膀胱癌术后尿路感染的病原菌类型及药敏分析

Analysis of pathogenic bacteria and their drug sensitivities of urinary tract infection after resection of bladder cancer

目的回顾性分析膀胱癌术后尿路感染的细菌类型及耐药情况,为临床医师选择抗菌药物提供参考依据。方法收集2017年1月至2021年9月徐州医科大学附属滕州市中心人民医院膀胱癌术后尿路感染患者277例的中段尿进行常规培养,其中男126例、女151例,年龄(66.7±8.7)岁,对病原菌进行鉴定及药敏试验。结果膀胱癌术后尿路感染的病原菌以革兰阴性杆菌为主77.62%(215/277),主要为大肠埃希菌42.24%(117/277)和肺炎克雷伯菌15.16%(42/277);其次是革兰阳性球菌21.30%(59/277),主要为粪肠球菌D群8.66%(24/277)和无乳链球菌B群4.69%(13/277);真菌检出占1.08%(3/277)。药敏试验结果显示大肠埃希菌和肺炎克雷伯菌较敏感的抗生素主要为厄他培南、亚胺培南、美洛培南(均>96%),耐药率较高的抗生素主要为氨苄西林、头孢唑啉、环丙沙星(均>60%);粪肠球菌D群和无乳链球菌B群对氨苄西林、利奈唑胺、青霉素、达托霉素、呋喃妥因、替加环素、替考拉宁、万古霉素敏感率较高(均>94%),粪肠球菌D群对克林霉素、四环素、红霉素耐药率较高(均>66%),无乳链球菌B群对克林霉素、红霉素、左旋氧氟沙星、莫西沙星耐药率较高(均>80%)。结论膀胱癌术后尿路感染的主要致病菌为革兰阴性菌,其中以大肠埃希菌和肺炎克雷伯菌为主,感染革兰阳性菌以粪肠球菌D群和无乳链球菌B群为主;致病菌对部分抗生素的耐药率较高,临床医生应注重病原菌的监测和药敏试验结果,合理应用抗生素。

Objective To retrospectively analyze the pathogenic bacteria and their drug sensitivities of urinary tract infection after resection of bladder cancer,and to provide references for clinicians to select antibiotics.Methods From January 2017 to September 2021,277 patients with urinary tract infection after resection of bladder tumor in Tengzhou Central People's Hospital Affiliated to Xuzhou Medical University were selected,including 126 males and 151 females,with an age of(66.7±8.7)years old,and their midstream urine samples were collected for routine culture.The identification and drug sensitivity test were carried out on pathogenic bacteria.Results The main pathogens of urinary tract infection after resection of bladder tumor were Gram-negative bacilli[77.62%(215/277)],mainly Escherichia coli[42.24%(117/277)]and Klebsiella pneumoniae[15.16%(42/277)];the second was Gram-positive cocci[21.30%(59/277)],mainly Enterococcus faecalis D group[8.66%(24/277)]and Streptococcus agalactiae B group[4.69%(13/277)];fungi accounted for 1.08%(3/277).The drug-sensitive test results showed that the more sensitive antibiotics of Escherichia coli and Klebsiella pneumoniae were mainly ertapenem,imipenem,and meropenem(all>96%),and the antibiotics with high resistance rate were mainly ampicillin,cefazolin,and ciprofloxacin(all>60%);Enterococcus faecalis D group and Streptococcus agalactiae B group showed higher sensitivity to ampicillin,linezolid,penicillin,daptomycin,nitrofurantoin,tigecycline,teicoplanin,and vancomycin(all>94%),Enterococcus faecalis D group was more resistant to clindamycin,tetracycline,and erythromycin(all>66%),and Streptococcus agalactiae B group was more resistant to clindamycin,erythromycin,levofloxacin,and moxifloxacin(all>80%).Conclusions The main pathogens of urinary tract infection after resection of bladder cancer are gram-negative bacilli,mainly Escherichia colicancer and Klebsiella pneumoniae,and the Gram-positive cocci are mainly Enterococcus faecalis D group and Streptococcus agalactiae B group.The resistance rates of pathogenic bacteria to some antibiotics are high,so clinicians should pay attention to monitoring and drug sensitivity test results of pathogenic bacteria,and apply antibiotics rationally.