抗生素使用整治后尿路感染病原菌分布及药敏结果分析

Drug susceptibility and distribution of pathogenic bacteria in urinary tract infection after use of antibiotics

目的调查尿路感染患者尿液标本中病原菌的分布及其耐药状况分析,以促进临床合理选择抗生素,降低细菌的耐药率。方法回顾性分析2010年至2014年门诊及住院患者9 674例尿液培养阳性标本,采用WHONET5.6软件对药敏结果进行统计分析。结果 9 674株细菌中,检出率排在前5位的分别是大肠埃希菌(32.63%)、粪肠球菌(10.56%)、肺炎克雷伯菌(8.75%)、热带假丝酵母菌(6.63%)、奇异变形杆菌(5.82%)。肠杆菌科细菌对碳青霉烯类、哌拉西林/他唑巴坦、阿米卡星有较高的敏感率;粪肠球菌对万古霉素、替考拉宁、利奈唑胺的平均耐药率分别为5.1%、4.6%、4.6%,且耐药率有下降的趋势(P<0.05);热带假丝酵母菌对5-氟胞嘧啶和两性霉素B的平均耐药率为3.4%、2.2%,对5-氟胞嘧啶的耐药率有下降趋势(P<0.05),对两性霉素B的耐药率有升高趋势(P<0.05)。结论 5年间尿路感染病原菌以革兰阴性菌为主,经过整治后大部分抗菌药物的耐药率有下降趋势。

Objective To explore the distribution and drug resistance of the pathogenic bacteria in urinary tract in- fection for clinical rational use of antibiotics and reduce the bacterial drug resistance rate. Methods The urine specimens with positive culturing result from 9 674 hospitalized patients from 2010 to 2014 were retrospec- tively analyzed, and the WHONET5.6 software was used to analyze the drug susceptibility. Results Of the 9 674 detected strains, the top five were Escherichia coli （32. 63%）, Enterococcus faecalis （10. 56%）, Klebsiella pneumoniae （ 8. 75%）, Candida tropicalis （ 6. 63%） and Proteus mirabilis （ 5. 82%） . Enterobaeteriaeeae showed high susceptibility to earbapenems, piperacillin/tazobactam and amikacin. The average resistance rates of Enterococcus faecalis to vancomycin, teicoplanin and linezolid were 5.1%, 4.6% and 4.6%, re- spectively, which showed a downward trend （P〈0.05） . The average resistance rates of Candida tropica- lis to fluorocytosine and amphotericin B were 3.4% and 2. 2%, respectively. The resistance rate of Candida tropicalis to fluoroeytosine declined （P 〈 0.05） while that to amphotericin B increased （P 〈 0.05） . Conclusion Gram-negative bacteria was the predominant pathogen in patients with urinary tract infection during the past five years, and the resistance rate of which to most antimicrobial drugs showed a downward trend after use of antibiotics.