2017-2021年滇中及滇西部地区多家三级医院尿液病原菌分布和耐药分析

Distribution and drug resistance analysis of urinary pathogenic bacteria in several tertiary hospitals in central and western Yunnan from 2017 to 2021

目的探讨2017-2021年云南省中部和西部地区多家三级综合医院尿标本中分离病原菌的分布和耐药情况,为临床初期经验性用药提供依据。方法分析2017-2021云南多家三级综合医院尿标本中检出的同一患者非重复细菌,采用纸片扩散法或自动仪器法进行药敏检测,按照美国临床和实验室标准协会(CLSI)2021年标准进行判读,使用WHONET5.6软件对数据进行统计分析。结果共检测出细菌27495株,革兰阴性菌20955株占76.2%,革兰阳性菌6540株(占23.8%);女性标本16966株(占61.7%),男性标本10529株(占38.3%);>65岁的标本11159株(占40.6%),>18~65岁的标本15295株(占55.6%),≤18岁的标本1041株(占3.8%);排前五位分别为大肠埃希菌(51.4%)、屎肠球菌(9.5%)、肺炎克雷伯菌(7.8%)、粪肠球菌(6.4%)、铜绿假单胞菌(3.0%)。其中大肠埃希菌对替加环素、碳青霉烯类、阿米卡星、呋喃妥因、哌拉西林/他唑巴坦、磷霉素的耐药率<5%;对青霉素类、第一、二、三代头孢菌素、喹诺酮类有较高的耐药水平在49.2%~100.0%;肺炎克雷伯菌对替加环素的耐药水平较低在0.0%~8.4%,对碳青霉烯类、阿米卡星耐药率介于5.8%~26.2%;铜绿假单胞菌对抗菌药物的耐药性均高于30.0%。屎肠球菌和粪肠球菌对万古霉素、利奈唑胺、替考拉宁、替加环素的耐药率<5.0%;粪肠球菌对磷霉素、呋喃妥因、氨苄西林、青霉素G的耐药率<10.0%。结论尿标本病原菌多样,早期经验性治疗的同时,应尽快根据培养鉴定及药敏结果针对性用药,从而提高治疗效果和减缓耐药性的产生和传播。

Objective To explore the composition distribution and drug resistance of pathogenic bacteria isolated from urine specimens in several tertiary general hospitals in central and western Yunnan Province from 2017 to 2021,and to provide a basis for the initial empirical clinical use of drugs.Methods Non-duplicate bacteria detected in urine specimens from the same patient in several tertiary general hospitals in Yunnan from 2017-2021 were analyzed for drug sensitivity testing by paper diffusion method or automated instrumental method,interpreted according to the American Clinical and Laboratory Standards Institute(CLSI)2021 standards,and the data were statistically analyzed using WHONET 5.6 software.Results A total of 27495 strains of bacteria were detected,20955 strains of Gram-negative bacteria accounted for 76.2%,and 6540 strains of Gram-positive bacteria accounted for 23.8%.16966 strains of female specimens accounted for 61.7%,and 10529 strains of male specimens accounted for 38.3%.11159 strains of>65 years old accounted for 40.6%,15295 strains aged>18-65 accounted for 55.6%,and 1041 strains≤18 years old accounted for 3.8%.The top five were Escherichia coli(51.4%),Enterococcus faecium(9.5%),Klebsiella pneumoniae(7.8%),Enterococcus faecalis(6.4%),Pseudomonas aeruginosa(3.0%).Among them,the resistance rates of Escherichia coli to tigecycline,carbapenems,amikacin,nitrofurantoin,piperacillin/tazobactam,and fosfomycin were less than 5%.It had a high level of resistance to penicillin,the first,second and third generation cephalosporins,quinolones and the drug resistance rates were 49.2%-100.0%.The drug resistance level of Klebsiella pneumoniae to tegacyclin was low,and the drug resistance rates were 0.0%-8.4%,the drug resistance rates to carbapenems and amikacin were 5.8%-26.2%.The resistance rates of Pseudomonas aeruginosa to antibiotics were higher than 30.0%.The resistance rates of Enterococcus faecalis and Enterococcus faecalis to vancomycin,linezolid,teicoplanin and tigecycline were less than 5.0%.The resistance rates of Enterococcus faecalis to fosfomycin,furantoin,ampicillin and penicillin G were less than 10.0%.Conclusion The pathogenic bacteria in urine specimens are diverse.Early empirical treatment should be conducted,at the same time,targeted medication should be given as soon as possible according to the results of culture identification and drug sensitivity,so as to improve the therapeutic effect and slow down the generation and spread of drug resistance.