宫颈癌术后放疗患者尿路感染的病原菌组成和耐药性分析

Analysis on pathogen composition and drug resistance of urinary tract infection in the patients undergoing postoperative radiotherapy for cervical cancer

目的探讨宫颈癌术后放疗患者尿路感染的菌群分布特点和耐药性,为临床合理应用抗生素提供参考。方法对2018年1~12月宫颈癌术后放疗尿路感染患者分离出的134株病原菌构成及耐药性进行统计分析,并对相应菌株进行ESBLs测定。结果在134株病原菌中,革兰阴性菌95株(70.89%),革兰阳性菌35株(26.12%)及真菌4株(2.99%)。前3位的病原菌依次为大肠埃希菌、粪肠球菌和肺炎克雷伯菌,分别占40.30%、17.91%和8.96%;大肠埃希菌和肺炎克雷伯菌的ESBLs检出率为37.04%和33.3%;大肠埃希菌对头孢吡肟、头孢西丁、厄他培南、哌拉西林/他唑巴坦、亚胺培南、阿米卡星和替加环素耐药率较低(<20%)。肺炎克雷伯菌的耐药率低于大肠埃希菌,仅对氨苄西林、呋喃妥因的耐药率大于30%。粪肠球菌对阿莫西林/克拉维酸、万古霉素、替加环素、青霉素耐药率较低(<9%)。结论宫颈癌术后放疗患者尿路感染的主要病原菌是大肠埃希菌、粪肠球菌及肺炎克雷伯菌,大肠埃希菌及肺炎克雷伯菌产ESBLs比率较高,应根据药敏试验合理选择用药。

Objective To investigate the distribution characteristics and drug resistance of urinary tract infection in the patients undergoing postoperative radiotherapy for cervical cancer, and to provide reference for the clinical rational application of antibiotics. Methods Statistical analysis was performed on the composition and drug resistance of 134 pathogenic bacteria isolated from patients with urinary tract infection undergoing postoperative radiotherapy for cervical cancer from January to December 2018. The corresponding strains were subjected to ESBLs determination. Results Of the 134 pathogens, 95 strains were Gram-negative bacteria(70.89%), and there were 35 Gram-positive bacteria(26.12%)and 4 fungi(2.99%). The top 3 pathogens were Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae, which accounted for 40.30%, 17.91% and 8.96%, respectively;the detection rates of ESBLs in Escherichia coli and Klebsiella pneumoniae were 37.04% and 33.3%;Escherichia coli showed a low drug resistance rate to cefepime, cefoxitin,ertapenem, piperacillin/tazobactam, imipenem, amikacin and tigecycline(<20%). The drug resistance rate of Klebsiella pneumoniae was lower than that of Escherichia coli, and the drug resistance rate to ampicillin and nitrofurantoin only was more than 30%. The drug resistance rate of Enterococcus faecalis to amoxicillin/clavulanic acid, vancomycin, tigecycline and penicillin was low(<9%). Conclusion The main pathogens in urinary tract infection in the patients with postoperative radiotherapy for cervical cancer are Escherichia coli, Enterococcus faecalis and Klebsiella pneumoniae. The ratio of ESBLs produced by Escherichia coli and Klebsiella pneumoniae is relatively high, and appropriate medication should be rationally selected according to the drug sensitivity test.