导尿管伴随性尿路感染患者感染生物被膜菌及药敏分析

Urethral Catheterization Complicated with Urinary Tract Infection of Bacteria Producing Biofilm and Drug Sensitivity Analysis

目的:了解柳州地区近2年来导尿管伴随性尿路感染(UTIc)患者生物被膜菌的形成情况、构成比及耐药性,促进合理使用抗生素。方法:对92支(来自86位病人,平均插管56d(范围1～182d)拔除)导尿管进行生物被膜菌定量培养及耐药性检测。结果:92支导尿管有68支(占73.91%)分离出76株生物被膜菌;被膜菌以大肠埃希菌为主,占36.84%;其次为肠球菌属、铜绿假单胞菌、表皮葡萄球菌。定量研究显示其密度可高达4×108cfu/mL;大肠埃希菌和铜绿假单胞菌除对亚胺培南保持100%敏感外,对其他抗生素耐药率均呈上升趋势;革兰阳性球菌耐药率也相当严重,仅万古霉素对革兰阳性球菌敏感率为100%。结论:导尿管内的细菌寄殖和生物被膜形成是导尿管伴随性尿路感染发病机制中的1个重要因素及持续存在的1个病原来源。由于病原菌耐药性呈上升趋势,临床应根据尿培养结果合理使用抗菌药物。

Objectives： To know the composition of the bacteria which producing biofilm and the drug resistance so as to guide the rational application of antibiotics among patients with urethral catheterization complicated with urinary tract infection during the last two years. Methods： Bacteria culture and drug resistance tests were done with ninety-two catheters from 86 cases with an average catheterization of 56 days（ranging from 1-182 days）. Results： Out of the 92 catheters, 68 （73.91%） detected 76 bacteria producing biofilm which include mainly Escherichia coli（36.84%） and Enterococci, Pseudomonas aeruginosa, and Staphylococcus epidermidis. The qualitative study showed a density of 4 ×10^8 cfu/mL. Escherichia coli and Pseudomonas aeruginosa were 100% sensitive to imipenem and increasingly resistant to the other antibiotics. Gram-positive coccis were only 100% sensitive to vancomycin and resistant to the other antibiotics. Conclusion： The bacteria generated and biofilm formed in the catheters were important resource and mechanism of urethral catheterization complicated with urinary tract infection. The drug resistance of the pathogenic bacteria is increasing. The clinical doctors should rationally use antibiotics according to the urine culture.