脑卒中患者尿路感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria causing urinary tract infection in patients with stroke

目的调查本院脑卒中患者合并尿路感染的病原菌分布及耐药状况,以指导临床合理应用抗菌药物。方法选择本院2009年1月至2012年6月共145例脑卒中合并尿路感染住院患者,按照《全国临床检验操作规程》进行尿细菌培养,药敏试验采用K-B方法。结果脑卒中患者尿路感染分离病原菌均有不同程度的耐药,主要病原菌为大肠埃希菌、粪肠球菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和真菌等,分别占48.97%(71/145)、13.10%(19/145)、6.89%(10/145)、6.21%(9/145)、4.83%(7/145)和8.97%(13/145),其中部分大肠埃希菌呈多药耐药。结论脑卒中患者多为老年人,该类患者基础疾病多,自理能力差,多合并神经源性膀胱,尿路感染发病率高,病原菌耐药性不断增加,须采取有效的干预措施预防和控制感染的发生。

Objective To investigate the species and drug resistance in pathogenic bacteria causing urinary tract infection in patients with stroke, so as to provide basis for clinical reasonable application of antibiotic drugs. Methods Total of 145 cases with stroke and combined with urinary tract infection from January 2009 to June 2012 were enrolled, urine specimens pathogens culture were carried out according to the National Clinical Laboratory Operation Rules. Drug susceptibility detection was performed by K-B methods. Results The separated pathogens from stroke patients with urinary tract infection had different drug resistance, with major pathogens as Escherichia coli （E. coli）, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and fungi, accounting 48.97% （71/145）, 13.10% （19/145）, 6.89% （10/145）, 6.21% （9/145）, 4.83% （7/145） and 8.97% （13/145）, respectively. Some E. coli showed multiple drug resistance. Conclusions The stroke patients are mainly aged people with underlying diseases, poor self-care, mostly complicated with neurogenic bladder and urethra voiding dysfunction, with high incidence of urinary tract infection, who presents an increasing tendency in the drug resistance to pathogens causing urinary tract infection. Therefore, effective interventions measures should be taken to prevent and conlrol urinary tract infection in stroke patients.