泌尿系感染患者病原菌分布及耐药性分析

Distribution and Drug Resistance of Pathogenic Bacteria in Patients with Urinary Tract Infection

目的 :通过分析珠海地区泌尿系感染患者病原菌分布及耐药性情况,为临床合理使用抗菌药物提供指导依据。方法 :对2015年10月-2016年10月珠海市人民医院门诊及住院有泌尿系感染症状的患者行中段尿培养出的596株病原菌进行鉴定,并进行体外药物敏感性试验。结果 :所培养出的596株病原菌中革兰阴性菌420株(70.5%),革兰阳性菌126株(21.1%),真菌50株(8.4%)。细菌构成比前三位为大肠埃希菌(42.4%,253/596)、肠球菌属(10.3%,61/596)、肺炎克雷伯菌(7.9%,47/596)。真菌中主要为热带念珠菌(3.5%,21/596)、光滑假丝酵母菌(3.4%,20/596)。分离的病原菌对常用抗菌药物均有不同程度的耐药性,大肠埃希菌对青霉素类、头孢菌素类及喹诺酮类抗菌药物耐药率高(52.6%~82.6%),分离出耐亚胺培南的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;葡萄球菌属对青霉素类、头孢菌素类及与β-内酰胺酶抑制剂复合的抗菌药物耐药性高(40.0%~88.9%),出现对万古霉素耐药的粪肠球菌。结论 :珠海市人民医院泌尿系感染病菌构成比中以革兰阴性菌为主,其中以大肠埃希菌常见,与国内各地报道相近。泌尿系感染病原菌对常用的抗菌药物已产生一定的耐药性,出现耐亚胺培南、万古霉素的菌株。因此,临床医师需注重泌尿系感染患者的尿细菌学培养,及时了解本地的病原菌分布及耐药性情况,尽可能按药敏结果指导用药,以减缓耐药菌株的进展。

Objective:To analyze the distribution and drug resistance of pathogenic bacteria in patients with urinary tract infection in Zhuhai Region and provide a basis for reasonable usage of antibiotics in clinic. Methods:A total of 596 strains of pathogenic bacteria were cultured from the midstream urine samples of outpatients and inpatients with symptoms of urinary tract infection symptoms in Zhuhai People's Hospital Affiliated to Jinan University from Oct 2015 to Oct 2016 and subjected to drug sensitivity test in vitro. Results:Of the 596 strains of pathogenic bacteria, 420 strains(70.5%) were gram negative, 126(21.1%) were gram positive, and 50(8.4%) were fungi. The strains ranking the top three of the bacterial constitution were Escherichia coli(42.4%, 253/596), Enterococci(10.3%, 61/596) and Klebsiella pneumoniae(7.9%, 47/596). The fungi were mainly Candida tropicalis(3.5%, 21/596) and Candida glabrata(3.4%, 20/596). The pathogenic bacterial strains showed varying degrees of resistance to frequently-used antimicrobial agents. Escherichia coli showed high resistance rates to Penicillins, Cephalosporins and quinolones(52.6%~82.6%). Imipenem-resistant Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were isolated. Staphylococcus showd high resistance rates to Penicillins, Cephalosporins and beta-lactamase inhibitor antibiotics(40.0%~82.9%). Vancomycin-resistant Enterococcus faecalis was detected. Conclusion:In Zhuhai People's Hospital, gram negative bacteria are the main pathogens of urinary tract infection while Escherichia coli is the most common pathogen, which are similar to those in domestic literature reports. The pathogenic bacteria of urinary tract infection have a certain resistance to frequently-used antimicrobial agents, and imipenem-and vancomycin-resistant pathogens were detected. Therefore, clinician should pay attention to the bacterial cultivation of patients with urinary tract infection so as to understand the distribution of pathogens and the drug resistance. In order to slowing the progress of drug resistant strains, the usage of antibiotics should be based on the results of drug sensitivity test as far as possible.