感染性结石患者尿液细菌的菌谱及耐药性特征

The characteristics of distribution and drug resistance of urinary bacteria in patients with infectious stones

目的分析感染性结石患者中段尿细菌谱特点及耐药性情况。方法回顾性分析广州医科大学附属第一医院2016年9月至2018年9月收治的254例感染性结石患者的临床资料。男101例,女153例。年龄(51.5±12.3)岁。合并高血压病58例(22.8%),糖尿病17例(6.7%),肾积水195例(76.8%)。结石负荷1443.5(660.8,2837.5)mm2。收集中段尿行细菌培养鉴定和药敏试验。所有患者均行经皮肾镜取石术。结果本研究254例,中段尿细菌培养阳性89例(35.0%),阴性165例(65.0%)。阳性组和阴性组的尿白细胞阳性例数分别为77例(86.5%)和83例(50.3%),尿亚硝酸盐阳性例数分别为57例(64.0%)和24例(14.5%),术后发热分别为23例(25.8%)和24例(14.5%),差异均有统计学意义(P<0.05)。中段尿细菌培养检出14种细菌,检出率最高的3种细菌依次为大肠埃希菌[38.2%(34/89)]、奇异变形杆菌[15.7%(14/89)]和铜绿假单胞菌[11.2%(10/89)]。药敏试验结果显示,上述3种细菌对头孢唑啉、头孢呋辛钠、头孢呋辛酯、氨苄西林和复方新诺明的耐药率均>40.0%;大肠埃希菌和铜绿假单胞菌对环丙沙星和左氧氟沙星的耐药率≥40.0%;大肠埃希菌和奇异变形杆菌对美罗培南、亚胺培南、厄他培南、哌拉西林/他唑巴坦和阿米卡星等的耐药率均<10.0%;大肠埃希菌对呋喃妥因和替加环素的耐药率,以及奇异变形杆菌对妥布霉素、氨曲南和头孢西丁的耐药率均<10%;铜绿假单胞菌对头孢他啶、头孢吡肟、庆大霉素和氨曲南等药物的耐药率均<10%。结论感染性结石患者中段尿细菌培养检出率最高的细菌依次是大肠埃希菌、奇异变形杆菌和铜绿假单胞菌,均对氨苄西林、复方新诺明和部分头孢菌素类药物的耐药率较高,对部分β-内酰胺酶抑制剂复合制剂和碳青霉烯类等抗菌药物的耐药率较低;大肠埃希菌和铜绿假单胞菌对环丙沙星和左氧氟沙星的耐药率较高。

Objective To investigate the characteristics of distribution and drug resistance of urinary bacteria in the mid-stream urine of patients with infectious stones.Methods The retrospective study analyzed the clinical data of 254 patients with infectious stones in the First Affiliated Hospital of Guangzhou Medical University from September 2016 to September 2018.All patients were treated with PCNL.Overall,there were 101 male and 153 female patients,with the mean age of(51.5±12.3)years,and the mean stone burden of 1443.5(660.8,2837.5)mm2.There were 58(22.8%)patients with hypertension,17(6.7%)patients with diabetes and 195(76.8%)with hydronephrosis.The mid-stream urine samples were obtained for bacterial culture and susceptibility test,and the results of urine culture and antimicrobial susceptibility were recorded and analyzed.Results Of 254 patients involved in this study,89(35.0%)were positive and 165(65.0%)were negative for urinary bacterial culture of the mid-stream.The proportion of patients with positive urine bacterial culture of the mid-stream who had positive urine leucocytes,positive urine nitrite and postoperative pyrexia were 86.5%(77/89),64.0%(57/89),25.8%(23/89),respectively,which was higher than that of patients with negative urine bacterial culture of the mid-stream[50.3%(83/165),14.5%(24/165),14.5%(24/165),P<0.05].Four teen kinds of bacteria were detected from the mid-stream urine,and the three bacteria with the highest detection rate in turn were Escherichia coli of 38.2%(34/89),Proteus mirabilis of 15.7%(14/89),and Pseudomonas aeruginosa of 11.2%(10/89).The results of this study showed that three common bacteria had high resistance to drug including Cefazolin,Cefuroxime,Cefuroxime ester,Ampicillin and Co-trimoxazole(all resistance rate>40%).The resistance rates of Escherichia coli and Pseudomonas aeruginosa to Ciprofloxacin and Levofloxacin were higher than or equal to 40%.The resistance rates of Escherichia coli and Proteus mirabilis to meropenem,imipenem,ertapenem,piperacillin/tazobactam and amikacin were all lower than 10%.In addition,the resistance rates of Escherichia coli to nitrofurantoin and tigecycline and Proteus mirabilis to tobramycin,aztreonam and cefoxitin were all less than 10%.The resistance rates of Pseudomonas aeruginosa to ceftazidime,cefepime,gentamicin and aztreonam were less than 10%.Conclusions The highest detection rate of urinary bacteria in culture of the mid-stream with infectious stones are Escherichia coli,Proteus mirabilis and Pseudomonas aeruginosa,all of which showed high resistance to Ampicillin,Cotrimoxazole,and some cephalosporins.Escherichia coli and Pseudomonas aeruginosa showe high resistance to Ciprofloxacin and Levofloxacin,and all of the three bacteria have low resistance rates to someβ-Lactamase inhibitor complex and carbapenems,suggesting a reference for clinical empirical medical treatment.