社区尿路感染的病原菌调查和耐药性分析

Pathogens for community-acquired urinary tract infections:distribution and drug resistance

目的通过对尿路感染病原微生物的调查,了解社区尿路感染的病原构成及其对抗生素的耐药性,为抗菌药物的合理应用提供依据。方法回顾性调查2004年1月1日—2007年12月31日复旦大学附属中山医院微生物检验室所有来自门诊和急诊的清洁中段尿培养的真性菌尿的记录和药敏试验结果。结果4年来,来自清洁中段尿和导尿管尿培养的真性菌尿菌株共2049株,革兰阴性杆菌在社区尿路感染病原菌中最常见,检出率为82.5%,其中大肠埃希菌仍是最主要的革兰阴性杆菌,占总菌株的68.0%;革兰阳性球菌的检出率为14.7%,真菌的检出率为2.8%。4年来,革兰阴性杆菌、革兰阳性球菌和真菌的构成比的差异无统计学意义(P>0.05)。大肠埃希菌、肺炎克雷伯菌对环丙沙星和大多数β内酰胺类抗生素都有较高的耐药性,但当这些抗生素与β内酰胺酶抑制剂联合应用后,细菌对它们的耐药率可有不同程度的下降。4年来大肠埃希菌和肺炎克雷伯菌对常用抗生素的耐药率的差异无统计学意义(P值均>0.05)。未发现对万古霉素耐药的肠球菌,除万古霉素以外,屎肠球菌对几乎所有抗生素都有很高的耐药率,且均显著高于粪肠球菌(P值均<0.01)。未发现对常用的两种三唑类抗真菌药氟康唑和伏立康唑耐药的白念珠菌,非白念珠菌对以上两种抗真菌药物也比较敏感,耐药率均仅为3.6%。结论社区尿路感染仍以大肠埃希菌最为常见,肠球菌次之,但常见病原菌的耐药现象较为严重,应及时检测病原菌及其耐药情况,制定相应的治疗方案,指导抗生素的合理应用。

Objective To investigate the distribution and antibiotic resistance of pathogens responsible for community-acquired urinary tract infections （UTIs）, so as to provide guidance for proper application of antibiotics. Methods The laboratory data （significant bacteriuria and results of antibiotic sensitivity tests） of urine samples of all the patients from the outpatient and emergent departments of Zhongshan Hospital during Jan. 1. 2004 to Dec. 31. 2007 were retrospectively analyzed. Results Gram-negative bacilli were the dominant strains in a total of 2 049 pathogenic strains （significant bacteriuria） discovered during the 4 years periods by, accounting for 82.5 % of the total, and among the 2 049 pathogenic strains Escherichia coli occupied 68.0 %. The proportions of Gram-positive cocci and fungi were 14.7% and 2.8%, respectively. There were no significant changes in the pathogen constitutions during the four years （P〈0.05）. Escherichia coli and pneumonia klebsiella spp showed high resistance rates to ciprofloxacin and most β-lactam antibiotics, but the resistances were lower after combined application of β-lactamase inhibitor. There were no significant changes in the resistance rates of Escherichia coli and pneumonia klebsiella spp to the commonly used antibiotics （both P〈0.05）. None of the isolated enterococci was found to be resistant to vancomycin, and the resistance rate of enterococcus faecium was significantly higher than that of enterococcus faecalis（all P〈0. 01 ）. The resistant rates of both non-candida albicans and candida albicans to fluconazole and voriconazole were low, with the drug resistance rate being merely 3.6%. Conclusions Escherichia coli remains to be the major pathogen in community-acquired urinary tract infections, which is followed by enterococci. The most common pathogens have a very high resistant rate. More attention is needed for the antibiotic resistance of the pathogens, so as to provide guidance for the proper use of antibiotics. （Shanghai Med J, 2009, 32： 764-768）