成人尿标本临床分离菌的分布及耐药性监测

目的:研究成人尿标本临床分离菌的分布及其耐药性,为临床使用抗菌药物提供依据。方法:收集某院2016年1月-2018年12月尿培养阳性菌株,采用VITEK 2-Compact仪器法或纸片扩散法测定分离菌的药物敏感性,参照CLSI 2018版折点判读结果,用WHONET5.6软件统计分析。结果:共分离出2 164株病原菌,革兰阴性杆菌占72.13%,革兰阳性球菌占23.01%,真菌占4.85%;主要为大肠埃希菌(50.05%)和肠球菌(14.33%)。3年间大肠埃希菌对喹诺酮类、碳青霉烯类耐药率有下降趋势,对头孢类耐药率无明显变化;肠球菌对喹诺酮类耐药率较高且无明显变化趋势,对青霉素类、高浓度庆大霉素耐药率有较大下降。革兰阴性杆菌对亚胺培南、美洛培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦较敏感。屎肠球菌对所测试抗菌药耐药率显著高于其他肠球菌,未发现耐万古霉素、替考拉宁和利奈唑胺革兰阳性球菌。结论:尿路感染病原菌分布广泛,主要为肠杆菌科细菌和肠球菌。及时送检尿标本做病原学检查,根据药敏结果、严格按照抗菌药物临床应用分级管理办法使用抗菌药,可以减缓或降低细菌耐药性的产生。

Distribution and drug resistance monitoring of clinical isolates in adult urine specimens

OBJECTIVE To study the distribution and drug resistance of clinical isolates from adult urine specimens, in order to further provide the reference for rational use of antibacterial agents. METHODS The strains isolated from the urine in our hospital from January 2016 to August 2018 were collected. The drug susceptibility of isolated bacteria was determinded by VITEK 2-Compact instrument method or disk diffusion method. Results was interpreted according to the breakpoints of CLSI 2018 and WHONET 5. 6 software was used to analyze the data.RESULTS A total of 2164 bacterial strains were isolated, including 72.13% Gram-negative bacilli, 23.01% Gram-positive cocci and 4.85% fungi, mainly Escherichia coli (50.05%) and Enterococcus (14.33%). The resistance rate of E. coli to quinolones and carbapenems decreased during the past 3 years, while the resistance rate to cephalosporins did not change significantly; the resistance rate of enterococci to quinolones was high and there was no significant change trend, and the resistance rate to penicillins and high concentration gentamicin decreased significantly. Gram-negative bacilli were more sensitive to imipenem, meropenem, piperacillin/tazobactam, and cefoperazone/sulbactam. Enterococcus faecium was significantly more resistant to the tested antimicrobials than other enterococci, and no gram-positive cocci resistant to vancomycin, teicoplanin, and linezolid were found. CONCLUSION The pathogens of urinary tract infection are widely distributed, mainly Enterobacteriaceae and Enterococcus. Urine samples should be submitted for etiological examination in time. The use of antibacterial drugs in strict accordance with the grading management of clinical application of antibacterial drugs based on the results of drug susceptibility can slow down or reduce the occurrence of bacterial drug resistance.