216例泌尿系感染病原菌分布及耐药性分析

Analysis of Pathogen Distribution and Drug Resistance of 216 Cases with Urinary Tract Infection

目的:对河北联合大学附属医院2014年1-12月泌尿系感染患者病原菌分布及耐药性进行分析,为临床治疗泌尿系感染提供依据。方法:收集2014年1-12月尿培养分离出的泌尿系感染的病原菌,菌株鉴定采用美国BD公司的Phoenix-100全自动细菌分析仪,药敏试验采用MIC法和K-B纸片法。结果:1 108份标本中共分离泌尿系感染纯致病菌216株;其中革兰阴性菌121株,以大肠埃希菌(72株,33.3%)为主,革兰阳性菌51株,主要为粪肠球菌(32株,14.8%),真菌44株,主要为白色念珠菌(22株,10.2%);这些病原菌主要分离自泌尿外科(65株,30.1%);216例泌尿系感染住院患者中男性构成比(63.0%)大于女性构成比(37.0%)。大肠埃希菌对氨苄西林、阿莫西林-克拉维酸、左氧氟沙星、庆大霉素耐药率比较高,分别为98.5%,75.3%,79.4%,70.6%;对亚胺培南、美罗培南、阿米卡星、哌拉西林-他唑巴坦、头孢哌酮-舒巴坦耐药率分别为6.9%,6.9%,11.8%,15.3%,11.1%,比较敏感;粪肠球菌和屎肠球菌对青霉素和左氧氟沙星耐药率较高,分别为84.4%,56.2%和88.9%,75.0%,对万古霉素、替考拉宁、利奈唑胺均较敏感,但是出现1例耐万古霉素的屎肠球菌;真菌中白色念珠菌对临床常用的抗真菌药物都保持着较高的敏感性,热带念珠菌对氟康唑耐药率为33.3%,对5-氟胞嘧啶、伏立康唑、两性霉素B、伊曲康唑比较敏感。结论:泌尿系感染的病原菌分布及耐药都各具特点,临床医生应经常关注其分布和耐药特点的变化,并根据药敏试验结果合理选择抗菌药。

ABSTRACTObjective：To analyze the pathogen distribution and drug resistance of the patients with urinary tract infection in the affiliated hospital of Hebei United University from January to December 2014, so as to provide an evidence for clinical treatment of urinary tract infections.Methods：Pathogenic bacteria isolated by urine culture of the samples of urinary tract infections were collected and the strains were identified using BD Phoenix-100 automat-ic bacterial analyzer. The drug sensitivity test was carried out by MIC method and K-B method.Results：Out of 1 108 specimens, 216 strains of pathogenic bacteria of urinary tract infection were isolated. About 121 strains were gram-negative bacteria, most of which wereEscherichiacoli（72 strains, 33.3%）, 51 strains were gram-positive bacteria, most of which wereEnterococcusfaecalis（32 strains, 14.8%）and 44 strains were fungi with the major strains ofCandidaalbicans（22 strains, 10.2%）. The pathogenic bacteria were mainly isolated from samples of urology department（65 strains, 30.1%）. In 216 cases, the composition of male patients（63.0%）was higher thanthat of female patients（37.0%）.Escherichiacolishowed more resistance to ampicillin, amoxicillin-clavulanic acid, levofloxacin, and gentamicin, with the resistance rate of 98.5%, 75.3%, 79.4% and 70.6% respectively.Escherichia coliwas less resistant to imipenem, meropenem, amikacin, piperacillin-tazobactam and cefoperazone-sulbactam, with resistance rate of 6.9%, 6.9%, 11.8%, 15.3% and 11.1% respectively.EnterococcusfaecalisandE.faeciumwere more resistant to penicillin and levofloxacin, with resistant rate of 84.4%, 56.2% and 88.9%, 75.0% respectively. EnterococcusfaecalisandE.faeciumwas sensitive to vancomycin, linezolid and teicoplanin, but there was one case ofEnterococcusfaeciumresistant to vancomycin.Candidaalbicansfungi had a high sensitivity to common antifungal drugs. Resistance rate oftropicalcandidato fluconazole was 33.3%.Tropicalcandidawas sensitive to 5-flucytosine, voriconazole,amphotericin B and itraconazole.Conclusion：Pathogenic bacteria distribution and drug resistance patterns of urinary tract infection have their own characteristics. Therefore clinicians should focus on the changes of characteristics of distribution and drug resistance, and choose appropriate antibacterial agents according to the results of drug sensitivity test.