社区与院内尿路感染的病原学比较及抗生素耐药性分析

目的为调查比较瑞金医院近期社区及院内尿路感染病原学构成特点及抗生素耐药情况. 方法回顾分析2004年1～6月,上海瑞金医院门诊与住院尿路感染患者中段尿培养及药敏试验结果. 结果社区与院内尿路感染的病原学分布以大肠埃希菌属、肠球菌属为主,但两菌所占比例明显不同;医院感染分离株耐药性普遍高于社区感染分离株;IMP、MEM、CAZ、FEP、TZP、CFS、CMZ治疗大肠埃希菌感染敏感性均>80%,而CIP、PIP、AMP、GEN均已产生>50%～80%耐药率;未检出耐VAN、TCL肠球菌菌株,AMP、NIT对肠球菌感染具有较高敏感性,而CIP、ERY已产生较高耐药性. 结论及时总结本地社区与院内尿路感染流行病学资料及耐药菌变迁规律,对指导临床正确选药意义重大.

Urinary Pathogens and Drug Tolerance Detection in Patients with Community-acquired and Hospital Urinary Tract Infection

OBJECTIVE To comprehend the urinary tract infection (UTI) by the common pathogens and antibiotic application in Ruijin Hospital in Shanghai and its vicinal community. METHODS From Jan 2004 to Jun 2004 the cases with UTI were investigated retrospectively; the pathogens and bacterial resistance in urine culture of the hospital and its vicinal community were compared. RESULTS The main pathogens that caused UTI were Escherichia coli and enterococci; the Gram negative ones accounted for 83% and 56% in community-acquired and hospitalUTI, the Gram positive ones were accounted for 17% and 44% in community-acquired and hospital UTI, respectively. There were higher resistance rate of strains isolated from hospital infecton (HI) group than out -hospitalinfection group. Drug sensibility test in vitro of the E. coli was 100% to IMP and MEM; and was highly sensible to CAZ, FEP, CZP, CFS, and CMZ; their resistant rate was lower 20%; that to CIP, PIP, AMP, and GEN was over 50-80% in out-hospital and hospital UTI, the highest sensitive drugs to enterococci were VAN and TCL. No resistant strain was found. The resistant rate to CIP and ERY was the highest. CONCLUSIONSThe variety of pathogens in the UTI and their drug resistance in HI and CAI are studied, it providesa reference basis for antibiotic clinical application.