妇产科患者尿路感染的病原菌分布及耐药性变迁

Pathogenic bacteria distribution and drug resistance change in patients with urinary tract infection in obstetrics and gynecology

目的 了解妇产科患者发生尿路感染的病原菌分布状况及耐药特点,分析其耐药性变迁.方法 选取2016年1月至2020年12月在本院妇产科病区住院的634例尿路感染患者,取患者的中段尿进行培养,比较分析不同年份的病原菌分布状况及耐药性变化趋势.结果 共检出病原菌706株,其中革兰阴性杆菌581株(82.30%)、革兰阳性球菌94株(13.31%)和念珠菌31株(4.39%).排名前3位的病原菌依次为大肠埃希菌(66.29%)、肺炎克雷伯菌(8.22%)和粪肠球菌(6.23%).奇异变形杆菌、无乳链球菌检出率呈上升趋势(P<0.05).尿路感染随着年龄增长呈上升趋势(χ^(2)=118.28,P<0.001).年龄≥61岁的妇产科患者具有最高的感染率[127/386(32.90%)].大肠埃希菌和肺炎克雷伯菌对头孢唑林的耐药率较高,大肠埃希菌在5年之间对庆大霉素、复方新诺明的耐药率呈下降趋势(均P>0.05).大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)菌株的检出率较高[61.11%(286/468)vs.46.55%(27/58)],大肠埃希菌产ESBLs菌株呈上升趋势(χ^(2)=10.03,P<0.05).粪肠球菌对四环素的耐药率较高且稳定,肺炎克雷伯菌和粪肠球菌在5年之间对各种抗菌药物的耐药率比较,差异均无统计学意义(均P>0.05).结论 大肠埃希菌是妇产科尿路感染的主要病原菌,且产ES-BLs菌株检出率较高.临床需关注病原菌分布状况及耐药性变化趋势,规范化使用抗菌药物.

Objective To understand the distribution and drug resistance of pathogenic bacteria in patients with urinary tract infection in obstetrics and gynecology,and to analyze the change of drug resistance.Methods From January 2016 to December 2020,634 patients with urinary tract infection who were hospitalized in the ward of obstetrics and gynecology of our hospital were selected.Midcourse urine of the patients was taken for culture,and the distribution of pathogenic bacteria and the change trend of drug resistance in different years were compared and analyzed.Results A total of 706 strains of pathogenic bacteria were detected,including 581(82.30%)gram-negative bacilli,94(13.31%)gram-positive cocci and 31(4.39%)candida.The top 3 pathogens were escherichia coli(66.29%),klebsiella pneumoniae(8.22%)and enterococcus faecalis(6.23%).The detection rates of proteus mirabilis and streptococcus agalactiae were increased(P<0.05).Urinary tract infection increased with age(χ^(2)=118.28,P<0.001).Obstetrics and gynecology patients≥61 years of age had the highest infection rate[127/386(32.90%)].The resistance rate of escherichia coli and klebsiella pneumoniae to cefazolin is high.The resistance rates of escherichia coli to gentamicin and trimethoprim-sulfamethoxazole showed a decreasing trend in five years(all P<0.05).The detection rate of ESBL-producing strains of escherichia coli and klebsiella pneumoniae was higher(61.11%vs.46.55%),and ESBL-producing strains of escherichia coli showed an increasing trend(χ^(2)=10.03,P<0.05).The resistance rate of enterococcus faecalis to tetracycline was high and stable.There was no significant difference in the resistance rates of klebsiella pneumoniae and enterococcus faecalis to various antibiotics in 5 years(P>0.05).Conclusions Escherichia coli is the main pathogen of urinary tract infection in obstetrics and gynecology,and the detection rate of ESBLs-producing strain is high.Clinical attention should be paid to the distribution of pathogenic bacteria and the trend of drug resistance,and the rational and standardized use of antibiotics.