河南地区2型糖尿病尿路感染的病原菌分布及耐药特点分析

Distribution and drug resistance of pathogenic bacteria causing urinary tract infection in patients with type 2 diabetes in Henan

目的分析河南地区2型糖尿病患者尿培养病原菌分布及耐药特点,为临床正确诊断该类患者尿路感染及合理应用抗菌药物提供依据。方法对郑州大学第一附属医院2012年1月1日至2015年10月31日收治的772例2型糖尿病患者的临床资料进行回顾性分析,分析病原菌的分布情况和药敏结果。结果标本分离出213株病原菌,阳性率为27.60%。革兰阴性菌121株,以大肠埃希菌分离数最多,其中62株菌株产超广谱β内酰胺酶(ESBLs)。在16株肺炎克雷伯菌中,14株产ESBLs。革兰阳性菌63株,以粪肠球菌分离数最多。真菌29株。对大肠埃希菌敏感性较高的抗菌药物是亚胺培南、阿米卡星以及哌拉西林/他唑巴坦,耐药率较高的为氨苄西林、头孢唑啉、左旋氧氟沙星。对肺炎克雷伯杆菌敏感率较高的是亚胺培南、哌拉西林/他唑巴坦、头孢吡肟、阿米卡星,耐药率较高的是氨苄西林、头孢唑啉、头孢曲松。粪肠球菌对万古霉素、替考拉宁、利奈唑胺等抗菌药物均较敏感,对红霉素、高浓度庆大霉素、高浓度链霉素均耐药,肠球菌属对利奈唑胺、万古霉素、替考拉宁敏感率均为100.0%。结论 2型糖尿病尿路感染致病菌以革兰阴性杆菌为主,大肠埃希菌及肺炎克雷伯菌中产超广谱内酰胺酶的菌株所占比例高。常见病原菌对抗菌药物均有不同程度的耐药变迁。

Objective To analyze the distribution and drug resistance of pathogenic bacteria causing urinary tract infection in patients with type 2 diabetes in Henan, and offer the scientific evidences for reasonable use of antibiotics and correct diagnosis of this diseases in patients with type 2 diabetics.Methods The data of 772 patients with type 2 diabetes treated in the First Affiliated Hospital of Zhengzhou University from January 1st of 2012 to October 31st of 2015 were retrospectively analyzed for having a good knowledge of the distribution and drug resistance of pathogenic bacteria causing urinary tract infection.Results 213 strains of pathogens were isolated from 772 urine specimens and the positive rate was 27.60%.121 （56.81%） Gram-negative cocci were isolated and the top 1 was Escherichia coli （38.03%）.There were 62 strains （76.54%） were ESBLs-producing in Escherichia coli.There were 14 strains （87.50%） were ESBLs-producing in Klebsiella pneumoniae.63 strains （29.58%） of Gram-positive cocci were isolated and the top 1 was Enterococcus faecalis （9.86%）.29 strains （13.61%） of fungus were isolated.Imipenem was the most sensitive to Escherichia coli, followed by amikacin and piperacillin/tazobactam.Resistance rates of Escherichia coli to ampicillin, cefazolin, levofloxacin were higher.Imipenem was the most sensitive to Klebsiella pneumoniae, followed by piperacillin/tazobactam, cefepime, amikacin.Resistance rates of Klebsiella pneumoniae to ampicillin, cefazolin, ceftriaxone were higher.Vancomycin, teicoplanin and linezolid were more sensitive to Enterococcus faecalis, and the resistance rates of Enterococcus faecalis to erythromycin, high concentration of gentamicin and high concentration of streptomycin.The sensitivities of Enterococcus to linezolid, vancomycin, teicoplanin was 100%.Conclusion Gram-negative bacillus is the main pathogenic bacteria causing urinary tract infection in patients with type 2 diabetes.High proportions of Escherichia coli and Klebsiella pneumoniae are ESBLs-producing strains.The common pathogenic bacteria are resistant to antibiotics in different degree.