利用秩和比法筛选尿石症合并尿路感染患者的经验性抗生素

Screening of empiric antibiotic use for urinary tract infection in urolithiasis patients by rank sum ratio

目的利用秩和比(RSR)法筛选尿石症合并尿路感染(UTI)患者的经验性抗生素,为临床用药提供参考依据。方法回顾性分析2014年1月至2015年10月贵州医科大学附属医院泌尿外科收治的52例尿石症合并UTI患者的尿培养结果,利用秩和比法对主要的致病菌株进行药物敏感性分析,对临床常用抗菌药物按其敏感性的优劣进行排序分档。结果本研究结果显示尿石症患者UTI排前5位的病原菌依次为大肠埃希菌、肺炎克雷伯菌、肠球菌属、肠杆菌属、葡萄球菌属;临床常用抗菌药物按其敏感性优劣分成3档:低度敏感档:氨苄西林、头孢曲松、复方新诺明、环丙沙星、头孢呋辛、左氧氟沙星、头孢唑林;中度敏感档:庆大霉素、头孢噻肟、头孢吡肟、头孢他啶、氨苄西林-舒巴坦、头孢西丁;高度敏感档:哌拉西林-他唑巴坦、头孢哌酮-舒巴坦、亚胺培南、头孢他啶-克拉维酸、阿米卡星、呋喃妥因、美罗培南。结论尿石症患者UTI致病菌以大肠埃希菌和肺炎克雷伯杆菌为主,临床上可考虑将头孢哌酮-舒巴坦、哌拉西林-他唑巴坦等含β-内酰胺酶抑制剂的抗菌药物作为尿石症合并UTI患者经验性用药的首选。

Objective To screen the antibiotic use for urinary tract infection （UTI） in urolithiasis patients by rank sum ratio （RSR） and to provide reference for rational use of antibiotics. Metho0s The results of urine culture and drug sensitive test of 52 cases of UTI with urolithiasis treated during Jan. 2014 and Oct. 2015 were retrospectively analyzed. The distribution of pathogenic bacteria of the patients was recorded and the drug-associated sensitive analysis for the pathogenic bacteria was performed via RSR. The antibacterial agents used clinically were ranked and graded according to the sensitivity. Results The outcomes of urine culture were listed below： E. coil, Klebsiella pneumonia, enterococcus, enterobacter, and staphylococcus. The drug-associated sensitivity of the top 5 pathogenic bacteria was analyzed and the antibiotics were classified into three levels in the light of sensitivity： low sensitivity： ampicillin, ceftriaxone, trimethoprim, sulfamethoxazole, ciprofloxacin, cefuroxime, levofloxacin, cefazolin;intermiedate sensitivity： gentamicin, cefotaxime, cefepime, ceftazidime pentahydrate, ampicillin-sal- bactam, cefoxitin;high sensitivity： piperacillin-tazobactam, cefperazone-sulbactam, cefperazone-sulbactam, ceftazidime-clavu- lanic acid, amikacin, macrodantin, meropenem. Conclusion E. cell and Klebsiella pneumonia are the major pathogens cau- sing urinary tract infections in patients with urolithiasis. The antibiotics with beta-lactamase inhibitor such as cefperazone-sul- bactam and piperacillin-tazobactam are the first choices.