泌尿系感染的病原菌分布及大肠埃希菌耐药性研究

Distribution of pathogenic bacteria causing urinary tract infection and drug resistance of Escherichia coli

目的 研究泌尿系感染的病原菌分布与大肠埃希菌耐药性。方法 选取312例泌尿系感染患者,收集所有患者的尿液标本,对其病原菌进行鉴别,并对大肠埃希菌进行体外药敏试验。分析病原菌种类及大肠埃希菌的耐药情况。结果 312例患者共分离得到病原菌186株。其中,革兰阴性杆菌157株(84.41%),大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、奇异变形杆菌、鲁氏不动杆菌、产气肠杆菌、洋葱伯克霍尔德菌、溶血不动杆菌、产酸克雷伯菌依次为118株(63.44%)、15株(8.06%)、10株(5.38%)、4株(2.15%)、3株(1.61%)、2株(1.08%)、2株(1.08%)、1株(0.54%)、1株(0.54%)、1株(0.54%);革兰阳性球菌共27株(14.52%),屎肠球菌、粪肠球菌、金黄色葡萄球菌、溶血葡萄球菌、无乳链球菌依次为10株(5.38%)、7株(3.76%)、6株(3.23%)、3株(1.61%)、1株(0.54%);真菌2株(1.08%),均为白色念球菌。所有病原菌中大肠埃希菌、肺炎克雷伯菌占比排在前三。经检测,大肠埃希菌对于氨苄西林、头孢唑林、哌拉西林/他唑巴坦、头孢他啶、头孢曲松、阿米卡星、头孢吡肟、环丙沙星、亚胺培南、氨曲南、头孢替坦、呋喃妥因、厄他培南的耐药率依次为84.75%、100.00%、1.69%、27.97%、59.32%、3.39%、14.41%、50.85%、0、35.59%、1.69%、2.54%、0,产超广谱β-内酰胺酶(ESBLs)阳性菌株(+)对于氨苄西林、头孢唑林、哌拉西林/他唑巴坦、头孢他啶、头孢曲松、阿米卡星、头孢吡肟、环丙沙星、亚胺培南、氨曲南、头孢替坦、呋喃妥因、厄他培南的耐药率依次为100.00%、100.00%、0、42.03%、97.10%、4.35%、23.19%、66.67%、0、55.07%、0、2.90%、0,产ESBLs阴性菌株(-)对于氨苄西林、头孢唑林、哌拉西林/他唑巴坦、头孢他啶、头孢曲松、阿米卡星、头孢吡肟、环丙沙星、亚胺培南、氨曲南、头孢替坦、呋喃妥因、厄他培南的耐药率依次为63.27%、100.00%、4.08%、8.16%、6.12%、2.04%、2.04%、28.57%、0、8.16%、4.08%、2.04%、0,提示大肠埃希菌对于青霉素类药物、头孢菌素类药物具有更高的耐药性,而对于呋喃妥因、哌拉西林/他唑巴坦、头孢替坦、阿米卡星具有较低的耐药性。结论 在泌尿系感染中,大肠埃希菌的检出率较高,且大肠埃希菌对青霉素类药物、头孢菌素类药物的耐药性更高。

Objective To study the distribution of pathogenic bacteria causing urinary tract infection and drug resistance of Escherichia coli.Methods A total of 312 patients with urinary tract infection were selected,and urine samples of all patients were collected to identify the pathogenic bacteria,and Escherichia coli was tested for drug sensitivity in vitro.The species of pathogenic bacteria and drug resistance of Escherichia coli were analyzed.Results A total of 186 strains of pathogenic bacteria were isolated from 312 patients.Among them,157 strains(84.41%)of Gram-negative bacilli,Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Proteus mirabilis,Acinetobacter lwoffii,Enterobacter aerogen,Burkholderia cepacia,Acinetobacter haemolyticus and Klebsiella oxytoca were 118 strains(63.44%),15 strains(8.06%),10 strains(5.38%),4 strains(2.15%),3 strains(1.61%),2 strains(1.08%),2 strains(1.08%),1 strain(0.54%),1 strain(0.54%),1 strain(0.54%);27 strains(14.52%)of Gram-positive cocci,Enterococcus faecium,Enterococcus faecalis,Staphylococcus aureus,Staphylococcus haemolyticus and Streptococcus agalactiae were 10 strains(5.38%),7 strains(3.76%),6 strains(3.23%),3 strains(1.61%)and 1 strain(0.54%);2 strains(1.08%)of fungi,all of which were Candida albicans.After testing,the resistance rates of Eschericea coli to ampicillin,cefazolin,piperacillin/tazobactam,ceftazidine,ceftriaxone,amikacin,cefepime,ciprofloxacin,imipenem,aztreonam,cefotetan,furantoin and ertapenem were 84.75%,100.00%,1.69%,27.97%,59.32%,3.39%,14.41%,50.85%,0,35.59%,1.69%,2.54%,0;the resistance rates of extended-spectrumβ-lactamases(ESBLs)-producing positive strains(+)to ampicillin,cefazolin,piperacillin/tazobactam,ceftazidine,ceftriaxone,amikacin,cefepime,ciprofloxacin,imipenem,aztreonam,cefotetan,furantoin and ertapenem were 100.00%,100.00%,0,42.03%,97.10%,4.35%,23.19%,66.67%,0,55.07%,0,2.90%,0;the resistance rates of ESBLs-producing negative strains(-)to ampicillin,cefazolin,piperacillin/tazobactam,ceftazidine,ceftriaxone,amikacin,cefepime,ciprofloxacin,imipenem,aztreonam,cefotetan,furantoin and ertapenem were 63.27%,100.00%,4.08%,8.16%,6.12%,2.04%,2.04%,and 2.04%,28.57%,0,8.16%,4.08%,2.04%,0.It was suggested that Escherichia coli has higher resistance to penicillins and cephalosporins,but lower resistance to furantoin,piperacillin/tazobactam,cefotetan and amikacin.Conclusion In urinary tract infection,the total detection rate of Escherichia coli is increasing continuously,and Escherichia coli has higher resistance to penicillins and cephalosporins.