中段尿培养病原菌分布与耐药性变迁

Distribution and antimicrobial resistance change of pathogens cultured from midstream urine

目的监测和分析扬州地区2009-2011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依据。方法采用法国生物梅里埃公司的VITEK-32全自动微生物仪,进行细菌鉴定和药物敏感试验,应用WHONET 5.3软件分析分离的病原菌的分布及药敏情况。结果 2009-2011年的尿路感染中大肠埃希菌仍位于首位(35.19%～42.19%);肺炎克雷伯菌、粪肠球和屎肠球菌的感染率有上升趋势,分别从2009年5.66%、3.68%、3.77%上升至2011年7.31%、4.78%、5.43%;奇异变形菌检出率有下降趋势,从2009年的5.92%降至2011年的3.87%;大肠埃希菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢西丁和阿米卡星的敏感率均>90.00%;喹诺酮类药物的敏感率稳定在约45.00%;头孢类药物的耐药率均有上升趋势。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,对指导临床合理使用抗菌药物具有重要意义。

OBJECTIVE To detect the distribution of bacteria cultured from the midstream urine and analyze their drug resistance from 2009 to 2011 in Yangzhou area so as to provide the latest evidence for the clinical rational use of antibiotics.METHODS VITEK system was applied to identify bacteria and drug susceptibility testing.WHONET 5.3 software was used to analyze the distribution and drug sensitivity of pathogenic bacteria cultured from the midstream urine.RESULTS From 2009 to 2011,Escherichia coli causing urinary tract infections still ranked the first place（35.19%-42.19%）,and incidence rates of Klebsiella pneumoniae infections,Enterococcus faecalis infections and Enterococcus faecium infections kept an upward tendency,respectively increasing from 5.66%,3.68%,and 3.77% in 2009 to 7.31%,4.78%,and 5.43% in 2011,however,the incidence rate of Proteus mirabilis decreased from 5.92% in 2009 to 3.87% in 2011.The drug susceptibility rates of E.coli to cefoperazone/sulbactam,imipenem,meropenem,piperacillin/tazobactam,cefoxitin and amikacin were higher than 90.00%,and the susceptibility rate to quinolones was stably at around 45.00%,the resistance rate to cephalosporins was increased.CONCLUSION It is of great significance in the guidance of reasonable use of antibiotics to regularly monitor and analyze the species of pathogens causing urinary tract infections and the change of their drug resistance.