琼海地区尿路感染病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance of urinary tract infection in Qionghai

目的了解琼海地区尿路感染病原菌的分布特点,分析其对常见抗菌药物的耐药性,为临床合理用药提供依据。方法收集琼海地区2家三级医院的17 364例尿液标本,对病原菌培养阳性标本进行菌种鉴定及药物敏感度试验,分析病原菌的分布特点及对常见抗菌药物的耐药性。结果共检出尿路感染病原菌2 292株,剔除同一患者的重复菌株后为1 945株。病原菌主要来源于泌尿外科、神经外科、肾内科、骨科等,患者多为50～90岁的中老年人(76.1%),其中71～80岁的老年人比例最高。其中革兰阴性菌1 153株(59.3%)、革兰阳性菌531株(27.3%)、真菌261株(13.4%)。排名前5位的病原菌分别是大肠埃希菌(33.8%)、粪肠球菌(13.2%)、肺炎克雷伯菌(6.1%)、白色假丝酵母菌(5.0%)、铜绿假单胞菌(4.9%)。肠杆菌科细菌中,大肠埃希菌对氨苄西林的耐药率最高,达84.1%,其对常用抗菌药物复方磺胺甲口恶唑、环丙沙星、头孢曲松钠、头孢唑啉钠、左氧氟沙星的耐药率均超过50%。肺炎克雷伯菌对复方磺胺甲口恶唑和头孢唑啉钠的耐药率最高,均为47.9%。奇异变形杆菌对呋喃妥因的耐药率最高,达95.7%。铜绿假单胞菌、鲍曼不动杆菌的耐药率较低,对常见抗菌药物均较敏感。粪肠球菌和屎肠球菌对利奈唑胺的非敏感率分别为5.2%和3.6%。溶血葡萄球菌、表皮葡萄球菌、金黄色葡萄球菌对苯唑西林的耐药率分别为89.1%、74.4%和26.5%。白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌对伊曲康唑的非敏感率分别为13.4%、36.7%、38.1%。结论引起感染的主要革兰阴性菌为大肠埃希菌,革兰阳性菌为粪肠球菌,真菌为白色假丝酵母菌。尿路感染病原菌对常见抗菌药物耐药严重,临床医师应重视尿液的细菌培养结果,避免滥用抗菌药物。

Objective To investigate the pathogen distribution of urinary tract infection in Qionghai and analyze the drug resistance towards common antibacterial drugs, aiming to provide evidence for rational use of drugs in clinical practice. Methods A total of 17 364 urine specimens were collected from two tertiary hospitals in Qionghai. The specimens with positive pathogens were subject to bacterial identification and drug susceptibility test. The distribution characteristics of pathogenic bacteria and the drug resistance to common antibacterial drugs were analyzed. Results A total of 2 292 strains of pathogenic bacteria were detected and 1 945 strains were finally obtained after eliminating the repeated strains from the same patient. The pathogenic bacteria mainly originated from Department of Urology, Neurosurgery, Nephrology and Orthopeadics, etc. A majority of the patients were aged 50-90 years( 76.1%) with the highest percentage in those aged 71-80 years. Among the isolated strains, 1 153 (59.3%) strains were gram-negative bacteria, 531 (27.3%) gram-positive bacteria and 261( 13.4%) fungi. The top five pathogens were Escherichia coli( 33.8%), Enterococcus faecalis (13.2%), Klebsiella pneumoniae( 6.1%), Candida albicans( 5.0%) and Pseudomonas aeruginosa( 4.9%). Among Enterobacteriaceae bacteria, Escherichia coli yielded the highest drug resistance rate to ampicillin up to 84.1%, and the drug resistance rate to common antibacterial drugs, such as compound sulfamethoxazole,ciprofloxacin, ceftriaxone sodium, cefazolin sodium and levofloxacin exceeded 50%. Klebsiella pneumoniae showed the highest drug resistance rate to compound sulfamethoxazole and cefazolin sodium up to 47.9%. The drug resistance rate of Proteus mirabilis to nitrofurantoin was the highest, reaching 95.7%. Pseudomonas aeruginosa and Acinetobacter baumannii had relatively low drug resistance rates and were sensitive to common antibacterial drugs. The insensitive rates of Enterococcus faecalis and Enterococcus faecium to linezolid were 5.2% and 3.6%. The drug resistance rates of Staphylococcus haemolyticus, Staphylococcus epidermidis and Staphylococcus aureus towards oxacillin were 89.1%, 74.4% and 26.5%, respectively. The non-sensitive rates of Candida albicans, Candida glabrata and Candida tropicalis to itraconazole were 13.4%, 36.7% and 38.1%, respectively. Conclusions Among the pathogens inducing urinary tract infection, the main gram-negative bacterium is Escherichia coli, the primary gram-positive bacterium is Enterococcus faecalis and the major fungus is Candida albicans. The pathogens related to urinary tract infection are highly resistant to common antimicrobial drugs. Clinicians should attach importance to the bacterial culture of urine samples to avoid the abuse of antibiotics.