肿瘤患者尿路感染大肠埃希菌的分布及耐药性监测

Distribution and drug resistance of Escherichia colicausing urinary tract infections in cancer patients

目的了解大肠埃希菌尿路感染的病种分布及对抗菌药物的耐药趋势,给临床合理用药提供参考。方法对2005年1月-2010年12月尿路感染肿瘤患者尿培养分离出的301株大肠埃希菌进行病种分布及耐药性统计分析,用纸片扩散法表型确证试验检测ESBLs。结果分离出大肠埃希菌前5位肿瘤疾病为宫颈癌、直肠癌、肺癌、子宫内膜癌及卵巢癌,分别占30.6%、13.3%、9.6%、5.6%及5.6%;301株大肠埃希菌产ESBLs检出率为74.1%,并有逐年升高趋势;对氨苄西林的耐药率达96.7%,喹诺酮类、头孢一～四代、庆大霉素耐药率>70.4%;对哌拉西林/他唑巴坦、磷霉素及呋喃妥因耐药率<10.1%。结论肿瘤患者尿路感染产ESBLs大肠埃希菌的检出率呈逐年增高趋势,对多种抗菌药物具有高度耐药性;对哌拉西林/他唑巴坦、磷霉素及呋喃妥因的耐药率较低,可用于肿瘤患者尿路感染早期经验用药。

OBJECTIVE To study the distribution of the diseases and the trend of antibiotic resistance of Escherichia coli(E.coli) causing urinary tract infections so as to provide bases for reasonable treatment.METHODS For the cancer patients with urinary tract infections from Jan 2005 to Dec 2010,we analyzed the distribution and antibiotic resistance of 301 strains of E.coli isolated from the patient′s urine samples.ESBLs were detected by disk diffusion phenotypic confirmatory test.RESULTS The top five diseases from which E.coli were isolated were the cervical cancer(30.6%),rectal cancer(13.3%),lung cancer(9.6%),endometrial cancer(5.6%),and ovarian cancer(5.6%).Of 301 strains of E.coli,the detection rate of ESBLs-producing E.coli was 74.1% and increased year by year;the resistance rate to ampicillin was 96.7%,the resistance rates to quinolones,cephalosporins from the first to the fourth generation,and gentamicin were higher than 70.4%;the resistance rates to piperacillin/tazobactam,fosfomycin and nitrofurantoin were lower than 10.1%.CONCLUSION For the cancer patients with urinary tract infections,there is a significant increasing trend in ESBLs-producing E.coli,which has high resistance to a variety of antimicrobial drugs;the resistance rates to piperacillin/tazobactam,fosfomycin and nitrofurantoin are relatively low,those antibiotics can be used as an empiric treatment of urinary tract infections in cancer patients in early stage.