891例住院患者泌尿系统感染主要病原菌及易感因素分析

Analysis on the main pathogenic bacteria and risk factors of 891 cases in hospital with urinary tract infections

目的 探讨住院患者泌尿系统感染的易感因素、主要病原菌分布及其耐药情况,为临床防治泌尿系统感染,合理选用抗菌药物提供依据.方法 对河南省商丘市第一人民医院2007年1月至2013年12月住院患者泌尿系统感染易感因素及其病原菌耐药情况进行回顾性分析.结果 分离的891株菌株中,革兰阴性菌638株,占71.6％;革兰阳性菌218株,占24.5％;假丝酵母菌属35株,占3.9％.革兰阴性菌以大肠埃希菌最多见,占43.5％;其次为肠球菌属细菌,占22.1％,以粪肠球菌和屎肠球菌为主.女性患者占62.1％(553/891),男性患者占37.9％(338/891).大肠埃希菌、克雷伯菌属及变形杆菌属中β内酰胺酶的检出率分别为59.0％(526/891)、57.8％(515/891)及15.1％(135/891);肠杆菌科细菌中产β内酰胺酶株对测试药物的耐药率比非产β内酰胺酶株高,肠杆菌科细菌对碳青霉烯类抗生素高度敏感.铜绿假单胞菌的分离率为4.0％(36/891),有6株多重耐药菌,3株对碳青酶烯类耐药.肠球菌属对利奈唑胺、万古霉素和替考拉宁均敏感.假丝酵母菌属以白假丝酵母菌为主,对两性霉素、氟胞嘧啶和制霉菌素敏感性高(100％),对伊曲康唑、伏立康唑及氟康唑耐药率分别为13.0％(116/891)、17.4％(155/891)及39.1％(348/891).临床患者泌尿系统感染与性别、年龄、基础疾病、侵入性操作及抗菌药物应用不合理等有关(P均＜0.05).结论 我院临床患者泌尿系统感染病原菌以大肠埃希菌为主,其次为肠球菌属.假丝酵母菌属分离率以白色假丝酵母菌为主.关注易感人群,合理应用抗菌药物.

Objective To investigate the distribution and drug resistance of major pathogens for urinary tract infections and related risk factors of hospitalized patients for prevention and treatment of urinary tract infections and to guide the reasonable application of antibiotics.Methods From January 2007 to December 2013 ,the risk factors and pathogen resistance of hospitalized patients with urinary system infection in the First People' s Hospital of Shangqiu were analyzed.Results Totally 891 strains were isolated, in which 638 (71.6％) were Gram-negative strains, 218 (24.5％) were Gram-positive strains, and 35 (3.9％) were Candida.Among Gram-negative strains, Escherichia coli was the most prevalent species, accounting for 43.5％, followed by Enterococcus spp(22.1％), major strains were Enterococcus faecalis and Enterococcus faecium.About 62.1％ (553/891) of the strains were isolated from female patients, 37.9％ (338/891) from male patients.The prevalence of ESBLs-producing strains in Escherichia coli, Klebsiella spp and P.Mirabilis were 59.0％ (526/891), 57.8％ (515/891) and 15.1％ (135/891).ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rate.The ESBLs-producing Enterobacteriaceae strains were highly susceptible to carbapenems.The average prevalence of Pseudomonas aeruginosa was 4.0％(36/891).Six strains were identified as multi-drug resistance of Pseudomonas aeruginosa were respectively, and 3 were carbapenem-resistant strains.Enterococcus spp were completely sensitive to linezolid, vancomycin and teicoplanin.Among Candida strains,the major strains Candida albicans was completely sensitive to amphotericin B, amphotericin and nystatin.The percentage of Candida albicans resistant to itraconazole,voriconazole and fluconazole was 13.0％ (116/891), 17.4％ (155/891) and 39.1％ (348/891).Clinical urinary tract infections related to sex, age, basic diseases, invasive operation and unreasonable application of antibiotics significantly (P＜0.05).Conclusion Escherichia coli is the leading clinical isolates strains account for most urinary tract infections in the First People' s Hospital of Shangqiu, followed by Enterococcus spp.The prevalence of Candida albicans is the major strains among Candida strains.Should be pay attention to the susceptible population and apply anbiotics reasonably.