神经内科患者泌尿系统感染的病原菌分布及耐药分析

Distribution and drug resistance of pathogens causing urinary tract infections in patients of neurology department

目的了解神经内科患者泌尿系统感染的病原菌分布及耐药性,为临床合理选择抗菌药物提供依据。方法分析2009年10月-2011年10月送检的754份标本,采用VITEK-2Compact全自动微生物分析仪系统进行进行病原菌鉴定和药敏试验,分析病原菌耐药性。结果共分离出310株病原菌,排除同一患者重复标本,主要病原菌有大肠埃希菌、肺炎克雷伯菌、肠球菌属,分别占33.9%、9.0%、13.8%,其中产ESBLs大肠埃希菌为39.2%,产ESBLs肺炎克雷伯菌为41.3%;大肠埃希菌及肺炎克雷伯菌对亚胺培南敏感率均为100.0%,对头孢哌酮/舒巴坦的敏感率均>95.0%,1株阴沟肠杆菌对亚胺培南耐药,改良Hodge试验阳性;金黄色葡萄球菌以及其他革兰阳性球菌对万古霉素的敏感率为100.0%,耐甲氧西林金黄色葡萄球菌检出率为38.5%;真菌分离率11.3%。结论引起神经内科泌尿系统感染常见病原菌仍以临床常见条件致病菌为主,这些病原菌对临床常用抗菌药物产生了一定的耐药性,需加强病原菌耐药监测,规范临床医师操作,药敏试验结果指导临床用药,以有效控制医院感染的发生。

OBJECTIVE To understand the distribution and drug resistance of pathogens causing the urinary tract infections in the patients of neurology department so as to guide the reasonable clinical use of antibiotics. METHODS A total of 754 specimens submitted from Oct 2009 to Oct 2011 were analyzed, VITEK-2 Compact automatic micro-analyzer system was used to perform the identification and drug susceptibility testing, and the drug resistance of the pathogens was analyzed. RESULTS A total of 310 strains of pathogens were isolated, exclu- ding the repeat specimens from the same patient , the main pathogens were Escherlchia coli, Klebsiella pneumon- iae, and Enterococcus, accounting for 33.9~/0, 9.0%, and 13.8~.~, among which the ESBLs-proclucing E. coli accounted for 39.2~/0, ESBLs-producing K. pneumoniae 41.3% . The drug susceptibility rates of the E. coli and K. pneurnoniae to imipenem were 100.0%, the drug susceptibility rates to cefoperazone/sulbactam were more than 95.0%; there was one strain of imipenem-resistant Enterobacter cloacae, with the modified Hodge test positive; Staphylococcus aureus and other gram-positive bacteria were 100.0% sensitive to vancomycin , the detection rate of the methicillin-resistant Staphylococcus aureus （MRSA） was 38.5%; the detection rate of the fungi was 11. 3%. CONCLUSION The opportunistic pathogens remain the common pathogens causing the urinary tract infec- tions in the neurology department and have produced certain drug resistance to the commonly used antibiotics. It is necessary to strengthen the monitoring of the drug resistance, standardize the operation, and guide the clinical medication on the basis of the drug susceptibility testing so as to effectively control the nosocomial infections.