十堰地区2343株非复杂性尿路感染常见病原菌及耐药性分析

Analysis of 2343 Strains of Common Pathogens and Drug Resistance of Uncomplicated Urinary Tract Infection in Shiyan Area

目的:了解十堰地区非复杂性尿路感染常见病原菌分布及耐药性变迁。方法:回顾性分析本院2015年1月-2019年12月临床诊断为非复杂性尿路感染患者中段尿分离菌和药敏试验结果。结果:共检出2343株细菌,革兰阳性菌498株(21.3%),革兰阴性菌1845株(78.7%)。革兰阴性菌以大肠埃希菌(57.2%)、肺炎克雷伯菌(5.7%)、奇异变形菌(5.3%)为主,三者对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、美罗培南、阿米卡星、头孢西丁耐药率最低,在10%左右;大肠埃希菌对呋喃妥因耐药率不超过2%。五年间,三代头孢耐药肠杆菌科细菌检出率呈逐年降低趋势;喹诺酮类耐药肠杆菌科细菌检出率呈先升高后降低趋势;碳青霉烯类耐药肠杆菌科细菌检出率稳定在1%左右,但有增长趋势。革兰阳性菌中主要以粪肠球菌(6.6%)和屎肠球菌(5.6%)为主,未检出其利奈唑胺、万古霉素、替考拉宁耐药。结论:大肠埃希菌是非复杂性尿道感染主要病原菌,随着耐药情况的改变,可能需要改变经验性抗感染策略,呋喃妥因、碳青霉烯类、β-内酰胺酶抑制剂类药物可作为非复杂性尿路感染经验性用药推荐。总体上,五年间主要细菌对常见抗菌药物耐药性呈下降趋势,但其耐药率仍较高,医院应加强抗菌药物的管理和抗菌药物的合理使用。

Objective To investigate the distribution of common pathogens and drug resistance changes in uncomplicated urinary tract infections in Shiyan area.Methods We retrospectively analyzed the results of urine isolates and drug susceptibility test of patients with uncomplicated urinary tract infections and clinically diagnosed in our hospital from January 2015 to December 2019.Results A total of 2343 strains of bacteria were detected,including 498 Gram-positive bacteria(21.3%)and 1845 Gram-negative bacteria(78.7%).Gram-negative bacteria were mainly Escherichia coli(57.2%),Klebsiella pneumoniae(5.7%)and Proteus mirabilis(5.3%),the three of which had the lowest resistance rate to cefoperazone/sulbactam,piperacillin/tazobactam,imipenem,meropenem,amikacin,and cefoxitin,at about 10%.The resistance rate of Escherichia coli to nitrofuratoin did not exceed 2%.During the past five years,the detection rate of the third-generation cephalosporin-resistant Enterobacteriaceae bacteria showed a decreasing trend year by year;the detection rate of quinolone-resistant Enterobacteriaceae bacteria increased first and then decreased;the detection rate of carbapenem-resistance Enterobacteriaceae was stable at about 1%,but there was a growing trend.Gram-positive bacteria were mainly Enterococcus faecalis(6.6%)and Enterococcus faecium(5.6%).No resistance to linezolid,vancomycin,or teicoplanin was detected.Conclusion Escherichia coli is the main pathogen of uncomplicated urinary tract infections.With the change of drug resistance,it may be necessary to change the empirical anti-infection strategy.Nitrofuratoin,carbapenems,β-lactamase inhibitors can be used as empirical medication recommendations for uncomplicated urinary tract infections.In general,the resistance of main bacteria to common antimicrobial drugs has been on the decline in the past five years,but the resistance rate is still high.Hospitals should strengthen the management of antimicrobials and the rational use of antimicrobials.