尿液培养主要病原菌分布和耐药性分析

[目的]分析某院临床泌尿系统感染尿液培养主要病原菌分布和耐药性,指导临床合理使用抗菌药物。[方法]经尿液培养分离出的693株病原菌,用法国生物梅里埃ATBExpression细菌鉴定/药敏系统进行鉴定和药敏试验,同时根据美国临床实验室标准化委员会(CLSI)标准,检测大肠埃希菌及肺炎克雷伯菌的超广谱β-内酰胺酶(ES-BL)。[结果]在尿培养分离出的693株病原菌中,革兰阴性杆菌455株(65.7%),革兰阳性菌174株(25.1%),真菌64株(9.2%);分离菌前3位为大肠埃希菌341株(49.2%)、粪肠球菌44株(6.4%)、肺炎克雷伯氏菌43株(6.2%)。检出ESBL大肠埃希菌和肺炎克雷伯菌占36.4%和32.6%,对喹诺酮类耐药率为32.6%～55.4%,对第3代头孢菌素耐药率﹥35.0%,对阿米卡星、哌拉西林/他唑巴坦的耐药率较低(5.0%～14.0%),未检出耐碳青酶烯类菌株。粪肠球菌对高水平庆大霉素耐药(HLAR)为22.7%,对喹诺酮类耐药率为31.8%～70.4%,对氨苄西林高度敏感(100%),未检出耐万古霉素粪肠球菌和葡萄球菌属。[结论]该院尿液培养主要的病原菌是肠杆菌科,以大肠埃希菌为主,耐药率呈上升的趋势,同时真菌感染不容勿视,临床医师应根据尿液培养和药敏结果合理用药。

ANALYSIS ON THE DISTRIBUTION OF PATHOGENIC BACTERIA AND THEIR DRUG RESISTANCE IN URINE CULTURES

[Objective]To investigate the distributionand drug resistance of pathogens in urine cultures in Futian Hospital,and to offer a basis for optimal application of antibiotics in clinic.[Methods]693 isolated strains were identified and their antibiotic susceptibility tests were performed by the ATB Expression of Bio-Merieux of France,and the extended spectrum β lactamases of E.coli and K.pneumoniae were detected in by the method recommended in CLSI.[Results]693 strains were isolated which contained 174 gram-positive bacteria(25.1%),455 gram-negative bacteria(65.7%),and 64 fungus(9.2%).The most popular isolates were E.coli(341,49.2%),Enterococcus faecalis(44,6.4%)and K lebsiella pneumoniae(43,6.2%).ESBLs-producing E.coli strains and K lebsiella pneumoniae accounted for 36.4% and 32.6%,respecitvely.The resistance rates of quinolones were at the range of 32.6%-55.4%,the resistance to the third cephalosporin was over 35.0%.The resistance rate was low to amikacin,piperacillin/tazobactam(5.0%-14.0%).All the isolates were susceptible to Carbapenems.The reistance rate of high level gentamicin and quinolones were 22.7% and 31.8%-70.4% in Enterococcus faecalis.All the Enterococcus faecalis were susceptible to ampicillin.There was no strains of Staphylococcus spp and Enterococcus spp resistant to vancomycin.[Conclusion]E.coli was the most popular isolates in urine cultures,and the drug-resistant rates were high.Meanwhile the fungus caused infection should not be neglected.Doctors should utilize antibiotics more reasonably according to the urine culture results.