泌尿系统结石合并下尿路感染的病原菌分布及耐药情况分析

Distribution and drug resistance of pathogens causing lower urinary tract infection in patients with urinary calculi

目的通过分析武警北京总队医院泌尿系统结石合并下尿路感染(UCUTI)患者的病原菌分布特点及耐药性情况,为临床合理选用抗菌药物提供参考.方法采集我院2022年1月-2023年12月UCUTI患者116例的中段尿样本,进行细菌培养、菌株鉴定和药物敏感性试验.结果共分离到病原菌138株,其中革兰阴性菌占71.01%、革兰阳性菌占24.64%、真菌占4.35%;构成比前三位的病原菌依次为大肠埃希菌(44.93%,62/138)、肺炎克雷伯菌(7.97%,11/138)、粪肠球菌(7.97%,11/138);真菌中主要为白色念珠菌(3.62%,5/138).UCUTI患者中段尿样本中主要革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、美罗培南、阿米卡星的耐药率较低(<20%);其中奇异变形杆菌对亚胺培南、美罗培南100%敏感.主要革兰阳性菌对万古霉素、利奈唑胺、呋喃妥因的耐药率较低(≤25%);其中屎肠球菌、金黄色葡萄球菌对万古霉素、利奈唑胺敏感率为100%,对加替沙星的耐药率较低(≤25%).结论UCUTI病原菌对多数常用抗菌药物产生了不同程度的耐药性,经验性治疗需定期监测病原菌的分布特点和耐药情况,并根据药敏结果及时选用合理的抗菌药物,以降低耐药性的发生概率.

Objective To investigate the distribution and drug resistance of pathogens in patients with urinary calculi complicated with lower urinary tract infection(UCUTI)in the Beijing Municipul Corps Hospital of Chinese People's Armed Police Force,providing some guidance for the rational clinical use of antibiotics.Methods The midstream specimen of urine from 116 patients with UCUTI in our hospital from January 2022 to December 2023 were collected for bacterial culture,strain identification and antibiotic susceptibility testing.Results A total of 138 bacterial strains were isolated,of which 71.01%were Gram-negative,24.64%were Gram-positive,and 4.35%were fungi;the top three strains were Escherichia coli(44.93%,62/138),Klebsiella pneumonia(7.97%,11/138),and Enterococcus faecalis(7.97%,11/138),respectively;the main species of fungi was Candida albicans(3.62%,5/138).The predominant Gram-negative strains in the midstream urine samples of UCUTI patients showed a low rate of resistance to piperacillin/tazobactam,cefoperazone/sulbactam,imipenem,meropenem,and amikacin(<20%);of these,Aspergillus chimericus was 100%susceptible to imipenem and meropenem.The major Gram-positive strains had low resistance rates(≤25%)to furotoxin,vancomycin,and linezolid;among them,Enterococcus faecalis and Staphylococcus aureus showed 100%sensitivity to vancomycin and linezolid,and a low resistance rate(≤25%)to gatifloxacin.Conclusion The pathogens of UCUTI patients have developed different degrees of resistance to the commonly used antibiotics,and empirical treatment requires regular monitoring of the distribution and drug resistance of these pathogens,and timely selection of reasonable antibiotics according to the results of drug susceptibility testing,in order to reduce the occurrence of drug resistance.