南京地区2006-2009年中段尿培养病原菌分布及耐药性变迁

Distribution and antimicrobial resistance change of pathogens cultured from midstream urine in Nanjing during 2006-2009

目的监测并分析南京地区2006-2009年中段尿培养病原菌分布和耐药性变迁,为临床合理选用抗菌药物提供最新依据。方法采用VITEK系统或API系统鉴定细菌和真菌,细菌药物敏感性测定采用纸片扩散法（K-B法）,真菌药物敏感性测定采用Rosco纸片法,应用WHONET5.3软件分析中段尿培养标本所分离的病原菌的分布及药敏情况。结果 2006-2009年的尿路感染仍然以细菌感染为主,大肠埃希菌位居首位占42.3%~46.1%,有下降趋势;肠球菌属和真菌感染的比例有所升高,2009年分别升高至14.6%和12.7%;大肠埃希菌产ESBLs酶的检出率明显升高,从2006年的12.5%升至2009年的34.1%;大肠埃希菌对碳青霉烯类药物的敏感性依然较高,对头孢菌素类的耐药率明显升高;肠球菌属在2009年对万古霉素和替考拉宁的耐药率分别为5.3%和3.0%;葡萄球菌属对万古霉素和替考拉宁仍高度敏感,未发现耐药菌株。结论定期监测和分析当地患者尿路感染病原菌种类及其耐药性变迁,对临床合理使用抗菌药物具有重要指导意义。

OBJECTIVE To detect the distribution of bacteria in the midstream urine and analyze its drug resistance change from 2006 to 2009 in Nanjing area,so as to provide the latest evidence of clinical rational use of antibiotics.METHODS VITEK system or API system was applied to identify bacteria and fungi.K-B method was used to test bacteria drug sensitivity and Rosco method was used to test fungal drug sensitivity.WHONET 5.3 software was used to analyze the distribution and drug sensitivity of pathogenic bacteria in urine samples isolated from the medistream urine.RESULTS From 2006 to 2009,the urinary tract infection was still mainly bacterial,which Escherichia coli was still ranked first（60.5%-63.4%） even with a downward trend.Enterococci and the proportion of fungal infections had respectively increased to 14.6% and 12.7% in 2009.The proportion of E.coli producing ESBLs enzyme was significantly increased from 12.5% in 2006 to 34.1% in 2009.E.coli was still sensitive to Vinyl hydrocarbon enzyme drugs and the resistance to cephalosporins was significantly increased.The drug resistance rates of Enterococci to vancomycin and teicoplanin were 5.3% and 3.0% in 2009,respectively.Staphylococcus was still highly sensitive to vancomycin and teicoplanin and no resistant strain was found.CONCLUSION Regular analysis and monitoring to pathogens species and the variance of drug resistance in local patients with urinary tract infection have important significance to guide the clinical use of antimicrobial agents.