尿路感染患者常见病原菌分布及耐药性分析

Distribution and drug resistance of common pathogens in patients with urinary tract infections

目的分析徐州医科大学附属医院尿路感染患者尿液标本的病原菌分布及大肠埃希菌对常用抗菌药物的耐药情况,为合理选用抗菌药物提供指导依据。方法收集2021年8月—2022年7月徐州医科大学附属医院送检的3882份自行收集或无菌导出的尿液标本,并进行中段尿培养,分析尿培养阳性标本病原菌分布结果、大肠埃希菌检出科室分布情况及其抗菌药物敏感性。结果3882份送检尿培养标本中尿培养阳性标本共881份(22.69%),其中由单一菌株引起的有846份,由2种混合菌株引起的有35份;共分离出916株病原菌,其中检出512株革兰阴性菌(55.90%),以大肠埃希菌(306株,33.41%)和肺炎克雷伯菌(75株,8.19%)为主;检出革兰阳性菌188株(20.52%),以屎肠球菌(80株,8.73%)和粪肠球菌(27株,2.95%)为主;检出216株真菌(23.58%),以白假丝酵母菌(77株,8.41%)和热带假丝酵母菌(58株,6.33%)为主。尿路致病性大肠埃希菌(UPEC)分离株中8.50%(26/306)分离自门诊患者,91.50%(280/306)分离自住院患者,其中泌尿外科、肾脏内科、风湿免疫科、神经内科和重症监护室(ICU)的检出率依次为32.68%、20.92%、8.50%、6.86%、6.21%。UPEC对替卡西林(88.24%)、头孢呋辛(61.49%)、头孢呋辛酯(62.94%)、左氧氟沙星(72.46%)和复方新诺明(58.03%)的耐药性较高,耐药率均高于50%;对其他抗菌药物较为敏感。结论该院尿路感染标本中病原菌构成复杂、种类多样,其中革兰阴性菌是尿路感染的主要致病菌,以大肠埃希菌占比最多,部分病原菌呈现高水平耐药。患者应积极配合医生开展病原菌鉴定及药物敏感试验,以便合理选用抗菌药物,避免多重耐药菌和新型耐药菌的出现。

Objective To analyze the distribution of pathogenic bacteria in urine samples of patients with urinary tract infections in the Affiliated Hospital of Xuzhou Medical University and the resistance of Escherichia coli to commonly used antibiotics,so as to provide guidance for the rational selection of antibiotics.Methods A total of 3882 self-collected or sterile urine samples were collected in the Affiliated Hospital of Xuzhou Medical University from August 2021 to July 2022.The midstream urine culture was carried out to analyze the distribution of pathogens in urine,the department distribution and antimicrobial susceptibility of Escherichia coli.Results A total of 881(22.69%)in 3882 cultured urine samples were positive for bacteria,where 846 were caused by a single strain and 35 were caused by two mixed strains;916 strains of pathogenic bacteria were isolated,including 512 strains of gram-negative bacteria(55.90%),where Escherichia coli(306 strains,33.41%)covered the largest percentage,followed by Klebsiella pneumoniae(75 strains,8.19%);188 strains of gram-positive bacteria(20.52%),where Enterococcus faecium(80 strains,8.73%)covered the largest percentage,followed by Enterococcus faecalis(27 strains,2.95%);216 strains of fungi(23.58%),where Candida albicans(77 strains,8.41%)and Candida tropicalis(58 strains,6.33%)covered the largest percentage.Among the 306 strains of uropathogenic Escherichia coli(UPEC),8.50%(26/306)were isolated from outpatients and 91.50%(280/306)from inpatients,with the highest detection rates of patients in Departments of Urology,Nephrology,Rheumatology,Neurology and intensive care unit(ICU),which accounted for 32.68%,20.92%,8.50%,6.86%and 6.21%,respectively.The resistance of UPEC to ticarcillin(88.24%),cefuroxime(61.49%),cefuroxime axetil(62.94%),levofloxacin(72.46%)and compound sulfamethoxazole(58.03%)were higher than 50%;but sensitive to other antibacterial drugs.Conclusions The composition of pathogens in this hospital is complicated and varied in the positive specimens of patients with urinary tract infections.Gram-negative bacteria are the leading cause,with Escherichia coli accounting for the largest percentage.Parts of pathogens present high levels of drug resistance.Patients should actively cooperated with physicians to carry out pathogen identification and antimicrobial susceptibility test,so that to select antibiotics reasonably for the treatment of urinary tract infections,and effectively avoid the emergence of multi-drug resistant bacteria and new drug-resistant bacteria.