医院泌尿道感染病原菌分布及耐药性分析

目的了解医院泌尿道感染病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法收集医院泌尿道感染患者尿液标本中分离的156株病原菌,进行细菌鉴定和药敏分析,并对大肠埃希菌和肺炎克雷伯菌进行超广谱β-内酰胺酶（ESBLs）的检测。结果医院泌尿道感染的病原菌主要为革兰阴性（G-）菌72株（46.15%）、其次是真菌55株（35.26%）、革兰阳性（G＋）菌29株（18.59%）;前5位菌株依次为大肠埃希菌、热带念珠菌、白色念珠菌、粪肠球菌和肺炎克雷伯菌;产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为57.50%、73.33%;病原菌对常用抗菌药物产生多重耐药,G-菌对多黏菌素B 100%敏感,头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、呋喃妥英、碳青酶烯类的敏感率〉80.0%,氨卞青霉素、环丙沙星的耐药率〉80.0%;G＋菌对万古霉素、利奈唑烷100.0%敏感,青霉素G的耐药率〉80.0%。结论重视泌尿道感染病原菌及耐药性检测,以药敏试验选用抗菌药物进行治疗十分重要。

Analysis of pathogens and antibiotic resistance in nosocomial urinary tract infections

Objective To study the distribution and antibiotic resistance of pathogens in nosocomial urinary tract infection and to provide evidence for administration of antibiotics.Methods A total of 156 pathogen strains were isolated from urine samples of patients with nosocomial urinary tract infection.Bacteria were identified and drug sensitivity analysis was conducted.Production of extended-spectrum β-lactamase（ESBLs）was tested for isolates of Escherichia coli and Klebsiella pneumoniae.Results The major pathogens of nosocomial urinary tract infection were Gram-negative（G-） bacteria（n=72,46.15%）,followed by fungi（n=55,35.26%） and Gram-positive（G＋）bacteria（n=29,18.59%）.The most common strains isolated were Escherichia coli,Candida tropicalis,Candida albicans,Enterococcus faecalis and Klebsiella pneumoniae in sequence.The proportions of ESBLS production were 57.50% and 73.33% for Escherichia coli and Klebsiella pneumoniae respectively.Pathogens had drug resistance to multiple common antibiotics.The sensitivity rate of G-bacteria was 100.0% to polymyxin B,and was higher than 80.0% to cefoperazone/ sulbactam,piperacillin/tazobactam,furantoin,carbapenems,ampicillin and ciprofloxacin respectively.The sensitivity rate of G＋ bacteria was 100.0% to vancomycin and oxazolidinone antibiotics respectively,and was higher than 80.0% to penicillin G.Conclusion Drug resistant strain of pathogens played an important role in urinary tract infection.The results suggested that drug sensitivity test was critical in antibiotics selection for the treatment.