泌尿系结石患者感染病原体分布及耐药趋势分析

Distribution of pathogens and drug resistance in patients with urinary infection

目的分析1053例泌尿系结石合并尿路感染患者尿培养结果及耐药趋势变化，为临床应用抗菌药物提供依据，指导合理使用抗生素。方法分析本院2012年6月至2015年6月收治的1053例泌尿系结石合并细菌感染患者中段尿培养及药敏试验结果。结果1053例患者中共检出致病菌199株，其中革兰氏阴性菌131株，占65．83％，以大肠埃希菌、奇异变形杆菌、肺炎克雷伯菌、铜绿假单胞菌为主；革兰氏阳性菌65株，占32．7％，以粪肠球菌、表皮葡萄球菌为主；真菌3株，占1．5％。肠杆菌科细菌对亚胺培南、美罗培南、哌拉西林，他唑巴坦、头孢哌酮／舒巴坦、头孢吡肟、阿米卡星的敏感率均大于70％。对哌拉西林、左旋氧氟沙星的耐药率均〉60％。非发酵菌除左旋氧氟沙星外，对其余抗菌药物均保持较高的敏感率。肠球菌及表皮葡萄球菌对万古霉素、利奈唑胺、替考拉宁为全敏感。结论泌尿系结石合并感染的致病菌以大肠埃希菌及粪肠球菌为主，多重耐药菌检出率较低，患者早期行中段尿培养对减少耐药菌的产生、合理应用抗生素有重要意义。

Objective To provide some references for the rational use of antibiotics analyzing the results of urinary pathogen detection and drug resistance in 1053 patients with urinary calculus complicated with urinary tract infection. Methods The results of urinary pathogen detection and drug susceptibility test in 1053 patients with urinary calculus complicated with urinary tract infection hospitalized into our hospital from June, 2012 to June, 2015 were analyzed. Results Among the1053 patients, 199 strains of pathogenic bacteria were detected; among which, 131 strains （65.83%）, mainly including escherichia coli, singular proteus, klebsiella pneumoniae, and pseudomonas aeruginosa, were gram-negative bacteria; 65 strains （32.7%）, mainly including enterococcus faecalis and epidermis staphylococcus, were gram-positive bacteria; and 3 strains （1.5%） were fungi. Not less than 70% of enterobacteriaceae were sensitive to imipenem, meropenem, piperacillin/tazobactam. Not less than 70% of enterobacteriaceae were resistant to piperacillin and ofloxacin. Except for ofloxacin, non- fermentative bacterial had high sensitive rate to the rest of antimicrobial agents. Enterococcus faecalis and epidermis staphylococcus were all sensitive to vancomycin, linezolid, and teicoplanin. Conclusions Urinarycalculi complicated with infection are mainly infected by escherichia coli and enterococcus faecalis. The detection rate of multiple resistant bacteria is low. To reduce the occurrence of drug-resistant bacteria, urinary pathogen should be detected early. Proper use of antibiotics is important.