长期耻骨上膀胱造瘘患者病原菌及药敏分析

Pathogen and antibiotic susceptibility in urinary strains in patients with long-term suprapubic catheterisation

目的：探讨长期耻骨上膀胱造瘘细菌谱及其药敏分析以及尿路感染相关危险因素。方法：分析2012年1月~2014年1月在我院行耻骨上膀胱造瘘术后的53例患者的临床资料,所有患者术前行尿常规检查及尿细菌培养,对阳性结果进行菌种鉴定和耐药性检测。结合患者的临床资料分析尿路相关感染的易感因素。结果：1本组患者53例,共100例次送检,尿培养阳性患者86例次,阳性率86%。共培养出23种86株病原菌,其中球菌25例（29%）,杆菌56例（65%）,真菌5例（6%）;大肠埃希菌占27%,肺炎克雷伯杆菌7%,铜绿假单胞菌占6%,奇异变形杆菌5%;表皮葡萄球菌占10%,溶血葡萄球菌占5%,粪肠球菌10%。其中产超广谱β-内酰胺酶大肠埃希氏菌例17例（占大肠埃希菌74%）,产超广谱β-内酰胺酶肺炎克雷伯菌6例（占肺炎克雷伯菌100%）。2亚胺培南、美罗培南、阿米卡星、哌拉西林-他唑巴坦等药物对革兰阴性杆菌有较好的药敏结果;呋喃妥因、利福平、万古霉素等药物对革兰阳性球菌敏感。3未发现对美洛培南耐药的革兰氏阴性杆菌菌株,而常用抗生素氯霉素、环丙沙星、头孢噻肟、头孢唑啉、氨苄西林、左氧氟沙星、哌拉西林和四环素耐药率均在50%以上。未发现对呋喃妥因、利福平等药物耐药革兰阳性球菌,而克林霉素、红霉素、环丙沙星、青霉素、庆大霉素、苯唑西林和复方新诺明普遍耐药,耐药比例均在70%以上。4本组发热患者17例,发热与尿常规白细胞阳性正相关（r=0.2,P=0.045）。细菌数与留置导尿管时间长短呈正相关（r=0.4,P=0.01）,尿常规白细胞阳性与是否有细菌呈显著相关（r=0.4,P〈0.01）,革兰氏阳性球菌与革兰氏阴性球菌相比两者引起尿常规异常的差异有统计学意义（P=0.005）。结论：耻骨上膀胱造瘘患者菌种分布以革兰阴性杆菌为主,主要致病菌为大肠埃希菌和肺炎克雷伯菌,革兰阳性菌以葡萄球菌为主,对不同抗生素的耐药率差异较大,对常用抗生素喹诺酮类及头孢类大部分不敏感,应根据药敏结果用药。

Objective：To survey the pathogens and antibiotic resistance in urinary strains from patients with long-term suprapubic catheterization so as to identify risk factors of catheter-associated urinary tract infection.Method：From January 2012 to January 2014,53 patients with suprapubic catheterisation were investigated clinically with urinalysis and urine culture.Uropathogens were identified and their susceptibility was tested.Data of patients＇ age and indwelling time were recorded so as to identify susceptible factors of catheter-associated urinary tract infection.Result：Out of 100 samples from 53 patients,86（86%）were culture positive.Gram-negative organisms were found in 65%,while 29% of them were gram-positive and 6% fungi,respectively.The most frequent causative organisms isolated were Escherichia coli（27%）,Klebsiella pneumoniae（7%）,Pseudomonas aeruginosa（6%）,Proteus mirabilis（5%）,Staphylococcus epidermidis（10%）,Staphylococcus haemolyticus（5%）and Enterococcus faecalis（10%）.Gram-negative bacilli were sensitive to imipenem,meropenem and amikacin,while gram-positive coccus were sensitive to nitrofurantoin and vancomycin.Gram-negative bacteria showed a high rate of resistance against chloramphenicol,ciprofloxacin,cefotaxime,cefazolin,ampicillin,levofloxacin,piperacillin and tetracycline.Gram-positive bacteria showed a high rate of resistance against clindamycin,erythromycin,ciprofloxacin,penicillin,gentamicin,oxacillin,and trimethoprim-sulfamethoxazole.Increasing indwelling time correlated with the number of microbial suprapubic catheter colonisation（r=0.4,P =0.01）.There was a significant correlation between positive result of urine test in blood cells and the existence of bacteria（r=0.4,P0.01）.Moreover,a statistical significance could be found in abnormal urine test caused by gram-positive coccus or gram-negative coccus（P =0.005）Conclusion：The main pathogen of urinary strains from patients with suprapubic catheterisation is gram-negative bacillus especially Escherichia coil and Klebsiella pneumoniae,while staphylococcus is the main type of gram-positive bacteria.For most patients,antibiotics should been given according to the laboratory results of urine culture.