住院患者尿路感染病原菌分布及耐药性监测

Distribution and antibiotic resistance of pathogens isolated from inpatients with urinary tractinfections

目的通过调查和分析住院患者尿路感染病原菌的分布及耐药状况，为抗菌药物的合理应用提供参考。方法对浙江萧山医院2009年1月～2011年12月住院患者尿培养阳性样本中分离的1033株菌株进行回顾性分析，尿液采用经典型浸片Urieult培养，药敏试验用K—B法进行，采用WHONET5．6软件对药敏试验结果进行分析。结果1033株阳性菌株中，革兰阴性菌681株（65．9％），革兰阳性菌197株（19．1％），真菌155株（15．0％）。分离株位居前三位的是大肠埃希菌402株（38．9％），肺炎克雷伯菌74株（7．2％）和白假丝酵母菌64株（6．2％）。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）检出率分别为60．7％（244／402）和45．9％（34／74）。亚胺培南、美罗培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和阿米卡星对大肠埃希菌和肺炎克雷伯菌显示较高的抗菌活性；肠球菌属、葡萄球菌对万古霉素、利奈唑胺和呋哺妥因耐药率低；假丝酵母菌对氟胞嘧啶、伏立康唑和两性霉素B有较高的敏感率。结论本组住院患者尿路感染病原菌以革兰阴性菌为主，尤以大肠埃希菌居多，监测和分析病原菌种类及其耐药性对指导临床合理用药具有重要意义。

Objective To investigate the distribution and antibiotic resistance of pathogens isolated fi＇om inpatients with urinary tract infections. Methods A retrospective analysis was carried out on 1033 strains of pathogens isolated from urine culture in patients with urinary tract infections in Zhejiang Xiaoshan Hospital during January 2009 and December 2011. Urine specimens were cultured with Uricult, and K-B method was used for drug susceptibility test, WHONET 5.6 software was used to analyse drug susceptibility test. Results Among 1033 strains of pathogens, 681 （65.9%） were gram-negative bacteria, 197 （19. 1% ） were gram-positive bacteria, and 155 （15.0%） were fungi. The three most prevalent bacteria were Escherichia coli （402 strains, 38.9% ） , Klebsiella pneumoniae （74 strains, 7.2% ） and Candida albicans （64 strains, 6.2% ）. 60.7% （244/402） of Escherichia coli and 45.9% （34/74） of Klebsiella pneumoniae were extended-spectrum β-lactamases （ESBLs） positive. Escherichia coli and Klebsiella pneumoniae were susceptible to imipenem, meropenem, cefoperazone/sulbactam, piperacillin/tazobactam and amikaein. Enterococcus and staphylococcus were susceptible to vancomycin, linezolid and furadantin. Candida was sensitive to flucytosine, voriconazole and amphotericin B. Conclusion Gram-negative bacteria mainly E. coli is the predominant pathogen to urinary tract infections in this group of patients. Regular analysis and monitoring of pathogen species and drug resistance is important for rational use of antibiotics.