康复期患者继发性尿路感染的病原菌分布及其耐药性

Distribution and drug resistance of pathogens from urinary tract infection patients in patients in recovery period

目的尿路感染是康复期患者最常见的继发性疾病,分析康复科继发性尿路感染主要病原菌及其耐药特点,指导临床合理用药。方法回顾分析2009年3月—2012年6月浙江省人民医院康复科住院469例继发尿路感染患者尿标本检出病原菌的分布及其药敏试验资料,并对主要革兰阴性菌进行ESBLs检测并进行统计学分析。结果尿标本分离出536株病原菌,革兰阴性菌59.9%(321/536),革兰阳性菌32.7%(175/536),真菌7.5%(40/536)。革兰阴性菌主要为大肠埃希氏菌和肺炎克雷伯氏菌,所有大肠埃希菌和肺炎克雷伯菌对亚胺培南均敏感,对3种酶抑制剂复合抗菌药物相对敏感,耐药率低于33.8%。ESBLs检出率分别为35.1%(74/211)和25.0%(12/48),产ESBLs大肠埃希氏菌和肺炎克雷伯氏菌对多数抗菌药物耐药率高于不产ESBLs株(4.9≤χ2≤43.3,P<0.05);革兰阳性菌主要为肠球属和葡萄球菌属。结论大肠埃希氏菌是尿路感染的主要病原菌,高度耐药且呈多药耐药,且是最常见产ESBLs菌株,产ESBLs菌株耐药性更严重。临床治疗应尽量根据药敏试验调整抗菌药物。

Objective To explore the common pathogenic bacteria and drug-resistance of pathogens from urinary tract infection in hospital rehabilitation department, so as to provide basis for reasonable use of drug in clinical practice. Methods We retrospectively analyzed the clinical data of 469 cases of secondary urinary tract infection from March 2009 to June 2012. The bacterial culture and identification were performed with urine samples, and the distribution and drug resistance of pathogens were studied. The t3-1actases（ESBLs） were also detected in mainly gram-negative bacteria and the statistical analysis was carried out with SPSS. Results A total of 536 isolates were isolated from 469 urine samples, in these isolates, gram-negative bacteria were major pathogenic bacteria that accounted for 59.9 % （321/536 ）, gram-positive bacteria and fungi were isolated 32.7% （175/536） and 7.5% （40/536） ,respectively. E. coli and K. pneumoniae isolates were the most predominant among gram-negative bacteria. All of E. coli and K. pneumoniae isolates were susceptible to imipenem, and sensitive to three kinds of compound enzyme inhibitors of antimicrobial agents relatively, resistance to less than 33.8%. 35.1% （74/211） of E. coli and 25.0% （ 12/48 ） of K. pneumoniae isolates produced ESBLs. The resistance rates of ESBLs-producing E. coli and K. pneumoniae isolates were higher than that of non ESBLs-producing isolates. En- terococcus and Staphylococcus were the most predominant among gram- positive bacteria. Conclusion E. coli is still the main pathogen for current urinary tract, the drug resistance of which is high and multiple, and is the most common isolates producing ESBLs. ESBLs-producing E. coli and K. pneumoniae isolates resistance were more serious. The antimicrobial therapy should be adjusted under the guidance of drug sensitivity test.