2016年-2020年尿路感染患者病原菌分布和耐药性分析

Distribution and drug resistance of pathogens isolated from urine samples of patients with suspected urinary tract infection during 2016-2020

目的调查和分析杭州师范大学附萧山医院2016年-2020年尿路感染患者病原菌分布和耐药性,为临床合理用药提供依据。方法采用VITEK 2 Compact全自动细菌鉴定药敏仪进行细菌鉴定和药敏分析,应用WHONET5.6进行数据分析。结果2016年-2020年共检出病原菌5117株,其中革兰阴性菌3309株(64.7%)、革兰阳性菌1395株(27.3%)真菌413株(8.0%)。革兰阴性菌检出前3位是大肠埃希菌2061株(40.3%),肺炎克雷伯菌371株(7.3%),铜绿假单胞菌217株(4.2%);革兰阳性菌检出前3位是屎肠球菌438株(8.6%),粪肠球菌407株(8.0%),无乳链球菌110株(2.1%);真菌检出前3位是光滑念珠菌177株(3.5%),白色念珠菌123株(2.4%),热带念珠菌81株(1.6%)。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)检出率分别为45.8%-55.0%和25.3%-36.4%,耐碳青霉烯大肠埃希菌(CREC)检出率为2.2%~4.1%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为24.7%-33.3%,耐碳青霉烯铜绿假单胞菌(CRPA)检出率为24.6%~35.1%。结论尿路感染患者病原菌构成比较稳定,革兰阴性杆菌以大肠埃希菌和肺炎克雷伯菌为主。CREC的检出率低且稳定,CRKP的检出率高、耐药形势更严峻。及时了解区域病原菌流行趋势,加强细菌耐药性监测,审慎选择抗菌药物对尿路感染的有效治疗十分重要。

Objective To investigate the distribution and drug resistance of pathogens isolated from the urine samples of patients with suspected urinary tract infection during 2016-2020,so as to provide basis for rational use of antibiotics.Methods VITEK 2 Compact system was used for the identification of pathogens and antimicrobial susceptibility testing.WHONET 5.6 software was used for data analysis.Results Totally 5117 pathogenic strains were isolated,among which there were 3309 strains of gram-negative bacilli(64.7%),1395 gram-positive bacilli(27.3%),and 413 fungus(8.0%).The top three gram-negative bacilli were 2061 strains of E.coli(40.3%),371 strains of K.pneumoniae(7.3%)and 217 strains of P.aeruginosa(4.2%).The top three gram-positive bacilli were 438 strains of E.faecium(8.6%),407 strains of E.faecalis(8.0%)and 110 strains of S.agalactiae(2.1%).The top three fungus were 177 strains of C.glabrata(3.5%),123 strains of C.albicans(2.4%)and 81 strains of C.tropicalis(1.6%).The detection rates of extended-spectrum β-lactamases of E.coli and K.pneumoniae were 45.8%-55.0%and 25.3%-36.4%,that of CREC and CRKP were 2.2%-4.1%and 24.7%-33.3%,and that of CRPA was 24.6%-35.1%.Conclusion The composition of pathogens in patients with suspected urinary tract infection in the past five years is relatively stable.The main Gram-negative bacteria are E.coli and K.pneumoniae.The detection rates of CREC every year are low and stable.The detection rates of CRKP are high and the drug resistance situation is more severe.It is very important to know the epidemic trend of pathogens in time,strengthen the monitoring of bacterial resistance and carefully select antibiotics for the effective treatment of urinary tract infection.