留置尿管相关尿路感染病原菌分布和耐药性分析

Analysis of distribution and drug resistance of pathogen in catheter-related urinary tract infection

目的调查和分析导尿管相关尿路感染(CAUTI)的病原菌分布及耐药性,为临床用药提供依据。方法采用回顾性调查方法,利用WHONET 5.6对浙江萧山医院2011年1月-2012年12月住院期间接受留置导尿患者的尿路感染发生情况进行分析。结果分离病原菌共309株(39种),其中革兰阴性菌174株(56.3%),革兰阳性菌64株(20.7%),真菌71株(23.0%);列前三位的是大肠埃希菌88株(28.5%)、肺炎克雷伯菌34株(11.0%)和白色念珠菌31株(10.0%)。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81.8%(72/88)和55.8%(19/34)。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显示较高抗菌活性(耐药率≤8.0%);5-氟胞嘧啶、伏立康唑和两性霉素B对念珠菌有较高的敏感率(≥98.6%)。结论 CAUTI病原菌以革兰阴性杆菌尤其是大肠埃希菌为主,含酶抑制剂抗生素适合作为经验用药;应严格无菌操作和加强护理管理,缩短导尿管留置时间并合理使用抗生素。

Objective To investigate the bacterial distribution and drug sensitivity of pathogen related to catheter - associated u- rinary tract infection （ CAUTI）, so as to provide the reference for the reasonable use of antibiotic in clinic. Methods A retro- spective analysis was carried out among the patients with indwelling urinary tract from Jan. 2011 to Dec. 2012 by WHONET 5,6 software. Results Totally 309 pathogenic strains were isolated, among which there were 174 strains of gram - negative bacilli （ 56.3% ） , 64 strains of gram - positive bacilli（20.7% ） and 71 strains of fungus（23.0% ）. The top three bacteria were E. coli （ 28.5% ） , K. pneumoniae（ 11.0% ） and Candida albicans（ 10.0% ）. The detection rate of extended - spectrum β- lactamases of E. coli and K. pneumoniae were 81.8% and 55.8%. E. coli were susceptible to imipenem, meropenem, cefoperazone/ sulbactam, piperacillin/tazobactam and amikacin（ R% ≤8.0% ）. Candida had higher sensitivity rate to flucytosine, voriconazole and amphotericin B （ S%≥98.6% ）. Conclusion Gram - negative bacilli such as E. coli was the predominant pathogen in CAUTI, and enzyme inhibitor antibiotics are suitable for empirical therapy. Strict aseptic operation and nursing management, shortening the indwelling time and reasonable use of antibiotic are all effective measures to reduce CAUTI.