结石伴下尿路感染患者感染病原菌分布及对磷霉素氨丁三醇敏感性

Distribution of pathogens isolated from urinary calculi patients complicated with lower urinary tract infection and drug susceptibility to fosfomycin tromethamine

目的 探究结石伴下尿路感染患者感染病原菌分布及对磷霉素氨丁三醇的敏感性。方法 选择2018年10月-2020年10月首都医科大学附属北京同仁医院收治的尿路结石伴下尿路感染患者68例,收集中段尿,进行病原菌培养及鉴定;将患者随机分为磷霉素氨丁三醇组和左氧氟沙星组,每组34例,两组均治疗1周,比较两组临床治疗效果。结果 中段尿共分离病原菌82株,其中革兰阴性菌52株,占63.41%,革兰阳性菌23株,占28.05%,真菌7株,占8.54%。主要革兰阴性菌对氨苄西林、哌拉西林、头孢噻肟、头孢吡肟、环丙沙星、左氧氟沙星、庆大霉素、磺胺甲噁唑/甲氧苄啶耐药率较高(≥50%),对阿米卡星、亚胺培南、美罗培南、头孢哌酮/舒巴坦钠、哌拉西林/他唑巴坦耐药率较低(<20%),粪肠球菌对庆大霉素、链霉素、四环素、红霉素的耐药率较高(≥50%),对呋喃妥因、万古霉素、利奈唑胺的耐药率较低(<20%)。磷霉素氨丁三醇组治疗有效率为88.24%,左氧氟沙星组为64.70%,比较差异有统计学意义(χ^(2)=5.231,P=0.022)。治疗后,磷霉素氨丁三醇组白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)及单核细胞趋化蛋白1(MCP1)水平低于左氧氟沙星组(P<0.05)。结论 尿路结石伴下尿路感染患者病原菌以革兰阴性菌为主,磷霉素氨丁三醇可作为尿路结石伴下尿路感染的初治首选药物,其疗效明显,细菌清除率和安全性较高。

OBJECTIVE To explore the distribution of pathogens isolated from urinary calculi patients complicated with lower urinary tract infection and drug susceptibility to fosfomycin tromethamine. METHODS A total of 68 urinary calculi patients complicated with lower urinary tract infection who were treated in the Capital Medical University Beijing Tongren Hospital from Oct 2018 to Oct 2020 were enrolled in the study. The midstream urine specimens were collected for culture of pathogens, the isolated pathogens were identified. The patients were randomly divided into the fosfomycin tromethamine group amd the levofloxacin group, with 34 cases in each group. Both groups were treated for 1 week, and the clinical curative effects were observed and compared between the two groups. RESULTS Totally 82 strains of pathogens were isolated from the midstream urine specimens, 52(63.41%) of which were gram-negative bacteria, 23(28.05%) were gram-positive bacteria, and 7(8.54%) were fungi. The drug resistance rates of the major species of gram-negative bacteria to ampicillin, piperacillin, cefotaxime, cefepime, ciprofloxacin, levofloxacin, gentamycin and sulfamethoxazole-trimethoprim were no less than 50%, while the drug resistance rates to amikacin, imipenem, meropenem, cefoperazone-sulbactam and piperacillin-tazobactam were less than 20%. The drug resistance rates of Enterococcus faecalis to gentamycin, streptomycin, tetracycline and erythromycin were no less than 50%, while the drug resistance rates to nitrofurantoin, vancomycin and linezolid were less than 20%. The effective rate of treatment was 88.24% in the fosfomycin tromethamine group, 64.70% in the levofloxacin group, and there was significant difference(χ^(2)=5.231,P=0.022). The levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and monocyte chemoattractant protein 1(MCP1) of the fosfomycin tromethamine group were lower than those of the levofloxacin group after the treatment(P<0.05). CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the urinary calculi patients complicated with lower urinary tract infection. Fosfomycin tromethamine can be used as the preferred drug for initial treatment of the urinary calculi patients complicated with lower urinary tract infection, with the curative effect remarkable, and the clearance rate of bacteria and safety are high.