泌尿系感染病原菌分布及药敏分析

Analysis of Pathogen Distribution and Drug Sensitivity of Urinary Tract Infection

目的:分析泌尿系感染病原菌分布及药敏结果,指导临床合理使用抗生素。方法:将2014年1月7日至2019年7月1日因泌尿系感染在中山大学孙逸仙纪念医院诊治的患者,对11283份尿液进行细菌菌种鉴定和药敏试验。结果:其中496份标本细菌培养阳性,前5位依次为大肠埃希菌211株(42.54%)、粪肠球菌51株(10.28%)、肺炎克雷伯菌40株(8.06%)、铜绿假单胞菌31株(6.25%)、奇异变形菌15株(3.02%)。265株肠杆菌科细菌中157株(59.25%)产超广谱β-内酰胺酶(extended-spectrumβ-lactamase,ESBLs),其中产ESBLs大肠埃希菌136(66.02%)株。产ESBLs菌对亚胺培南(100%)、替加环素(98.77%)、厄他培南(98.69%)、美洛培南(97.67%)、头孢替坦(96.36%)、丁胺卡那霉素(93.63%)、哌拉西林/他唑巴坦(92.31%)高度敏感。对环丙沙星、左氧氟沙星及头孢哌酮舒巴坦耐药率分别为78.33%、78.34%、14.19%。结论:泌尿系感染常见病原菌是大肠埃希菌。随着产ESBLs菌检出率升高,轻症患者建议优先考虑头孢哌酮舒巴坦,重症患者可考虑使用碳青霉烯类、哌拉西林/他唑巴坦。

Objective:To analyze the distribution of pathogenic bacteria and drug sensitivity results of urinary tract infection,and to guide the rational use of antibiotics in clinic. Methods:The urine samples of 11283 patients diagnosed and treated for urinary tract infection in Sun Yat-sen Memorial Hospital of Sun Yat-sen University on January 7,2014 and July 1,2019 were identified by bacterial strains and drug sensitivity test. Results:Among the 496 urine bacteria,211 strains of Escherichia coli(42.54%),51 strains of Enterococcus faecalis(10.28%),40 strains of Klebsiella pneumoniae(8.06%),31 strains of Pseudomonas aeruginosa(6.25%)and 15 strains of proteus singular(3.02%)were cultured positive. Of the 265 Enterobacteriaceae strains,157(59.25%)produced extended-spectrum β-lactamase(ESBLs),and 136(66.02%)produced ESBLs. The ESBLS-producing bacteria were highly sensitive to imipenem(100%),tegacycline(98.77%),ertapenem(98.69%),meropenem(97.67%),cefotetan(96.36%),amikacin(93.63%) and piperacillin/tazobactam(92.31%). The drug resistance rates to ciprofloxacin, levofloxacin and cefoperazone and sulbactam were 78.33%,78.34% and 14.19%,respectively. Conclusion:The common pathogenic bacteria of urinary tract infection is Escherichia coli. With the increased detection rate of ESBLS-producing bacteria,cefoperazone sulbactam is recommended as a priority for patients with mild disease,and carbapenems and piperacillin/tazobactam are considered for patients with severe disease.