女性尿路致病性大肠埃希菌耐药性及其产超广谱β-内酰胺酶分析

Analysis on drug resistance and extended-spectrumβ-lactamase of uropathogenic Escherichia coli isolated from female urinary tract

目的了解杭州市富阳区女性尿路致病性大肠埃希菌(Uropathogenic Escherichia coli,UPEC)的临床分布和耐药性变迁,分析超广谱β-内酰胺酶(Extended Spectrumβ-Lactamases,ESBLs)阴性菌株和阳性菌株的耐药性差异。方法回顾性分析杭州市富阳区第一人民医院2014年1月—2018年12月女性尿路感染患者分离的非重复大肠埃希菌,经VITEK-2 Compact全自动微生物分析系统进行细菌鉴定,采用纸片扩散法(K-B)进行药敏试验。采用双纸片确证试验检测分离菌株是否产ESBLs。耐药率统计采用whonet 5.6软件进行分析,统计数据采用SPSS16.0软件进行分析。结果628株女性UPEC分布前3位的科室依次是泌尿外科、普外科和重症监护病房,构成比依次为32.4%、21.1%和13.5%;产ESBLs菌株逐年增多,分离率从2014年的29.1%升至2018年的60.9%,总检出率高达48.7%(306/628),ESBLs阳性菌株对氨苄西林等16种药物的耐药率均高于ESBLs阴性菌株(P<0.01)。结论富阳区女性UPEC对多种抗菌药物的耐药率逐年上升,产ESBLs菌株检出率也呈逐年增高趋势,应高度重视对产ESBLs菌株的检测和耐药性监测,为临床合理用药提供参考。

Objective To research the clinical distribution and changes of drug resistance of uropathogenic Escherichia coli(UPEC)isolated from female urinary tract in Fuyang District,Hangzhou,analyze the differences of drug resistance of extended-spectrumβ-lactamase(ESBLs)negative strains and positive strains.Methods From January 2014 to December 2018,the UPEC strains isolated from female patients with urethral infection in the First People's Hospital of Fuyang District,Hangzhou were analyzed retrospectively,VITEK-2 Compact automatic microbiological analysis system was used for identification of bacteria,disk diffusion method was used for drug sensitive test.Double disk confirmatory test was used to detect ESBLs of isolated strains.Drug resistance was analyzed using whonet 5.6 software,data analysis was performed using SPSS 16.0 software.Results The top three departments of UPEC isolated from female patients with urethral infection were Department of Urological Surgery,Department of General Surgery,and Intensive Care Unit,the proportions were 32.4%,21.1%,and 13.5%,respectively.ESBLs-producing strains increased year by year,the separation rate increased from 29.1%in 2014 to 60.9%in 2018,and the total detection rate was as high as 48.7%(306/628).The resistance rate of ESBLs positive strains to antimicrobial agents was statistically significantly higher than that of ESBLs negative strains(P<0.01).Conclusion The resistance rate of UPEC to a variety of antimicrobial agents among the women in Fuyang Distrct increases year by year,and the detection rate of ESBLs-producing strains increases year by year.More attention should be paid to detection and drug resistance of ESBLs-producing strains,which can provide reference for clinical rational drug use.