2019年-2021年某院关节置换术后留置尿管患者尿路感染病原菌及耐药性分析

Analysis of Pathogenic Bacteria and Drug Resistance of Urinary Tract Infection in Patients with Indwelling Catheter after Joint Replacement in a Hospital from 2019 to 2021

目的分析某院关节置换术后留置尿管患者尿路感染病原菌及耐药性变化,为临床合理用药提供科学依据。方法回顾性分析2019年6月1日-2021年6月30日收治的82例关节置换术后留置尿管合并尿路感染患者的临床一般资料,对所有尿路感染患者尿液样本中的病原菌进行鉴定,分析其耐药性情况。结果82例留置尿管合并尿路感染患者尿液标本中共分离86株不重复病原菌,其中革兰阴性菌65株(75.58%),包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌分别为50株(58.14%)、10株(11.64%)、5株(5.81%),且大肠埃希菌和肺炎克雷伯菌中共检出28株超广谱β-内酰胺酶(ESBLs)菌,检出率为46.67%;革兰阳性菌18株(20.93%),包括屎肠球菌、粪肠球菌、金黄色葡萄球菌分别为8株(9.30%)、6株(6.98%)、1株(1.63%);真菌3株(3.45%)。大肠埃希菌对磺胺甲噁唑/甲氧苄啶、环丙沙星、头孢噻肟、左氧氟沙星的耐药率均>60%;肺炎克雷伯菌对磺胺甲噁唑/甲氧苄啶、环丙沙星的耐药率均>60%;屎肠球菌对青霉素、环丙沙星、左氧氟沙星的耐药率均>60%,2020年-2021年屎肠球菌对红霉素的耐药率均为100%;粪肠球菌对青霉素、红霉素、庆大霉素的耐药率为100%。结论2019年-2021年某医院关节置换术后留置尿管患者尿路感染病原菌主要以革兰阴性菌中的大肠埃希菌为主,3年之间的细菌谱与药敏特点无明显改变,但耐药性较高,存在较为严重的多药耐药现象。临床应密切监测耐药性情况,并根据药敏试验选择合理的抗菌药物治疗,从而提高治疗效果。

Objectives This study aims to explore the change of pathogenic bacteria and drug resistance of urinary tract infection in patients with indwelling catheter after joint replacement in recent years and to offer a scientific basis for rational use of drug in clinical practice.Methods General clinical data of 82 patients with indwelling urethral catheter complicated with UTIS admitted to Wangjing Hospital Chinese Academy of Traditional Chinese Medicine from June 1,2019 to June 30,2021 were retrospectively analyzed.Pathogenic bacteria in urine samples of all UTIS patients were identified,and drug resistance was analyzed according to the identification results.Results Atotal of 86 strains of non-repetitive pathogens were isolated from the urine samples of 82 patients with indwelling urinary catheter complicated with urinary tract infection,of which 65 strains(75.58%)were Gram-negative,including Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa,50 strains(58.14%),10 strains(11.64%)and 5 strains(5.81%)respectively.Atotal of 28 strains of ultra-broad spectrumβ-lactamase(ESBLs)were detected from Escherichia coli and Klebsiella pneumoniae,and the detection rate was 46.67%.There were 18 strains of Gram-positive bacteria(20.93%),including Enterococcus faecium,Enterococcus faecalis,and Staphylococcus aureus(8 strains(9.30%),6 strains(6.98%)and 1 strain(1.63%),respectively.3 strains of fungi(3.45%)were detected.The drug resistance rates of E.coli to sulfamethoxazole/trimethopridium,ciprofloxacin,cefotaxime,and levofloxacin were all>60%.The resistance rates of Klebsiella pneumoniae to sulfamethoxazole/trimethoprim and ciprofloxacin were all>60%.The resistance rates of Enterococcus faecium to penillin,ciprofloxacin,and levofloxacin were all>60%from 2019 to 2021,and the resistance rates of Enterococcus faecium to erythromycin were 100%from 2020 to 2021.From 2019 to 2021,the resistance rate of Enterococcus faecalis to penicillin,erythromycin,and gentamicin was 100%.Conclusions From 2019 to 2021,the pathogens of urinary tract infection in patients with indwelling catheters after joint replacement in Wangjing Hospital Chinese Academy of Traditional were mainly Escherichia coli from Gram negative bacteria.The bacterial spectrum and drug sensitivity characteristics had not changed significantly over three years,but the drug resistance was high,and there was a serious phenomenon of multidrug resistance.Therefore,drug resistance should be closely monitored in the clinic,and reasonable antimicrobial treatment should be selected according to the drug sensitivity test,so as to improve the therapeutic effect.