456例尿路感染临床分析

The clinical analysis of 456 cases with urinary tract infection

目的 为提高尿路感染的诊治水平。方法 对 4 5 6例尿路感染患者进行回顾性分析。结果 (1)尿路感染仍以女性多见 ,男∶女为 1∶6 .9。男性尿路感染大部分有易患因素。 (2 )清洁中段尿培养阳性率低 (39.4 % )。致病菌仍以G-菌为主 ,依次为大肠 ,变形和克雷伯氏菌 ;G+ 菌以肠球菌占首位。 (3)常见致病菌对氨苄西林、环丙沙星、复方新诺明的耐药率高达 90 % ;对G-菌 (大肠 ) ,以亚胺培南的耐药率最低 (1.2 % ) ,其次为头孢三嗪 (2 0 .3% ) ,阿米卡星 (2 2 .1% )。而对G+ 菌 (肠球菌 ) ,万古霉素仍保持最低的耐药率 (1.0 % )。结论 尿路感染致病菌主要为G-菌 ,一线经验选药可用头孢三嗪 ,阿米卡星。氨苄西林、环丙沙星、复方新诺明已广泛耐药 ;临床上对疑诊尿路感染者需要做细菌耐药性检测 ,根据其结果合理用药 ,同时及时发现和纠正易患因素。

Objective To raise the level of diagnosis and treatment of urinary tract infection (UTI). Methods 456 cases of UTI were analysed retrospectively. Results (1) Male: female ratio was 1:6.9. The most male patients with UTI had the special factors. (2) The positive rate of clearing urine cultivation was low (39.4%). The Gram negative (G -) bacteria were still common bacteria from UTI, and They were eschevichia coli, bacillus proteus, klebsiella pneumoniae in order of priority. The common Gram positive (G +) bacteria were enterococcus . (3) The drug resistance rate (DRR) of bacteria to ampicillin, cinrofloxacin, trimoxazole had been showed (90 ±%). DRR of imipenem is the lowest ( 1.2%) for G - bacteria, such as escherichia coli, rocephin (DRR 20%), and amikacin (DRR 22.1%). Tovancomycin was the most effected antimicrbial for G + bacteria, such as enterococcus (DRR 1.0%).Conclusions The main bacteria of UTI were G - bacteria. Rocephin and amikacin can be recommended as first line empirical therapy. The drug resistance of amipicillin, trimoxazole and cinrofloxacin is serious. It is suggested that there is urgent need for surveillances of bacterial resistance and rational use of antimicrobial agents should be emphasized during clinical therapy. It is also very important to find and rectify the special factors.