医院内泌尿道感染患者的病原菌耐药性分析

Analysis of Pathogenic Bacteria Resistance of Patients with Urinary Tract Infection in Hospital

目的了解湖北省襄阳市第一人民医院住院患者泌尿系感染的主要病原菌分布与抗生素对常用菌的耐药率。方法回顾性收集湖北省襄阳市第一人民医院2017年1月~12月住院患者1580份尿培养样本,采用全自动微生物鉴定仪480份阳性标本进行鉴定及药敏试验。应用WHONET5.6对数据进行分析。结果 480株病原菌中,革兰阴性杆菌353株(73.54%),以大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌为主;革兰阳性球菌85株占(17.71%),以肠球菌和凝固酶阴性葡萄球菌为主;真菌40株(8.33%)。检出的病原菌对各种抗生素的耐药率不同,所有分离的大肠埃希菌与肺炎克雷伯菌对三代头孢菌素和喹诺酮类耐药率均大于50%,并且外科系统分离的大肠埃希菌株耐药率高于内科系统;铜绿假单胞菌对β内酰胺酶抑制剂耐药率大于30%,高于其他病原菌对此类抗生素耐药率。未发现分离的革兰阳性菌对万古霉素和利奈唑胺耐药,凝固酶阴性葡萄球菌对苯唑西林耐药率达82.60%。结论本院泌尿系统感染中,以大肠埃希菌感染为主,β内酰胺酶抑制剂可用于大肠埃希菌和肺炎克雷伯菌常规治疗。

Objective To investigate the distribution of main pathogens of urinary tract infection and antibiotic resistance to commonly used bacteria in inpatients of Xiangyang first people's hospital of Hubei province.Methods A retrospective collection of 1580 urine culture samples of hospitalized patients from January to December 2017 in the first people's hospital of Xiangyang city,Hubei province was conducted.480 positive specimens were used for identification and drug susceptibility testing.Apply WHONET5.6 to analyze the data.Results Among the 480 pathogenic bacteria,353 strains of gram-negative bacilli(73.54%)were Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,85 of gram-positive cocci(17.71%),Enterococcus and coagulase negative staphylococcus,40 fungi(8.33%),were mainly Enterococcus and coagulase negative Staphylococcus.The resistance rates of pathogenic bacteria to all kinds of antibiotics were different.The resistance rate of all isolated Escherichia coli and Klebsiella pneumoniae to three generation cephalosporins and quinolones was more than 50%,and the resistance rate of Escherichia coli isolated from the surgical system was higher than that in the internal medicine system;The resistance rate of Pseudomonas aeruginosa toβlactamase inhibitors is more than 30%,which is higher than that of other pathogens.No gram positive bacteria isolated were resistant to vancomycin and linezolid,and the resistance rate of clotting negative staphylococci to oxacillin was 82.60%.Conclusion Escherichia coli is the main infection in the urinary tract infection in our hospital,and theβlactamase inhibitor can be used for routine treatment of Escherichia coli and Klebsiella pneumoniae.