糖尿病患者泌尿道感染病原菌耐药性分析

Analysis of drug-resistance of pathogenic bacteria causing urinary tract infections in patients with diabetes meuitus

目的探讨糖尿病(DM)患者继发泌尿道感染病原菌的种类分布和耐药性现状,为临床医师抗感染治疗提供合理用药的参考依据。方法采集2010年1月-2012年12月154例糖尿病继发泌尿道感染患者的尿液行细菌培养、鉴定和药敏试验,病原菌培养、鉴定的操作按照《全国临床检验操作规程》中的临床微生物学检验规定的方法进行;药敏试验采用CLSI规定的K-B法。结果 154例糖尿病患者泌尿道感染病原菌中大肠埃希菌检出率最高,检出86株占58.8%;产超广谱β-内酰胺酶细菌检出41株,检出率为38.3%;耐甲氧西林葡萄球菌检出8株,检出率为38.1%;未发现对碳青霉烯类抗菌药物耐药的革兰阴性杆菌及对糖肽类抗菌药物耐药的革兰阳性球菌;但是不同种类的细菌对临床常用的其他抗菌药物产生了不同程度的抗药性,大肠埃希菌和肺炎克雷伯菌对磺胺甲噁唑∕甲氧苄啶耐药率最高,均>60.0%。结论糖尿病患者泌尿道感染病原菌的耐药性因种类不同而异,建议根据病原菌检测数据选择敏感而且对肾脏无害的药物进行抗感染治疗。

OBJECTIVE To approach constituent ratio of species and drug-resistance of bacteria causing urinary tract infections in patients with diabetes mellitus （DM）, so as to pronde evidence for reasonable use of antibiotics for treatment. METHODS A total of 154 urine samples from diabetes patients with urinary tract infections fnm Jan. 2010 to Dec. 2012 were collected The bacterial culture, identification and susceptibility testing nere perfonrmd with reference to National Guide to Clinical LaboratoryProcedures. The susceptibility testings were performed by K-B methods recommended by CLSI. RESULTS Among 154 of strains, Escherichia coli （86 isolates, 58. 8%） ranked the top one. extended-spectrum β-lactamases was detected in 41 strains, accounting for 38. 3%. Meticillinresistant staphylococci （MRS） was detected in 8 strains, accounting for 38. 1 %. None of Carbapenems resistant gram negative bacilli and Glycopeptide resistant gram positive coccus was found. However, the different of bacteria shored differem resisteahce resistant to the common antibiotics. Resistance rates of Escherichia coli and Klebsiella pneumoniae to Sulfamethoxazole/Trimethoprim were more than 60 %. CONCLUSION Drug-resistance of bacteria in diabetes patients varied from bacterial specie to specie. It was recommended that the diniced doctor should choose the suitable drug and unharmful of kidneys drvgs for anti-infective therapy based on etiological detection.