泌尿系感染菌群分布及耐药性分析

目的探讨泌尿系感染的菌群分布特点及细菌耐药情况，为临床合理使用抗菌药物提供依据。方法收集2005年8月-2007年8月尿培养分离的病原菌并作细菌药敏及耐药性分析。结果共收集致病菌693株，主要为大肠埃希菌（258株）、白色假丝酵母菌（123株）、肠球菌属（85株）；ESBLs确证试验结果：258株大肠埃希菌中有72株产ESBLs酶，产酶率为27．9％；25株肺炎克雷伯菌中有5株产ESBLs酶，产酶率为20．0％。大肠埃希菌对氨苄西林／舒巴坦、头孢唑啉、喹喏酮类、庆大霉素、复方磺胺的敏感率〈30．0％，对阿米卡星、呋喃妥因、亚胺培南的敏感率为82．2％～99．2％；肠球菌属对呋喃妥因、万古霉素的敏感率较高〉70．0％；真菌对氟康唑的耐药性增高，达27．9％。结论大肠埃希菌仍为泌尿系感染的主要致病菌，以往治疗泌尿系感染的常用药物如庆大霉素、环丙沙星等已产生较高的耐药性；真菌有增加趋势，氟康唑的耐药性增高。临床应结合药物敏感试验结果，合理使用抗菌药物。

Distribution and Drug-resistance of Pathogens in Urinary System Infection

Objective To investigate the bacterial distribution and drug-resistance in urinary system infection,and to provide a foundation for reasonable selection of drugs in clinical practice.Method The drug-resistance of clinical isolates from urinary system infection from August 2005 to August 2007 was analyzed.Results Totally 693 bacteria strains were isolated.The most common pathogens in urinary system infection were Escherichia coli(258),Candida albicans(123),and Enterococcus(85).The incidence rate of ESBLs in 258 E.coli strains was 27.9%,and in 25 K.pneumoniae strains was 20.0%.The sensitivity of E.coli to ampicillin-sulbactam,cefazolin,quinolones,gentamicin and TMP-SMZ was less than 30.0%,but to amikacin,furantoin,impenem was between 82.2% and 99.2%.Enterococcus was sensitive to furantion and vancomycin,whose susceptibility was over 70.0%.The drug resistance to fluconazole of epiphyte increased to 27.9%.Conclusions E.coli is still the most predominant pathogen,and produces higher resistance to antibiotics which we are used such as gentamicin,ciprofloxacin,etc.At the same time,the infection rate of epiphyte is increasing gradually,and epiphyte produces higher resistance to fluconzole.Clinical selection of antimicrobial agent should consider the drug sensitivity and choice antibiotics rationally.