泌尿系统感染病原菌的分布及耐药性分析

Analysis on the pathogenic bacteria distribution and drug resistance of urinary tract infection

目的探讨中山市人民医院尿路感染常见病原菌分布和耐药性情况,指导临床更合理选用抗菌药物。方法对中山市人民医院2007年1月1日至2010年12月30日中段尿细菌培养阳性标本分离病原菌进行回顾性总结,对逐年分离病原菌进行种类分布与构成比分析,分析主要的革兰阴性杆菌和革兰阳性球菌对常见抗菌药物的耐药性。结果中段尿细菌培养阳性标本共分离出病原菌1 525株,其中革兰阴性杆菌1 032株(67.7%),革兰阳性球菌223株(14.6%),真菌270株(17.7%)。主要致病菌依次为大肠埃希菌645株(42.3%)、肺炎克雷伯菌117株(7.7%)、铜绿假单胞菌110株(7.2%)、白色假丝酵母菌105株(6.9%)、粪肠球菌92株(6.0%)、光滑假丝酵母菌79株(5.2%)、屎肠球菌42株(2.8%)。其中产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌分别为361株(产酶率56.0%)和57株(产酶率48.7%)。药敏试验结果显示,临床分离的主要病原菌对抗菌药物的耐药现象较严重。结论革兰阴性杆菌是尿路感染的主要病原菌,真菌感染呈上升趋势,病原菌的耐药现象较严重。重视尿路感染病原菌的监测和耐药性分析,对指导临床合理规范使用抗菌药物、控制耐药菌株的播散和院内感染具有重要意义。

Objective To research the distribution of common pathogenic bacteria and their cirug remstance ot urinary tract infection in this hospital for guiding clinical use of antibacterial agents. Methods Pathogenic bacteria isolated from the germiculture positive specimens of midstream urine from Jan. 2007 to Dec. 2010 in our hospital were retrospective summarized. The species and percentage of the pathogenic bacteria,the drug resistance of main gramnegative bacteria and gram-positive bacteria in common antibacterial agents were analyzed every year . Results 1 525 strains pathogenic bacteria were isolated from the germiculture positive specimens totally,with 1 032 strains of gramnegative bacteria（ 67.6 % ）, 223 strains of gram-positive bacteria （14.6 %）, 270 strains of fungi （17.7 %）. The main pathogenic bacteria were 645 strains of Escherichia coli（42.3 % ）, 117 strains of Klebsiella pneumoniae （7.7 %）, 110 strains of pseudomonas aeruginosa（7.2 %）, 105 strains of Candida albicans（6.9 % ）, 92 strains of Enterococcus faecalis（6.0%）,79 strains of Candida glabrata（5.2%）,and 42 strains of Enterococcus faecium（2.8%）. 361 strains of Escherichia coli and 57 strains of Klebsiella pneumoniae produced ESBL were detected out,with the enzyme production rates of 56.0 %/00 and 48.7 %. The antimicrobial susceptibility test results showed that the drug resistance of the pathogenic bacteria was in a very serious situation. Conclusion Gram-negative bacteria is the main pathogenic bacteria of urinary tract infection. Fungal infections is in a rising trend, and the drug resistance of the pathogenic bacteria is in a very serious situation. It should pay more attention to monitor the pathogenic bacteria and their drug resistance, which is important to guide clinic make use of antibacterial agents exactly, control the spread of the drug-resistant strains and nosocomial infection.