4974株尿培养病原菌谱与耐药特点分析

4974 strains of urine culture pathogenic bactrial spectrum and analysis on drug resistance characteristics

目的了解某院尿培养病原菌的分布及耐药情况,为治疗尿路感染提供依据。方法分析云南大学附属医院2015年1月至2019年12月住院患者中段尿培养阳性结果,采用微生物鉴定仪进行菌种鉴定及药敏试验,使用Whonet 5.6软件进行数据分析。结果共分离出4974株病原菌,其中革兰阴性菌3892株(78.2%),革兰阳性菌1082株(21.8%)。尿培养病原菌占比前5位分别为大肠埃希菌、肺炎克雷伯菌、屎肠球菌、铜绿假单胞菌、粪肠球菌。男性患者尿培养的大肠埃希菌和肺炎克雷伯菌对大部分抗菌药物的耐药率高于女性(P<0.05),女性患者尿培养的铜绿假单胞菌对大部分抗菌药物的耐药率高于男性(P<0.05)。≥65岁患者尿培养的大肠埃希菌对头孢他啶和环丙沙星的耐药率,以及屎肠球菌对高浓度链霉素耐药率均高于>14~<65岁患者尿培养的菌株(P<0.05)。>14~<65岁患者尿培养的肺炎克雷伯菌对头孢他啶、头孢曲松、氨曲南、庆大霉素、环丙沙星、左氧氟沙星的耐药率,铜绿假单胞菌对除头孢他啶以外的抗菌药物耐药率,以及粪肠球菌和屎肠球菌对红霉素和四环素耐药率均高于≥65岁患者尿培养的菌株(P<0.05)。大肠埃希菌对阿莫西林/克拉维酸、头孢哌酮/舒巴坦的耐药率呈升高趋势(P<0.05);肺炎克雷伯菌对青霉素类、阿莫西林/克拉维酸和哌拉西林/三唑巴坦、头孢菌素类、喹诺酮类、氨曲南、庆大霉素、复方磺胺甲噁唑、呋喃妥因耐药率较高(>40.0%),对厄他培南的耐药率呈升高趋势(P<0.05);铜绿假单胞菌对多数测试抗菌药物耐药率均呈升高趋势(P<0.05),尤其在2019年耐药率均较高(≥70.00%);屎肠球菌和粪肠球菌对抗菌药物的耐药情况较平稳(P>0.05)。结论大肠埃希菌和肠球菌仍然是尿路感染的主要病原菌,不同性别、不同年龄患者的病原菌谱和耐药性存在差异,尿培养病原菌中耐药率较高的大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌应为重点监测对象。

Objective To understand the distribution and drug resistance situation of urine culture pathogenic bacteria in a hospital to provide a basis for the treatment of urinary tract infection.Methods The midstream urine culture positive results of the inpatients in the Affiliated Hospital of Yunnan University from January 2015 to December 2019 were analyzed.The microbial identification instrument was used to identify the strains and conducted the drug sensitivity test,and the Whonet 5.6 software was used for the data analysis.Results A total of 4974 strains of pathogenic bacteria were isolated,including 3892 strains(78.2%)of Gram-negative bacteria,and 1082 strains(21.8%)of Gram-positive bacteria.The top five of urine culture pathogenic bacteria were Escherichia coli,Klebsiella pneumoniae,Enterococcus faecium,Pseudomonas aeruginosa and Enterococcus faecalis.The resistance rates of Escherichia coli and Klebsiella pneumoniae to most antibacterial drugs in males were higher than those in females(P<0.05);the resistance rates of Pseudomonas aeruginosa to most antibacterial drugs in females were higher than those in males(P<0.05).The resistance rates of Escherichia coli in urine cultures of the patients≥65 years old to ceftazidime,ciprofloxacin,and which of Enterococcus to high concentration streptomycin were higher than those of the patients>14-<65 years old(P<0.05).The resistance rates of Klebsiella pneumoniae to ceftazidime,ceftriaxone,aztreonam,gentamicin,ciprofloxacin,levofloxacin,the resistance rates of Pseudomonas aeruginosa to antibiotics other than ceftazidime,and which of Enterococcus faecalis and Enterococcus faecium to erythromycin and tetracycline in urine cultures of patients>14-<65 years old were higher than those of patients≥65 years old(P<0.05).The resistance rates of Escherichia coli to amoxicillin/clavulanic acid and cefoperazone/sulbactam showed an increasing trend(P<0.05).The resistance rates of Klebsiella pneumoniae to penicillins,amoxicillin/clavulinic acid and piperacillin/triazobactam,cephalosporins,quinolones,aztreonam,gentamicin,compound sulfamethoxazole and nitrofuratoin were high(>40.0%),and the resistance rate to ertapenem showed an increasing trend(P<0.05).The resistance rates of Pseudomonas aeruginosa to most tested antimicrobial agents showed an increasing trend(P<0.05),especially the drug resistance rates in 2019 were higher(≥70.0%).The resistance situation of Enterococcus faecium and Enterococcus faecalis to antimicrobial drugs was stable(P>0.05).Conclusion Escherichia coli and Enterococcus are still the major pathogenic bacteria of urinary tract infections.There were differences in the pathogenic bacterial spectrum and drug resistance between different sexes and among the patients with different ages.Among the urine culture pathogenic bacteria,Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa with high drug resistance rates should be the emphasis monitoring objects.