输尿管软镜围手术期尿培养及抗生素初步分析

Analysis of the urine cultures and perioperative antibiotic use in flexible ureteroscopy

目的:总结输尿管软镜围手术期抗生素的合理选择。方法:回顾性分析238例输尿管软镜围手术期尿培养及抗生素应用情况。结果:共培养出阳性菌株73株,其中革兰阴性菌54.79%(40/73),革兰阳性菌39.73%(29/73),主要为大肠埃希菌36.98%(27/73),粪肠球菌24.66%(18/73)。革兰阴性菌对氨苄西林、头孢唑啉、头孢曲松、左氧氟沙星、氨曲南等耐药率较高,革兰阳性菌对四环素、克林霉素、红霉素、庆大霉素、左氧氟沙星等耐药率较高。在尿培养阴性患者的抗生素经验性用药中,左氧氟沙星使用率70.76%(121/171)。结论:输尿管软镜围手术期应根据患者尿培养及药敏试验结果选用敏感抗生素,经验性用药应降低左氧氟沙星的使用率。

Objective:To summarize the experience of rational use of antibiotics during the perioperative period in flexible ureteroscopy.Methods:Retrospective analysis was performed in 238 cases concerning urine cultures and perioperative antibiotic use in flexible ureteroscopy.Results:A total of 73 positive urinary pathogens were presented during perioperative period,in which 54.79%(40/73)were gram-negative bacteria,39.73%(29/73)gram-positive bacteria.The predominant strains included Escherichia coli(27/73,36.98%)and Enterococcus faecalis(18/73,24.66%).Drug sensitive test indicated that gram-negative bacteria were highly resistant to ampicillin,cefazolin,ceftriaxone,levofloxacin and aztreonam,whereas gram-positive bacteria had higher resistance to tetracycline,clindamycin,erythromycin,gentamicin and levofloxacin.The use rate of levofloxacin was 70.76%(121/171)in the cases of empiric use of antibiotics.Conclusion:Physicians should use sensitive antibiotics based on the results of urine culture and drug sensitive test during the perioperative period in flexible ureteroscopy,and the empirical use of levofloxacin should be reduced.