurantoin, piperacillin/tazobactam, cefoperazone/sulbactam, cotrimoxazole, gentamicin, it was unchangeable （ P 〉 0.05 ）. Drug resistance rate of gram-negative bacilli to Quinolones and gentamycin 〉 50% , vancomycin （92%） , ehioramphenicol （82%） , nitrofurantoin （75%） was highly sensitive. [ Conclusion] Urinary tract infection still takes the enterobacteriaceae as the major cause with strong drug resistance of pathogenic bacteria. Clinicians should strengthen the detection of pathogens and drug resistance monitoring of patients with urinary tract infections. It has significance in rational antibiotics use.