导尿管相关菌尿的病例特点及病原学耐药分析

Bacterial resistant pattern and clinical characteristics in cases of catheter related bacteriuria

目的结合临床资料及病原菌的药敏检测结果,分析导尿管相关菌尿的病例特点和病原菌耐药情况。方法收集我院2010年至2014年所有住院病人的尿标本分离的非重复细菌1831株进行耐药率分析,通过电子病历系统收集患者资料。结果留置导尿和非留置导尿组中,无症状菌尿分别占55.9%和57.2%,留置导尿管组所有病人均接受了抗菌素治疗。有症状感染的病人合并菌血症的比例明显升高。大肠埃希菌在非尿管来源病原体中占60.1%,在导尿管来源病原体中占35.2%,肠球菌属在导尿管来源病原体中比例为34.9%。尿管来源和非尿管来源的大肠埃希菌对头孢菌素（第2,3,4代）、哌拉西林/他唑巴坦、喹诺酮类和呋喃妥因的耐药率分别为65%～80%和29.4%～68.8%,4.9%～9.8%和2.9%～4.2%,85%～90%和62.7%～77.3%,0～16.7%和7.4%～8.3%。没有发现对利奈唑胺耐药的肠球菌。导尿管来源和非导尿管来源的铜绿假单胞菌对头孢他啶、哌拉西林/他唑巴坦和碳青霉烯类的耐药率分别为11.9%～16.1%和5.7%～7.5%,4.8%～12.5%和2.9%～10.0%,11.9%～21.8%和2.5%～8.6%。而有症状组铜绿假单胞菌的耐药率均低于无症状组,两组耐药率差异5%～15%。结论导尿管相关的无症状菌尿病人仍在临床中接受抗菌素治疗。导尿管来源细菌对抗菌素耐药率高于非尿管来源细菌。

Objective To summarize bacterial resistance and clinical characteristics in the cases of catheter related bacteriuria. Methods A total of 1831 cases of catheter related bacteriuria and non- catheter related bacteriuria from January 2010 to December 2014 were included. The general characteristics were reviewed in electronic medical records. Minimal inhibitory concentration（ MIC） test were used to detect the antimicrobial sensitivity of bacteria. Results There was 55. 9% and 57. 2% of cases appeared as asymptomatic bacteriuria in catheter related cases and non- catheter related cases,all the cases received antibiotic therapy during hospitalization. There was no difference in clinical outcome between the group of asymptomatic bacteriuria and urinary tract infection in catheter related bacteria. Escherichia coli occupied the first place in the isolation of pathogen from both catheter related（ 35. 2%） and non-catheter related（ 60. 1%） cases. The resistant rate of Escherichia coli from catheter related / non- catheter related sample to cephalosporins,piperacillin / tazobactam,quinolones and nitrofurantoin was 65%- 80% /29. 4%- 68. 8%,4. 9%- 9. 8% /2. 9%- 4. 2%,85%- 90% /62. 7%- 77. 3% and 0- 16. 7% /7. 4%- 8. 3%,respectively. No resistant strain to linezolid was found in Enterococcus. The resistant rate of Pseudomonas aeruginosa from urine catheter / non- catheter related sample to ceftazidim,piperacillin / tazobactam,carbapenems was 11. 9%- 16. 1% /5. 9%- 7. 5%,4. 8%- 12. 5% /2. 9%- 10. 0% and11. 9%- 37. 8% /2. 5%- 8. 6%,respectively. The resistant rates of Pseudomonas aeruginosa in the group of infection were lower than those in the group of asymptomatic bacteriuria. Conclusion The patients with asymptomatic bacteriuria were received unnecessary antibiotic therapy. The resistant rates of bacteria from catheter were higher than those from non- catheter sample.