肾盂肾炎复发的细菌分析和治疗

Bacteria Analysis and Treatment in Patients with Recurrent Pyelonephritis

目的 :分析引起肾盂肾炎复发的细菌菌谱、药敏试验和产超广谱 β-内酰胺酶 (ESBLs)情况 ,并观察舒巴坦 /头孢哌酮的治疗效果。方法 :2 8例肾盂肾炎复发患者做尿细菌培养、药敏试验和检测ESBLs ,并用舒巴坦 /头孢哌酮治疗。结果 :革兰氏阴性杆菌感染占 6 4 % ,球菌感染占 36 %。革兰氏阴性杆菌产ESBLs共 14株 ,占阴性杆菌感染 78% ,其中复发 2次的阴性杆菌产酶率为 5 7% ,复发 3次以上的阴性杆菌产酶率为 91%。舒巴坦 /头孢哌酮与头孢哌酮、头孢三嗪、头孢他啶比效 ,药物敏感率和MIC90 均有显著性差异 (P <0 .0 5 )。舒巴坦 /头孢哌酮与头孢哌酮对产ESBLs阴性杆菌抗菌作用比较 ,两者高敏率分别为 92 .9%和 35 .7% (P <0 .0 1)。用舒巴坦 /头孢哌酮治疗后 ,尿细菌转阴率 92 .8%。结论 :杆菌是肾盂肾炎复发的重要致病菌 ,多数革兰氏阴性杆菌产ESBLs,产酶率与复发次数有关 ;头孢哌酮与舒巴坦配伍能增强对ESBLs的稳定性 ,是治疗肾盂肾炎复发有效的药物。

Objective:To analyse bacteria pattern,antimicrobial resistance pattern and extended-spectrum β-lactamase (ESBLs)in patients with recurrent pyelonephritis,and to observe effects with Sulbactam/Cefoperazone in the patients.Methods:Urine bacterial culture,antimicrobial resistance pattern and ESBLs′ measure were performed in 28 cases with recurrent pyelonephritis who were treated with Sulbactam/Cefoperazone.Results:64% cases were caused by gran-negative bacillus,36% by coccus.14 strains bacillus produced ESBLs.The positive rate of ESBLs was 78%.57%bacillus produced ESBLs in these patients with relapsing pyelonephritis twice,91% bacillus produced ESBLs in these patients with relapsing pyelonephritis over three times.Compared with Cefoperazone,Ceftriazone and ceftazidime,Sulbactam/Cefoperazone had higher antimicrobial resistance and lower minimal inhibitory concentrations(MIC 90 ) in drug-resistance bacteria( P <0.05 ).Antimicrobial resistance to ESBLs positive bacillus with Sulbactam/Cefoperazone was higher than with Cefoperazone.The negative rate of urine bacteria culture was 92.8% after having been treated with Sulbactam/Cefoperazone for.Conclusion:Coccus is main bacteria causing recurrent pyelonephritis.Bacillus causing recurrent pyelonephritis produce ESBLs frequently.ESBLs positive rate is related with relapse times.Combination of Cefoperazone and Sulbactam is more stable to β-lactamase than Cefoperazone or Ceftriazone or ceftazidime alone,this combination enhances the bactericidal activitity against β-lactamases producing stains.Sulbactam/Cefoperazone is more effective to patients with recurrent pyelonephritis.