尿路感染肠杆菌科细菌耐药性分析

Analysis of bacterial resistance in enterobacteriaceae from urinary tract infection

目的探讨秦皇岛地区尿路感染的主要病原菌及药敏状况,以期对临床诊断和治疗用药提供参考,为医院感染控制提供依据方法收集2016年1月至2019年12月秦皇岛市第一医院和海港医院送检微生物实验室的尿培养标本,采用法国梅里埃公司VITEK 2 Compact型全自动微生物鉴定仪进行细菌鉴定及药敏试验,通过碳青霉烯类失活(C1M)试验筛选耐碳青霉烯类肠杆菌科细菌,用PCR方法扩增耐药基因,以确定其基因型结果共送检尿标本5732例,分离病原菌1925株,阳性率为33.6%,肠杆菌科细菌感染比例占51%(982/1925)。大肠埃希菌对氨苄西林、氨苄西林/舒巴圯、头孢呋辛、环丙沙星、左氧氟沙星耐药率较高,耐药率均身60.0%,对ESBLs的耐药率为30%,对产碳青霉烯酶的耐药率为0.8%;肺炎克雷伯菌对ESBLs的耐药率为39.3%,而对碳青霉烯酶的耐药率为26.4%;奇异变形杆菌对氨苄西林和复方新诺明的耐药率均身70.0%,而对美罗培南(2.4%)、阿米卡星(6.1%)耐药率较低;阴沟肠杆菌对头孢曲松耐药率较高,为50%,而对美罗培南(5.3%)、阿米卡星(5.3%)耐药率较低47株耐碳青霉烯类肺炎克雷伯菌和5株大肠埃希菌C1M试验均为阳性,经PCR扩增后测序确认肺炎克雷伯菌全部携带KPC-2型碳青霉烯酶;5株大肠埃希菌有3株携带NDM-1型碳青霉烯酶,2株携带NDM-5型碳青霉烯酶结论尿培养分离的病原菌耐药率较高,尤其是肺炎克雷伯菌,临床应结合尿培养和药敏结果早期合理为患者选用抗菌药物,并且应加强尿培养监测,避免耐药菌株的产生。

Objective To investigate the main pathogens and drug sensitivity of urinary tract infection(UTI)in Qinhuangdao area,in order to provide reference for clinical diagnosis and treatment of UTI,and provide basis for nosocomial infection control.Methods The urine culture samples of microorganism laboratory were collected from the first hospital of Qinhuangdao and Haigang hospital from January 2016 to December 2019.The bacteria identification and drug sensitivity test were carried out by the VITKK 2 Compact auloniatic microorganism identification instrument.The carbapenem-resistant Enterobacteriaceae bacteria were screened by CIM test,and the genes were amplified by PCR method to determine their genotypes.Results There were 5732 urine samples,1925 isolates of pathogenic bacteria,the positive rate was 33.6%,the proportion of Enterobacteriaceae was 51%,and the resistance rate of escherichia coli to ampic illin,ampicillin/subactam,cefuroxime,ciprofloxacin and levo-floxacin was higher,all of which≥60.0%,ESBLs was 30%and carbapenemase was 0.8%.ESBLs strains of Klebsiella pneumoniae accounted for 39.3%,while carhapenemase strains accounted for 26.4%.The resistantance of Proteus mirabilis to ampicillin and compound Sulfamethoxazole was≥70.0%,but the resistance to meropenem and amikacin was lower.The resistance of Knteroharter cloacae to ceftriaxone was higher to 50%,while the resistanc e to meropenem and amikacin was lower.The CIM tests of 47 strains of carbapenem-resistant Klebsiella pneumoniae and 5 strains of Escherichia coli were positive.After PCR amplification,it was confirmed that Klebsiella pneumoniae carried KPC-2 carbapenemase,3 strains Escherichia coli carried NDM-1 carbapenemase anti 2 strains carried NDM-5 carbapenemase.Conclusions The drug resistance rate of pathogenic-bacteria isolated from urine culture is High,especially klebsiella pneumoniae,The clinical should combine the urine culture and the drug sensitivity result to select the antimicrobial agent reasonably early for the patient,and should strengthen the urine culture monitoring,avoids the drug-resistant strain to produce.