2017年广东医科大学附属医院尿培养中大肠埃希菌临床分布特点与耐药性分析

Clinical distribution and drug resistance of Escherichia coli in urine culture of Affiliated Hospital of Guangdong Medical University in 2017

目的:分析尿路感染中大肠埃希菌分布特点和耐药性,为临床合理用药提供参考依据。方法:收集2017年收治门诊和入院患者中段尿标本培养分离的菌株,并采用全自动微生物VITEK鉴定药敏系统和药敏纸片(K-B)法对分离菌株进行鉴定和药敏试验,分析病原菌分布特点和耐药情况。结果:剔除同一患者的重复菌株后,从2017年尿标本中共检出485株大肠埃希菌。科室分布以肾病外科(143株,29.5%)为主,其次分别为肾病内科(46株,9.5%)、肿瘤中心(37株,7.6%)。大肠埃希菌对亚胺培南、头孢替坦、头孢唑啉、阿米卡星、呋喃妥因、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦耐药率为<30%;对头孢曲松、环丙沙星、左旋氧氟沙星、复方新诺明和复合制剂氨苄西林/舒巴坦的耐药率仍>50%;对氨苄西林的耐药率>75%;产超广谱β-内酰胺酶的大肠埃希菌检出率为50.1%(243/485)。结论:本院尿路感染病原菌以大肠埃希菌为主;大肠埃希菌对第3代头孢菌素、氨苄西林和喹诺酮类药物耐药率较高,对碳青霉烯类抗生素的耐药率最低;产超广谱β-内酰胺酶的大肠埃希菌检出率高,对头孢曲松基本全部耐药,且存在对碳青霉烯类耐药的情况。临床应根据药敏结果合理使用抗菌药物,以达到有效治疗尿路感染和减少耐药菌株产生的目的。

Objective Objective to analyze the distribution characteristics and drug resistance of Escherichia coli in urinary tract infection,so as to provide reference for clinical rational drug use.Method In 2017,the strains isolated from the middle section of the outpatient and hospitalized patients were collected,and the isolation strains were identified and the drug sensitivity test was carried out by the automatic microbial VITEK identification system and the drug sensitive paper(K-B)method.The distribution characteristics and drug resistance of the pathogenic bacteria were analyzed.Results After removing the repetitive strains from the same patient,485 strains of Escherichia coli were detected in the urine samples of our hospital in 2017.The distribution of departments was mainly in nephrology surgery 143 strains,(29.5%),followed by nephrology(46 strains,9.5%),and tumor center(37 strains,7.6%).The resistance rate of Escherichia coli to imipenem,ceftaettan,cefazolin,Amikacin,furadoxin,piperacillin/tazobactam and Cefoperazone/sulbactam was less than 30%;the resistance rate of ceftriaxone,ciprofloxacin,levofloxacin,compound sulfamethoxamine and ampicillin/sulbactam was more than 50%;The drug resistance rate of ampicillin was more than 75%,and the detection rate of extended spectrum beta lactamase producing Escherichia coli was 50.1%(243/485).Conclusion The pathogenic bacteria of urinary tract infection in our hospital are mainly Escherichia coli,and Escherichia coli has high resistance to third generation cephalosporins,ampicillin and quinolones,and the rate of resistance to carbapenems is the lowest,and the rate of Escherichia coli producing super broad-spectrum beta lactamase is high,and all of them are resistant to ceftriaxone.Resistance to carbapenems.The rational use of antibiotics should be based on the results of drug sensitivity so as to achieve effective treatment of urinary tract infections and reduce the occurrence of drug-resistant strains.