前列腺增生患者尿路感染病原菌分布及其耐药性

Distribution and antimicrobial resistance of pathogens causing urinary tract infection in patients with prostatic hyperplasia

目的探讨前列腺增生患者尿路感染分离病原菌及耐药性情况,为临床诊断及合理使用抗菌药物提供依据。方法收集某院2012年2月8日—2013年10月12日171例前列腺增生合并尿路感染患者尿培养结果,对其进行回顾性分析。结果171例患者共分离病原菌192株,革兰阴性菌占79.17%,其中大肠埃希菌占37.50%,肺炎克雷伯菌占18.75%;革兰阳性菌占18.23%,假丝酵母菌占2.60%。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)细菌比率较高,分别为72.22%、63.89%,产ESBLs大肠埃希菌对抗菌药物(哌拉西林、头孢呋辛、头孢他啶、头孢曲松、氨曲南和左氧氟沙星)耐药率均高于非产ESBLs菌,产ESBLs肺炎克雷伯菌对抗菌药物(哌拉西林、头孢西丁、氨曲南、左氧氟沙星和复方磺胺甲口恶唑)耐药率均高于非产ESBLs菌。铜绿假单胞菌对亚胺培南、美罗培南耐药率均为50.00%;肠球菌对青霉素类、氨基糖苷类抗生素敏感率低,但未检出对利奈唑胺、万古霉素的耐药株。结论前列腺增生并尿路感染患者分离的菌株有较高耐药率,临床应根据其细菌分布特点及耐药性进行针对性治疗。

Objective To explore the distribution and antimicrobial resistance of pathogens causing urinary tract infection（UTI）in patients with prostatic hyperplasia,and provide reference for clinical diagnosis and rational antimicrobial therapy.Methods Urine culture results of 171 patients with prostatic hyperplasia complicated with UTI from February 8,2012 to October 12,2013 were analyzed retrospectively.Results A total of 192 bacterial isolates were isolated from171 patients,gram-negative bacteria accounted for 79.17%,37.50% of which were Escherichia coli（E.coli）strains,and 18.75% were Klebsiella pneumoniae（K.pneumoniae）;gram-positive bacteria and Candidaaccounted for 18.23% and 2.60%respectively.Of E.coli and K.pneumoniae,the proportion of extended-spectrumβ-lactamase（ESBLs）strains were relatively higher,which was 72.77% and 63.89% respectively,resistant rates of ESBLs-producing E.coli to piperacillin.cefuroixme,ceftazidime,ceftriaxone,aztreonam,and levofloxacin were all significantly higher than non-ESBLs strains,resistant rates of ESBLs-producing K.pneumoniaeto piperacillin,cefoxitin,aztreonam,levofloxacin,and compound sulfamethoxazole were all significantly higher than non-ESBLs strains.Resistant rates of Pseudomonas aeruginosa to imipenem and meropenem were both 50.00%,susceptibility rates of Enterococcus to penicillins and aminoglycosides were both low,linezolid-and vancomycin-resistant strain was not found.Conclusion Organisms isolated from patients with UTI associated with prostatic hyperplasia have high antimicrobial resistance,clinical therapy should be based on characteristics of bacterial distribution and antimicrobial resistance.