四川省某医院精神科患者尿路感染的病原菌分布及耐药性分析

目的了解精神科住院患者尿路感染的病原菌分布及细菌耐药情况,为临床经验性抗感染治疗提供参考。方法收集2016年-2018年在四川省精神卫生中心精神科住院治疗且存在尿路感染的患者171例,对尿液标本进行细菌分离培养,使用质谱(MALDI-TOF-MS)和Vitek 2 Compact全自动细菌鉴定系统进行细菌鉴定,采用微量肉汤稀释法进行体外药敏试验,使用WHONET 5. 6软件对药敏试验结果进行分析。结果在发生尿路感染的精神科住院患者中,女性106例(61. 99%),男性65例(38. 01%)。共分离出病原菌171株,最常见的致病菌是大肠埃希菌96株(56. 14%)],其次为肺炎克雷伯菌16株(9. 36%)]和摩根菌属9株(5. 26%)]。大肠埃希菌对氨苄西林、哌拉西林、庆大霉素、环丙沙星、左氧氟沙星、复方新诺明的敏感性均低于50%;对哌拉西林/他唑巴坦、头孢西丁、亚胺培南、磷霉素、呋喃妥因的敏感性均高于90%,检出1例对亚胺培南不敏感的大肠埃希菌,未发现对美罗培南、阿米卡星耐药的菌株。结论精神科住院患者尿路感染以女性多见,常见病原菌包括大肠埃希菌、肺炎克雷伯菌、摩根菌属,其中大肠埃希菌的耐药性较严重。

Analysis of the distribution and drug resistance of pathogenic bacteria causing urinary tract infections of psychiatric patients in a hospital in Sichuan Province

Objective To analyze the distribution of pathogens and bacterial resistance in psychiatric patients with urinary tract infection, and to provide references for clinical anti-infection treatment.Methods A total of 171 cases of psychiatric inpatients with urinary tract infections in Sichuan Mental Health between 2016 and 2018 were enrolled. Bacterial isolation and culture were carried out on the urine specimens, and the bacteria were identified by MALDI-TOF-MS and Vitek 2 Compact automatic microbial analysis system. The broth microdilution method was used for antimicrobial susceptibility test in vitro, and the results of the test were analyzed with WHONET 5.6.Results Among the psychiatric inpatients with urinary tract infections, 106 (61.99%) were female and 65 (38.01%) were male. A total of 171 strains of pathogenic bacterium were isolated, and the most common pathogens were Escherichia coli 96 strains (56.14%)], followed with Klebsiella pneumoniae 16 strains (9.36%)] and Morganella 9 strains (5.26%)]. The sensitivity of Escherichia coli to ampicillin, piperacillin, gentamicin, ciprofloxacin, levofloxacin and compound xinnoxamine were all lower than 50%, while the sensitivity to piperacillin/tazobactam, cefoxitin, imipenem, fosfomycin and nitrofurantoin were higher than 90%. One case of Escherichia coli was detected, while was not sensitive to imipenem, moreover, no meropenem- or amikacin-resistant strains were found.Conclusion Urinary tract infections in psychiatric inpatients are more common in female, and the common pathogens include Escherichia coli, Klebsiella pneumoniae and Morganella, among which Escherichia coli has more serious drug resistance.