尿液中细菌L型检出情况及耐药性分析

Detection and drug resistance of L-form bacteria in urine of patients with urinary infection

目的了解泌尿感染患者尿液标本细菌L型的检出情况,分析尿常规结果、病原菌分布情况及耐药性特点,为临床提供诊疗依据。方法对2014年1月至2015年12月1 532例住院和门诊泌尿感染患者的清洁中段尿标本的尿常规结果和微生物培养结果进行回顾性分析。严格按照《全国临床检验操作规程》要求采集患者尿液标本,2 h内完成尿液普通培养、高渗培养、尿常规检查及尿液离心后沉渣镜检。培养出细菌L型进行菌株鉴定和药敏试验,结果采用SPSS 13.0统计软件进行分析处理。结果共检出细菌L型132例,检出率为8.6%。132例细菌L型阳性病例中,白细胞酯酶阳性19例,阳性率14.4%;尿沉渣镜检白细胞阳性105例,阳性率79.5%。细菌L型检出率排名前三位的分别为大肠埃希菌、粪肠球菌、葡萄球菌,分别占40.9%、22.7%、12.1%。大肠埃希菌对氨苄西林、环丙沙星、左氧氟沙星、氨苄西林/舒巴坦、头孢唑啉、复方新诺明耐药率较高;粪肠球菌对克林霉素、奎奴普丁/达福普汀、红霉素、四环素耐药率较高;葡萄球菌对青霉素G、红霉素、头孢西丁、甲氧西林、环丙沙星耐药率较高。结论尿常规、尿沉渣镜检有助于细菌L型感染的辅助诊断,临床医生应根据尿培养结果合理、足疗程选用抗菌药物。

Objective To investigate the detection rate of L-form bacteria,analyze the results of routine urine tests and the distribution and drug resistance of the pathogens,so as to provide guidance for clinical treatment.Methods A total of 1,532 urine samples of patients with urinary infection from Jun 2014 to Dec2015 were collected,tested and cultured according to the requirements described in the National Guide to Clinical Laboratory Procedures.Then the isolated L form bacteria were identified,and their drug susceptibilities were determined.All the data were analyzed by using SPSS 13.0 software.Results A total of 132 strains of L-form bacteria were detected（8.6%）,among which there were 19 leukocyte esterase positive cases（14.4%）.The microscopy of urinary sediment found 105 leukocyte positive cases（79.5%）.The top3 pathogens were Escherichia coli（40.9%）,Enterococcus faecalis（22.7%） and Staphylococcus（12.1%）.Escherichia coli showed high resistance to ampicillin,ciprofloxacin,levofloxacin,ampicillin/sulbactam,cefazolin and trimethoprim/sulfamethoxazole,Enterococcus faecalis was highly resistant to clindamycin,quinupristin/dalfopristin,erythromycin and tetracycline,while Staphylococcus was highly resistant to penicillin G,erythromycin,cefoxitin,methicillin and ciprofloxacin.Conclusion Routine urine test and urinary sediment microscopy help in the auxiliary diagnosis of L-form bacteria infections.It is necessary to use antibiotics reasonably with adequat with adequate dosage and duratione dosage and duration.