尿路感染病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogens in Urinary Tract Infection

目的探讨尿路感染的病原菌分布特点及细菌耐药现状,为临床合理使用抗菌药物提供依据。方法应用天地人微生物分析系统,结合K-B法药敏试验对尿培养分离的216株细菌进行鉴定和药物敏感性测定,并对革兰阴性杆菌进行ESBLs的检测。结果216株病原菌中,革兰阴性杆菌141株,占65.3%;革兰阳性球菌65株,占30.1%;真菌10株,占4.6%。革兰阴性杆菌对亚胺培南敏感性最高,耐药率在0%～12.5%之间,对哌拉西林和庆大霉素耐药率分别达60.3%～66.6%和50.0%～70.3%。革兰阳性球菌中,葡萄球菌对万古霉素均敏感,对苯唑西林耐药率已达53.3%;肠球菌对常用抗菌药物的耐药率较高(26.3%～47.4%)有1株(5.3%)对万古霉素耐药。大肠埃希菌和肺炎克雷伯菌产ESBLs的菌株检出率分别为29.8%和21.0%。结论革兰阴性杆菌是我院尿路感染的主要病原菌;尿路感染常见病原菌耐药严重,应及时检测病原菌及其耐药情况,以便合理使用抗菌药物。

Objective To investigate the bacterial distribution and antibiotic resistance situation with urinary tract infection （UTI） for providing the evidence for rational use of antibiotics in clinic. Methods Identification and susceptibility test of 216 isolates from urine specimens were performed by TDR system and K - B method. In addition, ESBLs were also detected in gram - negative bacilli. Results Among 216 strains, gram - negative bacilli, gram - positive cocci, and fungi accounted for 65.3% （141/216）, 30. 1% （65/2,16）, and 4.6% （10/216） respectively. The gram- negative bacilli were the most sensitive to imipenem and the resistance rate was between 0% and 12.5%, the resistant rates to piperacillin and gentamicin were 60.3%-66.6% and 50.0%-70.3%, respectively. Among gram- positive cocci, all the Staphylococci were sensitive to vancomycin （100%）, but 53.3% of them were resistant to oxacillin. Enterococci were highly resistant （26.3% 47.4% ） to common antimicrobial drugs and one was resistant （5.3%） to vancomycin. 29.8 % of Escherichia coli and 21.0% of Klebsiella pneumoniae isolates produced ESBLs. Conclusions Gram - negative bacilli are the predominant organism in urinary tract infections in The Third Hospital of Ohangsha. The high antibiotic resistance of commonly encountered pathogens is a serious problem and much attention should be paid to detect pathogens and their antibiotic resistance.