34例嚴重尿源性膿毒症病原菌分佈及耐藥分析

Pathogenic bacteria distribution and antibiotic resistance of 34 urosepsis cases

目的分析2009年~2013年間澳門鏡湖醫院重症醫學科病房34例嚴重尿源性膿毒症的細菌培養及藥敏試驗結果,瞭解本院尿源性膿毒症的病原菌分佈及耐藥特點,為選用合適的抗生素提供依據。方法對2009年~2013年收住本院重症醫學科病房的34例嚴重尿源性膿毒症的血、尿培養標本,分離細菌並做藥物敏感性試驗。結果共檢出病原菌47株,其中革蘭氏陰性細菌45株(95.74%),革蘭氏陽性細菌2株(4.26%)。革蘭氏陰性桿菌以大腸埃希菌為主,佔78.72%,其次為肺炎克雷伯菌佔10.64%。45株革蘭氏陰性細菌的產超廣譜β-內酰胺酶(ESBLs)檢出率為24.44%。對喹諾酮類抗生素的耐藥嚴重,敏感性約50%;除Piperacillin/Tazobactam(100%)外,對頭孢類和β-內酰胺類/β-內酰胺酶抑制劑的敏感性約60%~70%;對碳青酶烯類100%敏感。結論本院尿源性膿毒症的病原菌以大腸埃希菌為主,對於尿源性膿毒症病人的初始經驗性抗生素治療可直接選擇碳青酶烯類,避免使用喹諾酮類。

Objective T To investigate the bacteria spectrum and the antibiotic resistance in 34 urosepsis cases based on the data of the intensive care unit in Kiang Wu hospital from 2009 to 2013,and to provide reference for choosing suitable antibiotics.Methods Bacterial identification and antibiotic resistance tests were performed from the blood and urine culture of 34 urosepsis cases.Results 47 bacterial strains were isolated including 45 strains of Gram-negative bacteria(95.74%)and 2 strains of Gram-positive bacteria(4.26%).Most of Gram-negative bacteria were Escherichia coli(78.72%),followed by Klebsiella pneumoniae(10.64%).About 24.44%of Gram-negative bacteria isolates produced ESBLs.Bacteria were highly resistant to Quinolones and the sensitivity was about 50%.The sensitivity to Sephalosporins andβ-lactams/β-Lactamase inhibitors was 60-70%,except Piperacillin/Tazobactam(100%).Most were sensitive to Carbapenem(100%).Conclusion The majority of pathogens was Echerichia coli in urosepsis in our hospital.Carbapenems is the first choice in initial empiric antibiotic therapy in urosepsis,and Quinolones should be avoided.