慢性肾衰竭合并尿路感染的病原分布及耐药性浅析

Distribution and drug resistance of pathogenic bacteria in chronic renal with urinary tract infection

目的 :分析研究慢性肾衰竭合并尿路感染的发病率、病原菌分布、耐药性及其中多重耐药菌检出情况,为临床合理选择抗生素提供理论依据。方法 :统计我院肾内科2010年1月~2016年6月慢性肾衰竭患者1052例,分析其中208例合并尿路感染者清洁中段尿尿培养结果及药敏情况。结果 :1052例慢性肾衰竭患者中有208例合并尿路感染,感染率为19.77%。208例尿路感染患者的尿液样本中有81例培养阳性,阳性率为38.9%;81株病原菌中包括革兰氏阴性菌69株,革兰氏阳性菌8株,真菌4株。大肠埃希菌对哌拉西林耐药率最高为82.93%,对头孢他啶/克拉维酸钾、亚胺培南的耐药率最低为7.32%;肺炎克雷伯菌对哌拉西林耐药率最高为77.78%;葡萄球菌属对青霉素、苯唑西林等耐药率最高为83.3%;肠球菌属对头孢曲松、庆大霉素等耐药率最高为100%;77株细菌中共检出多重耐药菌25株,其中产超广谱β-内酰胺酶肠杆菌科细菌(ESBLs)的检出率为32.26%,耐碳青霉烯类肠杆菌科细菌(CRE)的检出率为8.06%。结论 :慢性肾衰竭患者合并尿路感染的感染率较高,常见病原菌主要为革兰氏阴性菌,且以大肠埃希菌居多,不同病原菌对各类抗菌药物的耐药性不同,加强病原学检测及细菌耐药性监测、合理规范使用抗生素可有效控制尿路感染并减少耐药菌株的产生。

Objective To study the incidence of chronic renal failure with urinary tract infection, distribution and drug resistance of pathogenic bacteria, and multi-drug resistant organisms detection, to provide theoretical basis for reasonable choice of antibiotics. Methods Totally1052 chronic renal failure patients was hospitalized in the department of nephrology during January 2010 to June 2016, annlysis urine culture and drug susceptibility results of the 208 cases of which wasd mergerd urinary tract infections. Results There are 208 cases was diagnosed urinary tract infections in all 1052 chronic renal failure patients, infection rate was 19.77%. Totally 81 of 208 urine samples was positive, positive rate was 38.9%; Among 81 strains of pathogenic bacteria are gram-negative bacteria 69 strains, gram positive bacteria 8 strains, fungi 4 strains. E. coli had the drug resistant rate as high as 82.93% to piperacillin, while to ceftazidime/potassium clavulanate and imipenem was the lowest as 7.32%; Klebsiella pneumoniae to piperacillin had the highest resistant rate as 77.78%; Staphylococcus had the highest resistant rate to penicillin and oxacillin with 83.3%; And enterococcus was totally resistant to ceftriaxone and gentamycin, and sensitive to oxacillin and vancomycin. There are 25 multi-drug resistant organisms were checked out of all the 77 bacterias, the detection rate of extended-spectrum β-lactamases enterobacteriaceae was 32.26%, the detection rate of carbapenem-resistant enterobacteriaceae was 8.06%. Conclusion The infection rate of chronic renal failure patients with urinary tract infections is relatively high, the common pathogenic bacteria is mainly gram-negative bacteria, including the majority with e. coli, different pathogens to each kind of antimicrobial resistance, strengthen the etiology and bacterial drug resistance surveillance, reasonable use of antibiotics can effectively control the urinary tract infection and reduce the generation of drug-resistant strains.