前列腺炎患者前列腺液细菌培养及药敏试验分析

Culture of bacterial obtained from prostatic fluid of prostatitis patients and drug sensitivity test

目的了解细菌性前列腺炎的病原菌分布及耐药性，为临床合理用药提供参考。方法对医院2011年1月-2012年12月133例诊断为细菌性前列腺炎患者，按常规进行消毒尿道口并在排尿后由临床医师无菌操作取得前列腺液后置无菌男性棉拭子管，立即送检，将标本接种于血平板、麦康凯和巧克力平板，35℃恒温培养箱培养24-48h，分离出可疑菌落，采用法国生物梅里埃公司VITEK-2全自动微生物分析仪作细菌鉴定及药敏试验。结果133例前列腺炎患者中培养阳性107例，阳性率为80．45％；共分离出病原菌113株，其中革兰阴性菌99株占87．6％，以表皮葡萄球菌和金黄色葡萄球菌为主，分别占45．1％、24．8％；革兰阴性菌14株占12．4％；革兰阳性菌除对万古霉素100．0％敏感外，对其他抗菌药物均产生一定的耐药性，对磺胺甲嘌唑／甲氧苄啶和苯唑西林的耐药率较高，〉76．7％；革兰阴性菌对苯唑西林、红霉素耐药率较高，〉78．8％，对诺氟沙星、环丙沙星较敏感，耐药率〈14．3％。结论由于临床经验用药和广谱抗菌药物的滥用，导致细菌的耐药性日趋严重，因此临床应适时监测细菌性前列腺炎患者的病原菌及药敏试验结果，以此为依据，进行目标性治疗，尽量避免经验用药，以提高临床治疗效果。

OBJECTIVE To learn about the distribution and drug resistance of pathogens causing bacterial prostatitis so as to provide reference for rational use of drug in clinical practice. METHODS A total of 133 cases of patients who were diagnosed to suffer bacterial prostatitis in the hospital from Jan 2011 to Dec 2012 were selected as the subjects; they received urethral orifice first as routine and then after urination, the clinical physicians got prostatic fluid from them; the obtained prostatic fluid was placed in PS-SWAB tubes and was sent for inspection immediately; the specimens were inoculated in blood plate, MacConkey and chocolate plate, and were cultured in constant temperature incubation under 35℃ for 24-48 hours; the suspicious bacterial colonies were isolated and the Bi- omerieux VITEK-2 automatic microorganism analyzer was adopted for bacteria identification and drug sensitivity test. RESULTS There were 107 cases of positive cultures among the 133 cases of prostatitis patients, with positive rate of 80.45%; a total of 113 strains of pathogens were isolated, 99 strains were gram-positive bacteria （87. 6 %）, with Staphylococcus epidermidis （S. epidermidis） dominantly accounting for 45.1% and 24.8 % respectively; 14 strains were gram-negative bacteria （12.4%） ; except that gram-positive bacteria was 100.0% sensitive to vancomycin, they were also resistant to the other antibiotics to some extent; they had high drug resistance rate a- bove 76.7% to sulfamethoxazole-trimethoprim and oxacilin; gram-negative bacteria had high drug resistance rate above 78.8% to oxacillin and erythrocin, and had low resistance rate below 14.3% to norfloxacin and ciprofioxa- cin. CONCLUSION The experience-directed use of drug in clinical practice and abuse of broad-spectrum antibacteri- al lead to the more and more server drug resistance of bacteria; so it is required to monitor the pathogens of bacte- rial prostatitis patients and the drug sensitive test results in time, which will be taken as basis to conduct specific treatment, avoiding experience-directed use of drug and improving therapeutic effects in clinical practice.