北京丰台地区导尿管相关性尿路感染病原菌分布及耐药分析

Distribution and drug resistance of pathogenic bacterium in patients with catheter associated urinary tract infection in Fengtai district of Beijing city

目的了解北京丰台地区导尿管相关性尿路感染(CAUTI)患者的病原菌分布及耐药特点,为临床抗菌药物选择提供依据。方法对2014年1月至2015年12月北京丰台区东高地社区医院、万源路社区医院、东营房社区医院及北京航天总医院239例CAUTI患者进行尿培养及药物敏感性试验,统计分析病原菌特点及耐药情况。结果239例尿路感染患者标本培养出255株病原菌,其中革兰阴性菌141株(55.3%),革兰阳性菌44(17.3%),真菌70株(27.5%);革兰阴性菌以大肠埃希菌为主(73/255,28.6%),革兰阳性菌以肠球菌为主(17/255,6.7%),真菌以白色念珠菌为主(55/255,21.6%)。大肠埃希菌、白色念珠菌、屎肠球菌检出病例中,2015年所占比例均高于2014年。主要革兰阴性菌大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对氨苄西林、头孢唑林、氨苄西林/舒巴坦、环丙沙星的耐药率均>60.00%,对亚胺培南、美洛配能的耐药率均<8.33%;主要革兰阳性菌屎肠球菌、葡萄球菌对克林霉素、头孢西丁、妥布霉素、甲氧苄啶、庆大霉素、复方新诺明、苯唑西林、阿米卡星的耐药率均>75.00%,对利奈唑胺的耐药率<5.88%,对替考拉宁、万古霉素的耐药率均为0.00%。结论 CAUTI主要致病菌为革兰阴性菌,并有较多的条件致病菌如真菌及革兰阳性菌,致病菌耐药现状严重,应注意减少感染的发生,并严格遵循药物敏感性试验结果指导临床用药。

Objective To investigate the distribution and drug resistance of pathogenic bacterium in patients with catheter associated urinary tract infection（ CAUTI） in Fengtai district of Beijing city; and provide the evidence for the selection of clinical antibacterials. Methods A total of 239 cases of CAUTI were performed with urine culture and drug sensitive test in Donggaodi Community Hospital,Wanyuan Road Community Hospital,Dongyingfang Community Hospital and Beijing Aerospace General Hospital from January 2014 to December 2015. Characteristics and drug resistance of pathogenic bacterium were analyzed. Results A total of 255 strains of pathogenic bacterium were isolated from the specimens of 239 patients with CAUTI,including 141（ 55. 3%） strains of Gram-negative bacterium,44（ 17. 3%） strains of Gram-positive bacterium and 70（ 27. 5%）strains of fungus. The main Gram-negative bacterium,Gram-positive bacterium and fungus was Escherichia coli（ 73/255,28. 6%）,Enterococcus（ 17/255,6. 7%） and Candida albicans（ 55/255,21. 6%） respectively. The proportion the cases of Escherichia coli,Candida albicans and Enterococcus faecium in 2015 was higher than that in 2014. The drug resistance rate of main Gram-negative bactria（ Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa） to ampicillin,cefazolin,ampicillin/sulbactam and ciprofloxacin was more than 60. 00%; and the drug resistance rate of them to imipenem and meropenem less than8. 33%. The drug resistance rate of main Gram-positive bacterium（ Enterococcus faecium and Staphylococcus aureus） to clindamycin,cefoxitin,tobramycin,gentamicin,trimethoprim,sulfamethoxazole,oxacillin and amikacin was more than 75. 00%; the drug resistance rate of them to linezolid less than 5. 88%,and the drug resistance rate of them to teicoplanin and vancomycin was0. 00%. Conclusion The main pathogenic bacteria of CAUTI is Gram-negative bacteria,and there are more opportunistic pathogens such as fungi and Gram-positive bacteria. The drug resistance of pathogenic bacteria is serious,we should pay attention to reduce the incidence of infection,and strictly follow the drug sensitivity results to guide clinical medication.