上尿路结石合并感染的细菌培养及药物敏感性分析

Bacterial culture and drug sensitivity analysis of upper urinary tract calculi complicating with infection

目的:分析上尿路结石合并感染,包括急性感染者及无明显临床症状感染者的细菌培养及药物敏感性(药敏)结果,指导临床抗生素应用。方法:在北京大学人民医院2012年1月至2013年2月收治的上尿路结石病例中,选取中段尿培养、血培养或结石培养有阳性结果者为入选病例,其中因梗阻造成急性感染并接受急诊输尿管置入DJ管或肾造瘘者21例,作为急性感染组;随机选择同期无明显临床症状但合并细菌培养阳性的上尿路结石病例64例,作为普通感染组,比较两组细菌培养及药敏结果。结果:上尿路结石合并急性感染组21人,共培养出致病菌28株;普通感染组64人,共培养出致病菌70株。两组均以革兰阴性菌为主(急性组71.4%,普通组65.7%)。大肠杆菌为主要致病菌(急性组为35.7%,普通组32.9%),两组细菌分布差异无统计学意义(P>0.05);革兰阴性菌平均耐药率,急性感染组普遍高于普通感染组,但差异无统计学意义(P>0.05)。半合成青霉素类抗生素,除哌拉西林/他唑巴坦外,平均耐药率均在50%以上。二代头孢中头孢呋辛的平均耐药率达60%以上,三代头孢中头孢曲松耐药率达50%以上。喹诺酮类中环丙沙星与左氧氟沙星平均耐药率已达45%以上。氨基糖苷类敏感率较高,特别是阿米卡星,耐药率<10%。碳青霉烯类平均耐药率极低。头孢哌酮/舒巴坦的平均耐药率较低,明显优于头孢曲松(P<0.001),哌拉西林/他唑巴坦耐药率较低,明显优于哌拉西林(P<0.001)。结论:上尿路结石合并急性感染者与普通感染者在细菌分布及耐药程度上差异无统计学意义。半合成青霉素类、二代头孢、部分三代头孢、喹诺酮类耐药率较高,已不宜作为经验用药。氨基糖苷类及碳青霉烯类耐药率低,必要时可考虑使用。加入β-内酰胺酶抑制剂可有效降低耐药率,哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率较低,是目前临床较为理想的经验用药选择。

Objective： To investigate the bacteriology and drug sensitivity of upper urinary tract calculi patients,and to provide information for choosing suitable antibiotics. Methods： In the study,21 patients who suffered from lithiasis in upper urinary tract and required an emergency drainage for acute obstruction and infection were the ＂acute group＂; 64 patients with calculi in upper urinary tract and accompanied with no infectious symptoms were the ＂common group＂. The bacteriology and drug sensitivity of the two groups were investigated. Results： Gram-negative bacteria infected the most common of upper urinary tract calculi patients with infection,accounting for 71. 4% in the acute group and 65. 7% in the common group,among which Escherichia coli were the predominant ones（35. 7% in the acute group and 32. 9%in the common group）. No difference was found between these two groups in bacterial distribution（P 0. 05）. Although the average drug resistance rate of Gram-negative bacteria in the acute group was higher than that in the common group,it revealed no significant difference（P 0. 05）. The drug resistance rate to semisynthetic penicillin,cefuroxime and ceftriaxone were more than 50%,60%,and 50%,respectively. Quinolones,such as ciprofloxacin and levofloxacin,got a 45% drug resistance. Aminoglycoside,carbapenema were sensitive to Gram-negative bacteria. Cefoperazone /sulbactam and piperacillin /tazobactam were more effective than ceftriaxone and piperacillin,respectively. Conclusion： There was no significant difference between upper urinary tract calculi patients with acute infection and common infection in bacteriology and drug sensitivity. Semisynthetic penicillin,the second generation of cephalosporin and quinolone were no longer the good choices of empirical use. Antibiotics combined with β-lactamase inhibitors would be an ideal empirical therapeutic choice.