2012～2014年泌尿系感染大肠埃希菌耐药性的变迁

Change of antimicrobial resistance in Escherichia coli isolated from urine in 2012-2014

目的对泌尿系感染大肠埃希菌进行病原学及耐药性分析,为临床治疗泌尿系感染提供依据。方法收集2012年1月至2014年12月所有泌尿系感染患者分离出的大肠埃希菌240株,菌株鉴定采用美国BD公司的Phoenix-100全自动细菌分析仪,药敏试验采用肉汤稀释法和K-B纸片法。结果大肠埃希菌检出最多的科室是泌尿外科占22.5%,其次为肾内科12.9%,重症医学科11.3%,老年病科9.6%,神经内科8.8%。神经内科重症病区7.9%;该菌对于临床经验一线药物氨苄西林、头孢唑林、复方新诺明、氨苄西林/舒巴坦耐药率都比较高,3年平均耐药率分别为93.0%、77.2%、74.1%、81.5%;喹诺酮类药物左旋氧氟沙星3年的平均耐药率超过75%,且3年来逐年上升,2014年的耐药率与2013年和2012年相比差异均具有统计学意义(P<0.05);对头孢哌酮/舒巴坦(15.9%)、哌拉西林/他唑巴坦(21.6%)、亚胺培南(3.3%)、美洛培南(3.3%)比较敏感;对阿米卡星的耐药率较低为13.2%,但对同属于氨基糖苷类的庆大霉素耐药率比较高(65.0%)。结论大肠埃希菌的感染分布及药敏特点都在不断变化着,因此临床医生应根据药敏结果合理选择抗生素。

Objective To provide evidence for clinical treatment of urinary tract infections by analyzing the distribution and drug resistance of Escherichia coli from patients with urinary tract infection.Methods Escherichia coli was collected from the samples of urinary tract infections in Jan.2014 to Dec.2014 and the strains were identified using BD Phoenix-100 automatic bacterial analyzer.The drug sensitivity test was carried out by MIC method and K-B method.Results The distribution of Escherichia coli was most common in Department Urology,three years accounted for an average of 22.5%,followed by 12.9% of Nephrology,ICU accounted for 11.3%,Geriatrics accounted for 9.6%,Neurology 8.8%,Neurological Intensive Ward 7.9%.The bacteria for clinical experience of first-line drugs ampicillin,cefazolin,sulfamethoxazole,ampicillin/sulbactam resistance rates were relatively high,the three year average resistance rate 93.0%,77.2%,74.1%,81.5%.Levofloxacin of quinolones showed three years the average resistance rate more than 75%,and in three years increased year by year,2014 compared with 2012 and 2013,the difference was statistically significant（P 〈0.05）.To cefoperazone/sulbactam（15.9%）,piperacillin/tazobactam（21.6%）,imipenem（3.3%）,meropenem（3.3%）,the bacteria were more sensitive;low resistance rate on amikacin was 13.2%,but the relatively high rate of gentamicin resistant belonged to aminoglycosides（65.0%）.Conclusion The infection distribution and sensitivity of Escherichia coli are constantly changing,so clinicians should choose antibiotics accordingly.