脑卒中患者多重耐药菌尿路感染的病原学及药敏结果分析

Analysis of eti ology and drug sensitivity of multidrug-resistant organisms in urinary tract infection in stroke patients

目的分析脑卒中患者多重耐药菌(MDRO)尿路感染的病原学及药敏结果,以期为临床治疗提供参考。方法选取厦门大学附属第一医院2015年1月—2022年1月收治的1812例脑卒中患者作为研究对象。统计脑卒中患者MDRO尿路感染发生率。收集MDRO尿路感染患者的性别、年龄、脑卒中类型、是否合并2型糖尿病、是否合并其他泌尿系统疾病等资料。鉴定MDRO菌株名称、检测菌株药物敏感性、检测菌株产超广谱β-内酰胺酶(ESBLs)情况。结果脑卒中患者发生尿路感染72例,发生率为3.97%(72/1812)。72例尿路感染患者中,检出致病菌56株,检出率77.78%(56/72)。其中,革兰阴性杆菌检出38株,占比67.85%(38/56);革兰阳性球菌检出11株,占比19.65%(11/56);真菌检出7株,占比12.50%(7/56)。对革兰阴性菌株检测发现,在38株病原菌中,有13株产ESBLs,总检出率为34.21%。其中,有8株大肠埃希菌产ESBLs,检出率为40.00%;有4株肺炎克雷伯菌中产ESBLs,检出率为45.00%。不同性别、年龄、是否合并2型糖尿病、是否合并其他泌尿系疾病患者发生MDRO尿路感染率比较,差异均有统计学意义(P<0.05)。大肠埃希菌、肺炎克雷伯菌对氨苄西林、哌拉西林、氧氟沙星和庆大霉素均有较强的耐药性,耐药率均在30%以上。金黄色葡萄球菌整体耐药性较强,尤其是对青霉素、莫西沙星、氧氟沙星不敏感,对利福平较敏感,对万古霉素、利奈唑胺敏感率高;粪肠球菌、屎肠球均对青霉素、利福平敏感率低,粪肠球菌对氧氟沙星较敏感,但屎肠球菌对氧氟沙星、莫西沙星敏感率较低,二者对万古霉素、利奈唑胺敏感性高。结论脑卒中患者尿路感染病原菌以革兰阴性菌为主,感染发生率与患者合并症密切相关。临床工作中,应严格遵守无菌操作规范,重视脑卒中患者尿路感染病原菌的检测,根据病情及时调整抗生素使用方案,进而降低抗生素滥用和MDRO感染发生率。

Objective To analyze the etiology and drug sensitivity of multidrug-resistant organisms(MDRO)in urinary tract infection in stroke patients to provide a reference for clinical treatment.Methods A total of 1812 stroke patients admitted to the First Affiliated Hospital of Xiamen University from January 2015 to January 2022 were selected as the study participants.The incidence of MDRO in urinary tract infection was counted in patients with stroke.Data on gender,age,stroke type,presence or absence of type 2 diabetes mellitus,and presence or absence of other urinary system diseases were collected from patients with MDRO urinary tract infection.The name of MDRO strains was identified,the drug sensitivity of strains was detected,and extended-spectrumβ-lactamases(ESBLs)production of strains was tested.Results There were 72 cases of urinary tract infection in stroke patients,with an incidence of 3.97%(72/1812).Of the 72 patients with urinary tract infections,56 strains were detected,with a detection rate of 77.78%(56/72).Among them,38 strains of gram-negative bacilli were detected,accounting for 67.85%(38/56);11 strains of gram-positive cocci were detected,accounting for 19.65%(11/56);and 7 strains of fungi were detected,accounting for 12.50%(7/56).Detection of Gram-negative strains of urinary tract infection showed that 13 of 38 pathogens produced ESBLs,with an overall detection rate of 34.21%.Among them,8 strains of E.coli produced ESBLs,with a detection rate of 40.00%;4 strains of K.pneumoniae produced ESBLs,with a detection rate of 45.00%.There were significant differences in the MDRO rate of urinary tract infection among patients of different gender,age,type 2 diabetes,and other urinary system diseases(P<0.05).Escherichia coli and K.pneumoniae were strongly resistant to ampicillin,piperacillin,ofloxacin,and gentamicin,with resistance rates of over 30%.Staphylococcus aureus has strong overall drug resistance,especially to penicillin,moxifloxacin,and ofloxacin,which is more sensitive to rifampicin and has a high sensitivity rate to vancomycin and linezolid.Enterococcus faecalis and Enterococcus faecium have a low sensitivity rate to penicillin and rifampicin,Enterococcus faecalis is more sensitive to ofloxacin,but Enterococcus faecium has a low sensitivity rate to ofloxacin and moxifloxacin,and both of them have a high sensitivity to vancomycin and linezolid.Conclusion Gram-negative bacteria are the main pathogens of urinary tract infection in stroke patients,and the incidence of infection is closely related to complications.Clinically,aseptic operation specifications should be strictly followed,attention should be paid to the detection of pathogens of urinary tract infection in stroke patients,and antibiotic use regimens should be adjusted in time following the condition,so as to reduce antibiotic abuse and the incidence of MDRO.