2018~2020年某院尿液标本中大肠埃希菌的耐药性分析

Drug resistance analysis of Escherichia coli in urine specimens from a hospital from 2018 to 2020

目的 了解近3年本院尿液标本病原菌分布及大肠埃希菌对常用抗菌药物耐药情况,为临床合理选择抗菌药物提供依据。方法 2018~2020年四川省广安市人民医院1391例患者的尿液标本,分析尿液标本中病原菌分布情况、肠埃希菌科室分布情况、大肠埃希菌抗菌药物敏感性、产超广谱β内酰胺酶(ESBLs)大肠埃希菌检出情况及耐药情况、ESBLs阴性大肠埃希菌耐药情况。结果 1391例患者尿液标本中分离出1120株革兰阴性菌,主要以大肠埃希菌(711株)、肺炎克雷伯菌(107株)和奇异变形杆菌(60株)为主;271株革兰阳性菌,主要以粪肠球菌(104株)、屎肠球菌(88株)和无乳链球菌(16株)为主。大肠埃希菌4.6%(33/711)的菌株分离来自门诊患者, 95.4%(678/711)的菌株分离来自住院患者。具体科室分布如下:大肠埃希菌主要分布于泌尿外科、神经内科、普内科、ICU等,检出率依次为63.6%(452/711)、11.7%(83/711)、5.5%(39/711)、3.5%(25/711)。711株大肠埃希菌对青霉素类,第一、二、三代头孢菌素(头孢噻肟、头孢他啶除外),氟喹诺酮类以及复方新诺明、四环素耐药率均>50%;对其他抗菌药物较为敏感。711株大肠埃希菌中产ESBLs菌株352株(49.5%), ESBLs阴性大肠埃希菌366株(51.5%)。产ESBLs菌株对氨苄西林、哌拉西林以及第一、二、三代头孢菌类(头孢他啶除外)耐药率>95%,对氟喹诺酮类耐药率>70%。ESBLs阴性大肠埃希菌对头孢菌素类抗菌药物较敏感,耐药率均<20%。结论 近3年本院尿液标本中主要病原菌大肠埃希菌对多类抗菌药物耐药,近半数菌株产ESBLs,需加强感控管理。

Objective To understand the drug resistance of Escherichia coli to commonly used antibacterial agents in recent 3 years, so as to provide evidence for clinicians to choose antibiotics reasonably.Methods The urine specimens of 1391 patients from the People’s Hospital of Guang’an, Sichuan Province from 2018 to 2020 were collected to analyze the distribution of pathogenic bacteria in urine specimens, the department distribution of Escherichia coli, the antibacterial sensitivity of Escherichia coli, the detection of Escherichia coli producing extended spectrum β-lactamases(ESBLs) and drug resistance, and the drug resistance of ESBLsnegative Escherichia coli. Results 1120 Gram-negative strains were isolated from the urine specimens of 1391 patients, mainly Escherichia coli(711 strains), Klebsiella pneumoniae(107 strains) and Proteus mirabilis(60 strains);271 Gram-positive strains, mainly Enterococcus faecalis(104 strains), Enterococcus faecium(88strains) and Streptococcus agalactis(16 strains). 4.6%(33/711) of Escherichia coli strains were isolated from outpatients, and 95.4%(678/711) were isolated from inpatients. The specific departmental distribution was as follows: Escherichia coli was mainly distributed in urology, neurology, general medicine, and ICU, with detection rates of 63.6%(452/711), 11.7%(83/711), 5.5%(39/711), and 3.5%(25/711), in that order. 711 strains of Escherichia coli were >50% resistant to penicillins, first, second and third generation cephalosporins(except cefotaxime and ceftazidime), fluoroquinolones, and cotrimoxazole and tetracycline. It was more sensitive to other antibacterial agents. Among the 711 Escherichia coli strains, 352 strains(49.5%) were ESBLs-producing strains and 366 strains(51.5%) were ESBLs-negative Escherichia coli. The ESBLs-producing strains were >95%resistant to ampicillin, piperacillin, and the first, second, and third generation cephalosporins(except ceftazidime).The resistance rate to fluoroquinolones was >70%. ESBLs-negative Escherichia coli were more sensitive to cephalosporin antibacterial agents, with resistance rates of <20%. Conclusion In the past three years, the main pathogenic bacteria Escherichia coli in our urine specimens are resistant to many types of antimicrobial agents,and nearly half of the strains produce ESBLs, which needs to be controlled and managed.