上尿路结石术后泌尿系感染患者的中段尿病原微生物培养结果及菌株耐药性分析

Pathogenic microorganism culture results and drug resistance of strains in midstream urine of patients with urinary infection after upper urinary tract stone surgery

目的分析上尿路结石(UUC)术后泌尿系感染患者的中段尿病原微生物培养结果及菌株耐药性。方法回顾性选取2019年1月至2023年6月赣州市南康区第一人民医院收治的78例UUC患者临床资料,统计并分析其中段尿病原菌检出结果及耐药性情况。结果78例UUC术后泌尿系感染患者共取78份中段尿样本,共检出102株病原菌,其中革兰阴性菌65株占63.7%,主要为大肠埃希菌和铜绿假单胞菌;革兰阳性菌32株占31.4%,主要为屎肠球菌和粪肠球菌;真菌5株占4.9%,包括白色假丝酵母菌和热带念珠菌;主要革兰阴性菌对环丙沙星、氨苄西林、头孢唑林、头孢他啶、头孢噻肟和哌拉西林等耐药率较高(61.3%~87.1%),对诺氟沙星、阿莫西林、头孢呋辛、头孢哌酮、亚胺培南及庆大霉素等抗菌药物耐药性处于中低水平(4.6%~48.4%),对美罗培南及阿米卡星无耐药性;主要革兰阴性菌对庆大霉素、红霉素、链霉素、青霉素G及氨苄西林等耐药率较高(60.0%~86.7%),对氯霉素、左氧氟沙星、环丙沙星及替考拉宁的耐药率处于中低水平(20.0%~53.3%),对万古霉素及利奈唑胺无耐药性。结论UUC术后泌尿系感染患者中段尿病原微生物培养的病原菌种类较多,主要以革兰阴性菌为主,且不同致病菌属耐药性不同,临床应根据致病菌合理选择抗菌药。

Objective To analyze the pathogenic microorganism culture results and drug resistance of strains in midstream urine of patients with urinary infection after operation for upper urinary tract calculi(UUC).Methods A retrospective study was conducted among 78 patients with UUC admitted to Nankang District First People's Hospital from January 2019 to June 2023.The detection results and drug resistance of pathogenic bacteria in midstream urine were statistically analyzed.Results A total of 102 strains of pathogenic bacteria were detected,including 65(63.7%)strains of gram-negative bacteria(mainly including escherichia coli and pseudomonas aeruginosa),32(31.4%)strains of gram-positive bacteria(mainly including enterococcus faecium and Enterococcus faecalis)and 5(4.9%)strains of fungi(including candida albicans and candida tropicalis).The main gram-negative bacteria were highly resistant to ciprofloxacin,ampicillin,cefazolin,ceftazidime,cefotaxime and piperacllin(61.3%-87.1%),but the resistance to antibiotics such as norfloxacin,amoxicillin,cefuroxime,cefoperazone,imipenem and gentamicin was at a medium to low level(4.6%~48.4%),without resistance to meropenem or amikacin.The main Gram-negative bacteria were highly resistant to gentamicin,erythromycin,streptomycin,penicillin G and ampicillin(60.0%~86.7%),but the resistance to chloramphenicol,levofloxacin,ciprofloxacin and teicoplanin was at a medium to low level(20.0%~53.3%),without resistance to vancomycin or linezolid.Conclusion There are many types of pathogenic bacteria cultured in midstream urine of patients with urinary infection after operation for UUC,which mainly include gram-negative bacteria.Different pathogenic bacteria have different drug resistance.Therefore,antibiotics should be selected reasonably according to the pathogenic bacteria in clinical practice.