妇产科患者尿路感染的菌群分布及耐药性分析

Distribution and drug resistance of pathogens causing urinary tract infection in patients of department of gynecology and obstetrics

目的探讨妇产科患者尿路感染的菌群分布和耐药特点,以指导医师合理选择抗菌药物。方法收集2014年1月-2015年12月妇产科临床住院患者尿培养分离的细菌,采用法国生物梅里埃公司VITEK-2Compact全自动细菌鉴定及药敏分析仪对菌株进行鉴定和药物敏感性试验。结果共收集尿培养阳性菌444株,来自409例尿路感染患者,444株病原菌中革兰阴性菌374株占84.2%,革兰阳性菌58株占13.1%,真菌12株占2.7%,排前3位病原菌依次为大肠埃希菌、肺炎克雷伯菌和粪肠球菌,分别占61.7%、10.8%和7.4%;大肠埃希菌和克雷伯菌属的ESBLs检出率较高,分别为74.5%和64.7%;除对碳青霉烯类、头孢替坦、哌拉西林/他唑巴坦、呋喃妥因、阿米卡星等药物耐药率较低外,对其他抗菌药物耐药较严重;粪肠球菌对青霉素G、替考拉宁、氨苄西林、利奈唑胺、万古霉素、替加环素、呋喃妥因等敏感,耐药率均<9.0%;凝固酶阴性葡萄球菌对甲氧苄嘧啶、阿米卡星、利福平、替考拉宁、利奈唑胺、万古霉素、替加环素、呋喃妥因等耐药率均为0。结论大肠埃希菌和肺炎克雷伯菌是妇产科医院尿路感染的主要病原菌,产ESBLs比率高,耐药率较严重,应加强抗菌药物管理,合理使用抗菌药物。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing urinary tract infection in patients of department of gynecology and obstetrics so as to provide guidance for reasonable use of antibiotics.METHODS The pathogens were isolated from urine culture of the patients who were hospitalized the department of gynecology and obstetrics from Jan 2014 to Dec 2015,the isolated pathogens were identified by using VITEK-2 Compact automatic bacteria identification system of BioM＆#233;rieux,France,and the drug susceptibility testing was performed with the use of drug susceptibility analyzer.RESULTS A total of 444 strains of pathogens were cultured positive from the urine specimens of the 409 patients with urinary tract infection,including 374 （84.2 %） strains f gram-negative bacteria,58 （13.1 %） strains of gram-positive bacteria,and 12 （2.7 %） strains of fungi;Escherichia coli,Klebsiella pneumoniae,and Enterococcus faecalis ranked the top 3 species of pathogens,accounting for 61.7%,10.8%,and 7.4%,respectively.The isolation rates of ESBLs-producing E.coli and Klebsiella spp were 74.5% and 64.7%,respectively.The pathogens were highly resistant to all of the antibiotics except for carbapenems,cefotetan,piperacillin-tazobactam,nitrofurantoin,and amikacin.The drug resistance rates of the E.faecalis strains to penicillin G,teicoplanin,ampicillin,linezolid,vancomycin,tigecycline,and nitrofurantoin were less than 9.0%.The drug resistance rates of the coagulase-negative Staphylococcus strains to trimethoprim,amikacin,rifampicin,teicoplanin,linezolid,vancomycin,tigecycline,and nitrofurantoin were 0.CONCLUSION E.coli and K.pneumoniae are the predominant species of pathogens causing the urinary tract infection in the patients of department of gynecology and obstetrics,the isolation rate of the ESBLs-producing strains is high,and the pathogens are highly drug-resistant.It is necessary to strengthen the management of antibiotics and reasonably use antibiotics.