社区获得性细菌尿路感染病原学分析

Etiological Analysis of Community Acquired Bacterial Urinary Tract Infections

目的:对社区获得性尿路感染患者尿培养病原菌进行分析,为临床治疗提供依据。方法:收集社区获得性尿路感染病例564例分离的病原菌,用纸片扩散法进行药敏试验,采用WHONET 5.6版软件进行统计分析。结果:引起社区获得性尿路感染的主要病原菌为大肠埃希菌,占62.8%。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌的超广谱β内酰胺酶(ESBLs)发生率分别为58.2%,44.2%和12.5%。成人组分离的大肠埃希菌对氟喹诺酮类药物的耐药率显著高于儿童组。分离的革兰阳性菌以肠球菌为主,未发现对利奈唑胺、万古霉素、替考拉宁和替加环素耐药的肠球菌。屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌。结论:社区获得性尿路感染的主要病原菌为大肠埃希菌,临床医生要密切关注分离菌的变迁及耐药性情况,合理使用抗菌药物。

Objective:To analyze pathogenic bacteria in urine culture of community acquired urinary tract infections(CAUTI)patients and to provide basis for clinical treatment of CAUTI.Methods:A total of 564 isolated pathogens from CAUTI were collected.Drug susceptibility test was carried out by disk diffusion method.The WHONET 5.6 software was used for statistical analysis.Results:The main pathogen causing CAUTI was Escherichia coli,accounting for 62.8%.The incidence of extended-spectrumβ-lactamases(ESBLs)of Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis were 58.2%,44.2%and 12.5%,respectively.The resistance rate of Enterococcus spp.isolated from adults to fluoroquinolones was significantly higher than that of children.Enterococcus spp.was the main isolated Gram-positive bacteria.No Enterococcus spp.resistant to linezolid,vancomycin,teicoplanin or tegacycline was found.The resistant rate of Enterococcus faecium was higher than Enterococcus faecalis when tested with most antibiotics.Conclusion:Escherichia coli is the main pathogen of CAUTI.Clinicians should pay close attention to the changes of isolates and drug resistance,and use antibiotics reasonably.