内科和外科患者医院获得性泌尿系感染的病原菌分布及菌株耐药性比较

Differences in distribution and drug resistance of pathogens for hospital-acquired urinary tract infections between patients in internal medicine wards and surgical wards

目的：了解内科和外科病房医院获得性泌尿系感染的主要病原菌分布及菌株对抗菌药物耐药性的差异。方法连续收集秦皇岛市第一医院2012年1月至2014年12月住院患者586份清洁中段尿样本，采用Vitek 2 Compact 全自动微生物鉴定及药敏系统进行菌株的鉴定和药敏试验。应用Excel和SPSS 11．5软件对数据进行分析。结果共检出病原菌661株，其中404株来自内科患者，257株来自外科患者。内科患者大肠埃希菌（44.6％）和肠球菌（23.0％）的检出率高于外科患者（33.1％和16.3％），而铜绿假单胞菌的检出率（4.0％）低于外科患者（24.5％），差异均具有统计学意义（χ2＝8.620、4.309和63.056，P＜0.05或＜0.01）。所有患者分离到的大肠埃希菌和肺炎克雷伯菌对哌拉西林／他唑巴坦、头孢替坦、阿米卡星、亚胺培南和美罗培南的敏感率均较高，为85％～100.0％；大肠埃希菌对氨苄西林／舒巴坦、左氧氟沙星和环丙沙星的敏感性较低，均＜30.0％，且外科患者比内科患者敏感性更低（χ2＝4.987、4.575和5.359，P＜0.05）；分离自内科患者的肺炎克雷伯菌对头孢他啶、庆大霉素和氨曲南的敏感率分别为68.8％、60.6％和69.7％，均高于外科患者（36.0％、32.0％和40.0％），二者差异有统计学意义（χ2＝6.068、4.661和5.115，P＜0.05）。铜绿假单胞菌对哌拉西林／他唑巴坦和阿米卡星的敏感性较高，且分离自外科患者的菌株对这两种药物的敏感性（98.4％和96.8％）高于分离自内科患者的菌株（75.0％和81.3％），差异有统计学意义（χ2＝11.797和5.221，P＜0.05）；分离自外科患者的铜绿假单胞菌对头孢吡肟敏感性亦高（92.1％），但分离自内科患者的菌株对其敏感性却较低（37.5％）（χ2＝24.696，P＜0.01）。屎肠球菌和粪肠球菌对替加环素、万古霉素和利奈唑胺均保持高度敏感，敏感性＞95.0％；粪肠球菌除了对奎奴普丁／达福普汀和四环素高度耐药外，对其他常用抗菌药物的敏感性均大于屎肠球菌，但分离自外科患者的粪肠球菌对莫西沙星的敏感性（33.3％）远低于内科患者（70.8％）（χ2＝4.629，P＜0.05）。结论内、外科患者泌尿系感染的主要病原菌分布不同，对抗菌药物的敏感性存在差异。

Objective To investigate the distribution and drug resistance of pathogens for hospital-acquired urinary tract infections between patients in internal medicine wards and in surgical wards .Methods A total of 586 midstream urine samples were collected from patients in the First Municipal Hospital of Qinhuangdao during January 2012 and December 2014.Vitek 2 Compact system was applied in bacteria identification and drug sensitivity tests .Excel and SPSS 11.5 software were applied for data analysis . Results A total of 661 strains were isolated , in which 404 strains were from internal medicine wards and 257 strains were from surgical wards .Escherichia coli （44.6%vs.33.1%） and Enterococcus （23.0%vs.＆nbsp;16.3%） infections were more common in the internal medicine wards （χ2 =8.620 and 4.309, P〈0.05）, while the occurrence of Pseudomonas aeruginosa infection （4.0%vs.24.5%） was higher in surgical wards （χ2 =63.056, P 〈0.01）.Escherichia coli and Klebsiella pneumonia strains were highly sensitive to piperacillin/tazobactam, cefptetan, amikacin, imipenem, and meropenem, and the sensitivity rates were from 85% to 100.0%.The sensitivity rates of Escherichia coli to ampicillin/sulbactam, levofloxacin and ciprofloxacin were 〈30%, and strains from surgical wards had lower sensitivity rates to these drug than those isolated from internal medicine wards （χ2 =4.987, 4.575 and 5.359, P〈0.05）.The sensitivity rates of Klebsiella pneumonia isolated from internal medicine wards to ceftazidime , gentamicin and aztreonam were 68.8%, 60.6% and 69.7%, which were higher than those isolated from surgical wards （36.0%, 32.0%, and 40.0%）, and the differences were of statistical significance （χ2 =6.068,4.661 and 5.115, P〈0.05）.Pseudomonas aeruginosa strains were highly sensitive to piperacillin/tazobactam and amikacin, and the susceptibilities of strains isolated from surgical wards （98.4%and 96.8%） were higher than those isolated from internal medicine wards （75.0% and 81.3%） （χ2 =11.797 and 5.221, P 〈0.05）. Pseudomonas aeruginosa strains isolated from surgical wards were also highly sensitive to cefepime （92.1%）, but the sensitive rate of strains from internal medicine wards was only 37.5%, and the difference was of statistical significance （χ2 =24.696, P〈0.01）.Enterococcus faecium and Enterococcus faecalis were sensitive to tigecycline , vancomycin and linezolid with the sensitivity rates over 95%.Except quinupristin/dalfopristin and tetracycline , the sensitivities of Enterococcus faecalis to other antibiotics were higher than Enterococcus faecium.Susceptibility of Enterococcus faecium from surgical wards （33.3%） to moxifloxacin was lower than those from internal medicine wards （70.8%）, and the difference was of statistical significance （χ2 =4.629, P 〈0.05）.Conclusion There are differences in distribution and antimicrobial susceptibility of pathogens isolated from internal medicine wards and from surgical wards .