泌尿系感染患者中段尿标本病原菌构成及药敏分析

Pathogen composition and drug susceptibility analysis in urinary tract infection

目的分析尿路感染患者的病原菌构成及其对常用抗菌药物的耐药性,为临床抗感染治疗提供指导。方法选择2015年1月至2019年10月本院6440份标本检出的2288株中段尿培养阳性菌株,经基质辅助激光解吸电离-飞行时间质谱仪明确鉴定结果,以K-B纸片法为主进行体外抗菌药物敏感性试验,采用WHONET 5.6软件进行数据分析。结果送检的6440份标本中,剔除同一患者相同部位分离的重复菌株后共检出病原菌2288株,检出率为35.53%。其中革兰阴性菌1327株,占58.00%;革兰阳性菌645株,占28.19%;真菌316株,占13.81%。排名前五位的病原菌分别是大肠埃希菌、屎肠球菌、肺炎克雷伯菌、粪肠球菌和白假丝酵母菌。主要革兰阴性菌中大肠埃希菌、肺炎克雷伯菌以及奇异变形杆菌对头孢曲松、头孢噻肟的耐药率均已超过50%,大肠埃希菌对环丙沙星和左氧氟沙星的耐药率分别为70.1%和67.3%。主要革兰阳性菌种屎肠球菌对青霉素G、氨苄西林、环丙沙星、左氧氟沙星以及呋喃妥因的耐药率明显较粪肠球菌高,均大于85%,但对四环素的耐药率明显低于粪肠球菌的100%;屎肠球菌、粪肠球菌及金黄色葡萄球菌中目前未检出对糖肽类抗生素的耐药。结论中段尿培养是诊断泌尿系感染的金标准,临床在抗菌药物治疗前应正确及时留取标本送检,并根据各类病原菌的耐药情况和患者具体临床表现选择合理有效的抗菌药物。

Objective To analyze the composition of pathogens causing urinary tract infection and drug resistance to guide the clinical anti-infection treatment.Methods From January 2015 to October 2019,a total of 6440 specimens of mid-stream urine were tested and 2288 strains of positive mid-stream urine culture in a hospital were selected.The identification was performed by using the laser desorption-flight time quality spectrum and the sensitivity test of antimicrobial agents in vitro was conducted by K-B slip method.The WHONET 5.6 software was used for data analysis.Results Among the 6440 specimens submitted for examination,2288 strains of pathogenic bacteria were detected after removing the repeated strains isolated from the same part in the same patient,with the detection rate of 35.53%.Among the 2288 specimens,1327 strains of gram-negative bacteria were found,accounting for 58.00%,gram positive bacteria 645 strains,accounting for 28.19%and fungi 316 strains,accounting for 13.81%.The top five pathogens were Escherichia coli,Enterococcus faecium,Klebsiella pneumoniae,Enterococcus faecalis and Candida albicans.The drug resistance rates of Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis to ceftriaxone and cefotaxime among the major gram-negative bacteria were all over 50%,and the drug resistance rates of Escherichia coli to ciprofloxacin and levofloxacin were 70.1%and 67.3%respectively.Among the major gram-positive bacteria,the resistance rate of Enterococcus faecium,to penicillin G,ampicillin,ciprofloxacin,levofloxacin and furantoin was significantly higher than that of Enterococcus faecalis(>85%),but the resistance rate of tetracycline was significantly lower than that of Enterococcus faecalis(100%).The resistance to glycopeptide antibiotics has not been detected in Enterococcus faecalis,Enterococcus faecalis and Staphylococcus aureus.Conclusion Mid-section urine culture is the gold standard for the diagnosis of urinary tract infection.Specimens should be collected and tested correctly and timely before antimicrobial treatment,and reasonable and effective antimicrobial agents should be selected according to the drug resistance of various pathogens and the specific clinical manifestations in patients.