社区获得性与医院获得性泌尿道感染病原菌及耐药性

Pathogens and antimicrobial resistance in community-associated and healthcare-associated urinary tract infection

目的分析社区获得性和医院获得性泌尿道感染病原菌构成和耐药性差异。方法回顾性调查2013年1月—2014年6月某院960例泌尿道感染住院患者的临床资料和尿标本微生物送检信息,分析其感染病原菌构成和耐药性差异。结果社区感染403例,医院感染557例;社区获得性和医院获得性泌尿道感染病原菌均以革兰阴性菌(G-)为主,分别占78.16%和66.97%。社区获得性和医院获得性泌尿道感染病原菌构成比较,差异有统计学意义(χ2=21.68,P<0.001)。社区感染与医院感染大肠埃希菌耐药率比较:哌拉西林/他唑巴坦、头孢唑林、头孢哌酮/舒巴坦、氨曲南、美罗培南、厄他培南、庆大霉素、复方磺胺甲口恶唑耐药率差异均有统计学意义(均P<0.05);除氨曲南外,大肠埃希菌对上述抗菌药物的耐药率医院感染均高于社区感染。医院感染屎肠球菌对青霉素、氨苄西林、庆大霉素、左氧氟沙星、环丙沙星、莫西沙星的耐药率均高于社区感染的屎肠球菌,差异均有统计学意义(均P<0.05)。结论社区获得性和医院获得性泌尿道感染病原菌构成和耐药率方面存在一定差异,应结合病原菌构成特点和耐药菌的变化规律,选择适宜的治疗药物,防止和减少耐药菌产生,提高临床治疗效果。

Objective To analyze the difference in constituent and antimicrobial resistance of pathogens in commu-nity-associated urinary tract infection（CA-UTI）and healthcare-associated UTI（HA-UTI）.Methods Clinical data and microbial detection of urine specimens of 960 patients with UTI in a hospital between January 2013 and June 2014 were investigated retrospectively,difference in constituent and antimicrobial resistance of pathogens were ana-lyzed.Results 403 cases were CA-UTI,and 557 were HA-UTI;pathogens in both CA-UTI and HA-UTI were gram-negative bacteria,accounting for 78.16% and 66.97% respectively.Constituent of pathogens in CA-UTI and HA-UTI were significantly different（χ^2 =21 .68,P 〈0.001 ）.Resistant rates of Escherichia coli to piperacillin /tazobactam,cefazolin,cefoperazone / sulbactam,aztreonam,meropenem,ertapenem,gentamicin,and compound sulfamethoxazole were all significantly different between CA-UTI and HA-UTI （all P 〈0.05）;Except aztreonam, resistant rates of Escherichia coli in HA-UTI to the other antimicrobial agents were all higher than CA-UTI.Re-sistant rates of Enterococcus faecium in HA-UTI to penicillin,ampicillin,gentamicin,levofloxacin,ciprofloxacin, and moxifloxacin were all higher than CA-UTI（all P 〈0.05）.Conclusion Constituent and antimicrobial resistance of pathogens in CA-UTI and HA-UTI are different,proper antimicrobial agents should be chosen according to con-stituent features of pathogens and change in antimicrobial resistance,so as to prevent and reduce the emergence of drug-resistant strains,and improve therapeutic effectiveness.