脑卒中患者尿管相关性感染的病原菌分布及耐药性分析

Analysis on the distribution and the drug resistance of the pathogenic bacteria of catheter associated infections in the patients with cerebral apoplexy

目的:分析脑卒中患者尿管相关性尿路感染(CAUTI)的病原菌分布及耐药性。方法:选取198例脑卒中合并CAUTI患者作为研究对象,对其尿液样本中的病原菌分布及耐药性进行回顾性分析。结果:分离出212株病原菌,其中,革兰阴性菌107株占50.47%,革兰阳性菌83株占39.15%,真菌22株占10.38%,大肠埃希菌、粪肠球菌、肺炎克雷伯菌为主要病原菌,构成比分别为20.75%、15.09%、12.74%。革兰阴性菌对氨苄西林、环丙沙星、左氧氟沙星、头孢唑啉、头孢曲松、头孢呋辛、庆大霉素的耐药率较高,对阿米卡星、头孢吡肟、哌拉西林/他唑巴坦的耐药率较低,未检出对美罗培南或亚胺培南耐药的菌株。革兰阳性菌对青霉素G、红霉素、四环素、庆大霉素的耐药率较高,未检出对万古霉素或替考拉宁耐药的菌株。在葡萄球菌属病原菌中,共检出7株耐甲氧西林葡萄球菌(MRS),检出率为21.88%。在大肠埃希菌和肺炎克雷伯菌中,共检出22株产超广谱β-内酰胺酶(ESBLs)菌,检出率为30.99%。结论:脑卒中后合并CAUTI患者的病原菌分布具有特征性,病原菌的耐药性较强,存在一定程度的多重耐药现象,临床医生应给予高度的重视和有效的预防,并选取敏感性抗菌药物进行抗感染治疗。

Objective：To analyze the distribution and the drug resistance of the pathogenic bacteria of catheter associated urinary tract infections（ CAUTI） in the patients with cerebral apoplexy. Methods：198 cases of patients with cerebral apoplexy complicated with CAUTI were selected as the research subjects. The distribution and the drug resistance of pathogenic bacteria in the urine samples of the patients were analyzed retrospectively. Results：212 strains of pathogenic bacteria were isolated,among them,107 strains were gram negative bacteria accounting for 50. 47%,83 strains were gram positive bacteria accounting for 39. 15%,22 strains were fungi accounting for 10. 38%. Escherichia coli,Enterococcus and Klebsiella pneumoniae were the main pathogenic bacteria,accounting for20. 75%,15. 09% and 12. 74%,respectively. The drug resistance rates of the gram negative bacteria to ampicillin,ciprofloxacin,levofloxacin,cefazolin,cefuroxime,ceftriaxone and gentamicin were higher,those to amikacin,cefepime and piperacillin/tazobactam were lower. No strain resistant to meropenem or imipenem was isolated. The drug resistance rates of the gram positive bacteria to penicillin G,erythromycin,tetracycline,gentamicin were higher. No strain resistant to vancomycin or teicoplanin was isolated. In the Staphylococcus strains,7 strains of methicillin resistant staphylococcus（ MRS） were detected,the detection rate was 21. 88%. In the Escherichia coli and Klebsiella pneumoniae strains,22 strains of extended spectrum β-lactamases（ ESBLs） producing bacteria were detected,the detection rate was 30. 99%. Conclusion：The distribution of pathogenic bacteria in patients with cerebral apoplexy complicated with CAUTI has some characteristics. The drug resistance of the pathogenic bacteria is higher and there are some existences of multiple resistance.The clinicians should pay more attention and effective prevention,and select the sensitive antibiotics for anti infection treatments.