糖尿病肾病患者泌尿系统肠球菌多重耐药菌株感染状况和耐药性分析

目的：为了了解糖尿病肾病患者泌尿系统肠球菌感染状况和耐药情况,为临床治疗及防治糖尿病肾病泌尿系统肠球菌感染提供最新参考依据.方法：收集我院2009年-2013年糖尿病肾病患者泌尿系统感染中段尿培养出的肠球菌菌株并分析其耐药性.结果：中段尿培养检出120株肠球菌,粪肠球菌和屎肠球菌检出为主,分别66株（55.0%）、44株（36.7%）,从高到低依次为鸟肠球菌、母鸡肠球菌、铅黄肠球菌.粪肠球菌和屎肠球菌是糖尿病肾病患者泌尿系统感染肠球菌最常见的菌种.120株肠球菌中MDR菌株83株（69.2%）,其中氨基糖苷类高度耐药菌株HLAR多重耐药株64株（53.3%）,1株耐万古霉素VRE菌株.药敏表明：万古霉素和替卡拉宁的敏感度最高.粪肠球菌对氨苄西林、青霉素和呋喃妥因的敏感度较高;而屎肠球菌刚相反敏感率较低.结论：糖尿病肾病患者肠球菌MDR菌株感染严重,多重耐药对临床治疗带来不利,临床应注重病原菌的检测,根据药敏结果合理选择药物,延缓和控制耐药菌的产生.     

肠外瘘并发腹腔感染的致病菌谱与耐药性分析

目的 研究肠外瘘并发腹腔感染的主要致病菌谱及致病菌对常用抗生素的耐药特点.方法 取226例肠外瘘并发腹腔感染患者的腹腔脓液进行细菌培养和抗生素药物敏感试验.结果 获取菌株520株,其中革兰阴性菌333株,革兰阳性菌180株,真菌7株.前10位的为大肠埃希菌131株,金黄色葡萄球菌62株,肠球菌59株,铜绿假单胞菌50株,肺炎克雷伯杆菌23株,鲍曼不动杆菌18株,阴沟肠杆菌17株,奇异变形杆菌15株,摩氏摩根菌15株,粪肠球菌12株.大肠埃希菌和肺炎克雷伯杆菌中表达超广谱13内酰胺酶阳性菌株分别为102株和17株.甲氧两林耐药金黄色葡萄球菌60株.结论 肠外瘘并发腹腔感染的致病菌谱以革兰阴性菌为主,超广谱β内酰胺酶阳性率较高;金黄色葡萄球菌则基本对甲氧西林耐药.     

2019～2021年某三级综合医院泌尿道感染病原菌分布及耐药性分析

目的探讨某三级综合医院的泌尿道感染病原菌分布及耐药性, 为临床合理使用抗菌药物及院内感染监控提供指导。方法从本院检验系统中筛选2019年1月1日至2021年12月31日泌尿道感染患者的4 748例尿标本培养结果, 回顾性分析其病原菌分布及耐药性。结果 4 748例尿培养标本共分离出1 026株病原菌, 其中革兰阴性菌812株(79.14%), 革兰阳性菌210株(20.47%), 真菌4株(0.39%)。病原菌占比前5位分别是大肠埃希菌610株(59.45%)、屎肠球菌81株(7.89%)、粪肠球菌76株(7.41%)、肺炎克雷伯菌60株(5.85%)、彭氏变形菌51株(4.97%);大肠埃希菌对碳青霉烯类的耐药率<2%, 对阿米卡星、哌拉西林/他唑巴坦的耐药率<10%;粪肠球菌对氨苄西林、呋喃妥因的耐药率<10%, 屎肠道球菌对青霉素类、喹诺酮类、红霉素等的耐药率>90%, 粪肠球菌对青霉素类、呋喃妥因的耐药率<10%, 未检出对万古霉素、利奈唑胺、替加环素耐药的菌株。结论泌尿道感染病原菌以大肠埃希菌为主, 其次为屎肠球菌、粪肠球菌。菌群分布及耐药性监测...     

下呼吸道感染的病原菌分布与耐药性分析

目的：分析临床下呼吸道感染病原菌构成及耐药情况,以指导临床医师合理应用抗菌药物.方法：分析2008年1月-2012年12月解放军总医院第一附属医院从痰（19 365份）、支气管灌洗液（4 203份）以及支气管肺泡灌洗液（302份）标本分离细菌的鉴定及药敏试验结果.结果：共分离出非重复病原菌10 635株,其中革兰阴性杆菌5 244株（49.3%）,革兰阳性球菌2 495株（23.5%）,真菌2 896株（27.2%）.未发现葡萄球菌属对万古霉素、替考拉宁和利奈唑胺的耐药菌株,发现3株大肠埃希菌和32株肺炎克雷伯菌对碳青霉烯类耐药菌株（CRE）,多重耐药铜绿假单胞菌（MDRPA）和鲍曼不动杆菌（MDRAB）分别占14.2%和46.3%.真菌以白色念珠菌为主,对抗真菌药较敏感.结论：下呼吸道感染分离的病原菌中鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌是主要病原菌,同时耐碳青霉烯类的肠杆菌科细菌（CRE）以及耐万古霉素的肠球菌属（VRE）也是临床抗感染治疗的难点.     

急性坏死性胰腺炎合并感染的病原菌及耐药性分析

目的：研究急性坏死性胰腺炎（ANP）合并感染的病原菌分布及耐药性,并探讨其对ANP患者预后的影响。 方法：回顾性分析2010年10月—2014年10月收治的72例有明确病原学依据的ANP合并感染患者的临床资料。 结果： 72例ANP患者中,腹腔及腹膜后感染47例（65.28%）,呼吸道感染37例（51.39%）,血流感染32例（44.44%）,其中血流感染与患者死亡密切相关（P<0.05）。检出病原菌235株,其中革兰阴性细菌159株（67.66%）,革兰阳性细菌60株（25.53%）,真菌16株（6.81%）。获得的病原菌中排名前6位的依次是：鲍曼不动杆菌（24.68%）,铜绿假单胞菌（8.94%）,肺炎克雷伯菌（8.09%）,屎肠球菌/粪肠球菌（8.09%）,大肠埃希菌（7.66%）,金黄色葡萄球菌（4.68%）。耐药性分析显示,鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别达95.92%和52.63%,对头孢哌酮/舒巴坦的耐药率分别为59.26%和50.00%。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）检出率分别为64.29%和80.00%,对头孢哌酮/舒巴坦的耐药率分别为31.58%和18.75%,而对亚胺培南的耐药率分别为23.08%和7.14%。19株屎肠球菌/粪肠球菌中仅1株对万古霉素耐药,对利奈唑烷尚未发现耐药菌株。耐甲氧西林金黄色葡萄球菌检出率为72.73%,对万古霉素、利奈唑烷和呋喃妥因尚未发现耐药菌株。16株真菌对常用抗真菌药物均未发现耐药菌株。 结论：血流感染是ANP患者死亡的重要原因。ANP患者的病原菌仍以革兰阴性菌为主,但革兰阳性菌和真菌的比例不容忽视。多重耐药菌已成为ANP合并感染的巨大的挑战。     

烧伤病房728株感染病原菌的分布特点及耐药性分析

目的了解笔者单位近5年烧伤感染病原菌的分布特点及耐药情况。方法收集2001-2006年笔者单位306例烧伤患者创面分泌物等标本中分离的病原菌，对其菌种分布特点及耐药性进行分析。结果革兰阳性菌378株，其中金黄色葡萄球菌的菌株数居首位，尤以甲氧西林耐药金黄色葡萄球菌居多，表皮葡萄球菌和粪肠球菌的菌株数分别位居第2、3位。革兰阴性杆菌338株，其中鲍氏不动杆菌的菌株数居首位，阴沟肠杆菌和铜绿假单胞菌的菌株数分别位居第2、3位。检出真菌12株。结论笔者单位病原菌的分布情况，可能与甲氧西林耐药葡萄球菌呈多重耐药性以及鲍氏不动杆菌产生各种类型的β内酰胺酶有关。     

肛周脓肿的病原菌分布及多重耐药菌检出情况分析

通过对肛周脓肿病原菌的分布、耐药性及多重耐药菌感染情况进行分析,来指导临床合理选择抗菌药物,预防多重耐药菌的增加。将2017年11月—2018年10月100例肛周脓肿感染患者肛周脓液进行培养,把培养分离的病原菌通过菌种分布、药敏鉴定结果和多重耐药菌的检出情况进行回顾性分析。100例肛周脓液培养出78株病原菌,培养阳性率78.0%。其中以革兰阴性杆菌为主,占87.2%(68/78),菌种所占比例为大肠埃希菌45株(57.7%),肺炎克雷伯菌11株(14.1%),弗劳地枸橼酸杆菌5株(6.4%),阴沟肠杆菌4株(5.1%),普通变形杆2株(2.6%),液化沙雷菌1株(1.3%)。革兰阳性球菌占12.8%(10/78),其中金黄色葡萄球菌8株(10.3%)和粪肠球菌2株(2.6%)。分离出的大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)的菌株19株,分离率为42.2%,肺炎克雷伯菌ESBLs的阳性菌株为2株,检出率为18.2%;检出耐甲氧西林的金黄色葡萄球菌(MRSA)3株,检出率为37.5%。革兰阴性菌对碳氢酶烯类药物、加酶抑制剂、氟喹诺酮类、四代头孢类药物耐药率较低,没有检测出耐碳青霉烯类肠杆菌科细菌(CRE);检出的肠球菌和金黄色葡萄球菌对万古霉素和利奈唑胺都敏感。肛周脓液培养出的病原菌以革兰阴性菌为主,病原菌种类分布广泛,耐药情况较严重,有多重耐药菌分布,在临床上应根据患者肛周脓液药敏试验结果对抗菌药物进行合理选择以减少多重耐药菌的产生。     

血培养病原菌分布及耐药性分析

目的分析医院血流感染病原菌的分布特点和耐药情况,为临床预防和控制感染提供依据。方法回顾性分析2011年6月至2014年6月本院临床血培养标本中病原菌的感染特点及其药敏。采用BD BACTEC 9120血培养仪进行血培养,BD Phoenix 100全自动细菌鉴定/药敏分析系统对菌株进行鉴定和药敏试验,真菌药敏采用K-B纸片法,用WHONET 5.6软件进行数据分析。结果 9 116例血培养标本中共检出病原菌896株,阳性检出率为9.8%,其中革兰阴性杆菌491株,革兰阳性球菌350株,真菌37株,厌氧菌9株以及革兰阳性杆菌9株;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦敏感率较高,大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别为49.5%和38.5%;鲍曼不动杆菌的耐药率高于铜绿假单胞菌,多重耐药和泛耐药鲍曼不动杆菌的检出率分别为32.6%和20.9%,多重耐药铜绿假单胞菌的检出率为18.4%;耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为44.4%和70.4%;未发现耐万古霉素、替考拉宁和利奈唑胺的葡萄球菌和肠球菌;粪肠球菌对抗菌药物的耐药率显著低于屎肠球菌。结论本院血流感染病原菌以肠杆菌科细菌为主,凝固酶阴性葡萄球菌感染不容忽视。临床应高度重视早期血培养,合理使用抗菌药物,有效减少耐药菌株的产生。     

普通外科感染的菌种变迁及耐药性检测

目的 了解普通外科感染的菌种变迁和耐药情况。方法 分析1993年6月至1997年7月我院普通外科感染患者送检细菌培养阳性的557例。结果 分离革兰阴性（G^-)菌38种1045株（71.4%),其中除最常见的大肠埃利希菌外,阴沟肠杆菌的检出率明显增高,列第3位,革兰阳性（G^ )菌8种418株（28.6%),金黄色葡萄球菌和表皮葡萄球菌分别占第1、2位,粪肠球菌列第3位。阴沟肠杆菌和粪肠球菌系多重耐药菌种,细菌的药敏测定表明：G^-菌的敏感药物为氟喹诺酮类或第3代头孢菌素类药物;对G^ 菌抗菌活性较高的则是万古霉素、利福平等。结论 当前重视抗菌药物的合理应用对延缓菌种变迁和耐药性增长是有重要意义。     

肾移植受者术后医院感染流行病学单中心分析

目的探讨肾移植受者术后医院感染流行病学特点及其防控措施。方法 2014年1月至2017年12月对456例肾移植受者进行监测,分析肾移植术后医院感染情况,包括基本情况、感染部位、感染病原体类型。结果 456例肾移植受者中,发生医院感染78例(17.1%),术后感染时间为9(3～21)d。感染部位主要为下呼吸道、泌尿系统和血流感染。感染病原体类型包括葡萄球菌13株、屎肠球菌6株、真菌6株、嗜麦芽窄食单胞菌4株、鲍曼不动杆菌4株、铜绿假单胞菌4株、表皮葡萄球菌4株、肺炎克雷伯菌1株、大肠埃希菌1株、其他阴性菌9株。其中多重耐药菌感染11例(14%),死亡4例。结论肾移植受者术后医院感染发生率较高、术后发病早、多重耐药菌感染常见且病死率高,应充分做好术前准备、积极预防术后下呼吸道感染、规范实施多重耐药菌防治措施。     

Urinary tract infections after kidney transplantation]

Clinical significance of urinary tract infections (UTI) after kidney transplantation was studied in 57 cases. Of these patients, the UTI occurred in 63% of cases during follow-up after transplantation. Although the bacteriuria were observed more frequently in living-related donor (LD) group at pre-operation, cadaveric donor (CD) group showed significantly higher frequency in bacteriuria and UTI after transplantation. The initial UTI occurred within 4 weeks after transplantation in 86% of cases. The significant risk factors in the occurrence of UTI were presence of bacteriuria in post-operation, CD group, mismatch numbers in HLA, amount of steroid, and ages of donor and recipient. Of the bacteria isolated, about half were pathogens in UTI, which was a 2 times higher risk compared with the time of chronic hemodialysis. Gram negative rods were found to be major pathogen in UTI cases. The effect of UTI on graft survival was not obvious. However, of the patients who have bacteriuria at operation, 52% were found to have bacteriuria due to the same strain during follow-up. Therefore, bacteriological examination of urine at transplantation must be done carefully.     

尿路结构异常儿童合并泌尿系感染的病原菌分析

目的探讨尿路结构异常儿童合并泌尿系感染（UTI）致病菌的分布及药物敏感及耐药情况。 方法收集2012年1月至2016年12月中山大学附属第三医院及汕头市中心医院符合UTI住院患儿476例,分为尿路正常组及尿路异常组,比较两组间病原菌构成比及对抗菌药物的敏感和耐药情况。 结果尿路异常者162例（肾积水最为常见,占43.83%）,尿路正常儿童314例。尿路异常儿童合并感染常见于男性（P<0.05）,共检出致病菌166株,革兰氏阴性菌（G^-）为主（71.08%）,大肠埃希菌占首位（40.36%）,肠球菌属居第2位（22.89%）,粪肠球菌在尿路异常组常见（χ²=4.59,P=0.032）。两组间常见病原菌耐药性差异无统计学意义。 结论尿路结构异常男性儿童易发生泌尿系感染,且肠球菌感染的发生率高于尿路结构正常儿童。     

青少年尿路感染细菌分布以及耐药性分析

【摘要】 目的 探究近一年来深圳光明新区尿路感染青少年患者细菌分布情况和耐药情况。方法将2014年7月到2015年7月就诊光明新区医院的18~20岁尿路感染患者44例作为研究对象,收集中段尿分离培养细菌共得1382株菌落,分析尿路感染细菌的种类、分布和通过药敏试验分析耐药性。结果〓革兰氏阳性菌20.12%,真菌3.04%,革兰氏阴性菌76.85%;屎肠球菌37.41%,近平滑假丝酵母菌38.10%,大肠埃希菌50.47%。金黄色葡萄球菌对环丙沙星耐药性最强,屎肠球菌耐药性最强的为左氧氟沙星,粪肠球菌耐药性最强的为克林霉素,大肠埃希菌耐药性最强的为头孢曲松,铜绿假单胞菌耐药性最强的为氨曲南,肺炎克雷伯菌耐药性最强的为头孢曲松,柠檬酸杆菌耐药性最强的为环丙沙星。结论〓对于18~20的青少年岁的尿路感染患者,革兰氏阴性菌尤其是大肠埃希菌为主产生耐药性较为广泛。     

Urinary tract infections in renal transplant recipients

Urinary tract infection (UTI) is the most common infectious complication following renal transplantation. The purposes of this study were to determine the causative agents of UTIs among renal transplant recipients and to compare the antibiotic susceptibilities of Escherichia coli strains isolated from renal transplant recipients and complicated community-acquired UTIs. We evaluated 75 episodes of 63 recipients with confirmed UTI who underwent transplantation during the period 1981 to 2006 at our center. Medical records of the patients were reviewed retrospectively. To compare the susceptibility rates of E coli, 226 isolates from nontransplant patients with complicated community-acquired UTIs were also evaluated. Ten episodes (13.3%) occurred in the first month following the transplantation, 11 (14.7%) in the period of the second month to the sixth month, and 54 (72%) after the sixth month of transplantation. Forty-six (61.3%) isolates were E coli. Among these isolates, ciprofloxacin resistance rates were 50% (2/4) in the first month after transplantation, 75% (6/8) in the period of the second month to the sixth month, and 32.4% (11/34) beyond 6 months after transplantation. The resistance rates of trimethoprim/sulfamethoxazole (TMP-SMX) in the same time periods were 100% (4/4), 87.5% (7/8), and 70.6% (24/34), respectively. The rates of resistance to TMP-SMX among E coli isolated from renal recipients were significantly higher than those in community-acquired complicated UTIs. The increased resistance of urinary pathogens to this agent is a major concern. Although high resistance rates of ciprofloxacin against E coli strains were determined in this group, it was not found to be statistically significant.     

复杂性细菌性尿路感染病原菌构成及耐药性分析

目的 探讨复杂性细菌性尿路感染的病原菌分布及耐药性特点,为该病抗菌药物的合理使用提供参考.方法 回顾性分析108例复杂性尿路感染患者的临床资料及药敏试验结果.结果 108例尿液标本中共检出325株病原菌,其中218株(67.08％)为革兰氏阴性菌株,62株(19.08％)为革兰氏阳性菌株,另外45株(13.85％)为真菌;革兰氏阴性菌株中,大肠埃希菌占30.15％,其次为铜绿假单胞菌(16.00％)、阴沟肠杆菌(9.23％)以及肺炎克雷伯杆菌(7.69％);革兰氏阳性菌株中以金黄色葡萄球菌(7.08％)、粪肠球菌(5.54％)以及尿肠球菌(4.92％)多见.革兰阴性菌及阳性菌对头孢类、青霉素类、庆大霉素及喹诺酮类耐药性高,多在50％以上,革兰阴性菌对美罗培南及亚胺培南耐药率较低,均在20％以下甚至为0;革兰阳性菌对万古霉素、替考拉宁及利奈唑胺保持较高的敏感性,耐药性多在10％以下.结论 复杂性尿路感染的病原菌菌谱及耐药性均发生了显著变化,临床上应进行药敏试验选择敏感性高的抗菌药物,经验性用药时不宜选用常规的头孢类及喹诺酮类.     

脑卒中患者无症状菌尿症与有症状尿路感染的病原菌分布及耐药特征

目的比较脑卒中患者无症状菌尿症与有症状尿路感染的病原菌分布及耐药特征，为临床诊治提供依据。 方法选取2016年1月1日至2018年月12月30日天门市第一人民医院收治的287例尿微生物培养阳性的脑卒中患者为研究对象，分为无症状菌尿症组（192例）和有症状尿路感染组（95例），分析两组患者病原菌分布及耐药特点、血清降钙素原、尿白细胞计数和抗菌药物使用。 结果287例患者共检出细菌323株，其中以大肠埃希菌（48.92%、158/323）、肺炎克雷伯杆菌（7.12%、23/323）、屎肠球菌（12.07%、39/323）和粪肠球菌（4.64%、15/323）为主。无症状菌尿组与有症状尿路感染组患者尿微生物培养显示，大肠埃希菌（40.68% vs. 53.66%）、阴沟肠杆菌（9.32% vs. 3.41%）和屎肠球菌（18.64% vs. 8.29%）构成比差异均有统计学意义（χ²=－5.050、P = 0.025，χ² = 4.915、P = 0.027，χ² = 7.559、P = 0.006）。287例患者尿微生物培养病原菌中大肠埃希菌对左氧氟沙星、环丙沙星、头孢噻肟和头孢呋辛耐药率分别为46.20%（73/158）、51.27%（81/158）、55.70%（88/158）和57.59%（91/158）。屎肠球菌对庆大霉素、呋喃妥因、左氧氟沙星、青霉素、氨苄西林和环丙沙星耐药率分别为54.55%（18/33）、71.79%（28/39）、94.87%（37/39）、97.37%（37/38）、97.44%（38/39）和97.44%（38/39）。无症状菌尿组与有症状尿路感染组患者尿白细胞异常比例（57.81% vs. 87.37%）、尿白细胞计数中位数（35.70个/μl vs. 547.60个/μl）差异均有统计学意义（χ² = 25.346、P < 0.001，Z = －9.246、P < 0.001）。ROC曲线显示两组患者尿白细胞的Cut-off值为261.34，95%CI为0.78～0.89。无症状组与有症状尿路感染组患者导管留置率（50.52% vs. 80.00%）、抗菌药物使用率（61.46% vs. 91.58%）以及使用天数中位数（4 d vs. 9 d）差异均有统计学意义（χ² = 23.067、P < 0.001，χ² = 28.253、P < 0.001，Z = 7.110、P < 0.001）。 结论脑卒中患者尿白细胞数对无症状菌尿和有症状泌尿道感染的鉴别诊断具有一定价值。应根据病原菌药敏试验结果合理选用抗菌药物，减少无症状菌尿患者抗菌药物的不合理应用，以减少耐药菌株产生。     

Urinary tract infections in the early posttransplant period after kidney transplantation: etiologic agents and their susceptibility

Objective

Urinary tract infection (UTI) is among the most common infections in solid organ transplantation, especially in kidney transplantation.

Patients and Methods

This study included 295 adult patients undergoing KTx between September 2001 and December 2007. All patients were followed prospectively for UTI during the first 4 weeks after surgery. Samples of urine were investigated by bacteriological cultures to identify microorganisms in accord with standard procedures. Susceptibility testing was performed using Clinical and Laboratory Standards Institute procedures.

Results

Urine specimens (n = 582) were obtained from 84.5% of 245 recipients during the first month after transplantation. Among the isolated bacterial strains (n = 291), the most common were Gram-negative bacteria (56.4%) predominantly Serratia marcescens (32.3%) and Enterobacter cloacae (14.6%). Extended- spectrum beta-lactamase (ESBL+) strains were isolated in 52.5% of cases. Gram-positive bacteria comprised 35.7%; most commonly, high-level aminoglycoside resistant (HLAR; 87.8%) and vancomycin-resistant (VRE; 11%) Enterococci. There were fungal strains in 23 cases (7.9%).

Conclusion

Our study showed predominantly Gram-negative rods from the Enterobacteriaceae family comprising (84.8%) of Gram-negative isolates: 52.5% ESBL and resistant enterococci (87.5%) in Gram-positive isolates. The increased proportion of isolates of multi-drug-resistant bacterial agents which can cause severe UTIs may be due to our frequent use of ceftriaxone for perioperative bacterial prophylaxis.     

泌尿外科住院患者中段尿培养病原菌分布及耐药性分析

目的 了解泌尿外科住院患者尿培养病原菌的分布和耐药性,为临床合理用药提供依据.方法 回顾性统计2014年1月至2015年6月本院泌尿外科患者中段尿培养的临床资料,进行耐药性分析.结果 泌尿外科共送检1624份尿标本,其中532份分离出病原菌,阳性率为32.76％.532份阳性标本共分离病原菌566株,其中革兰氏阴性杆菌449株,占79.33％,革兰氏阳性球菌93株,占16.43％,真菌24株,占4.24％.分离率居前五位的细菌分别是大肠埃希菌(53.53％)、屎肠球菌(5.65％)、铜绿假单胞菌(4.77％)、粪肠球菌(4.24％)、肺炎克雷伯菌(3.89％).大肠埃希菌对头孢菌素类、喹诺酮类、四环素类、磺胺类药物均表现为较高的耐药率;屎肠球菌对氨苄西林、高浓度庆大霉素、喹诺酮类药物耐药率较高.结论 泌尿外科住院患者尿培养病原菌以大肠埃希菌为主,细菌耐药情况严重,加强尿培养监测及定期对细菌耐药性进行总结分析对指导临床规范、合理使用抗菌药物具有非常重要的意义.     

尿路感染中段尿病原菌的分布及耐药性

Objective To analyze the distribution and antimicrobial resistance of pathogenic bacteria in urinary tract infection (UTI) so as to provide evidence for appropriate selection of antimicrobial agents in clinical practice. Methods From January 2001 to December 2008 in Shanghai Ruijin Hospital, 4683 strains of pathogenic bacteria isolated from urine samples were detected by ATB system; drug susceptibility test was performed with disk diffusion method and pathogenic bacteria distribution and drug resistance was analyzed with WHO NET 5.3 software. Results Among 4683 strains of pathogenic bacteria, most was gram-negative bacilli, accounting for about 77.8%, of which predominant strain was Escherichia coli (68.7%, 3217/4683). The predominant strain of gram-positive bacteria was Enterococcus faecalis, accounting for 10.0% (468/4683). Escherichia coli showed high resistance rates to ampicillin, piperacillin and compound sulfamethoxazole (SMZ-TMP), which were 76.6%, 61.7% and 57.4% respectively, while a low resistance to imipenem, cefoperazone-sulbactam, piperacillin-tazobactam. Enterococcus faecalis showed high resistance rates to erythromycin, gentamicin and levofloxacin, which were 65.8%, 43.2% and 31.1% respectively, and were most susceptive to vancomycin and teicoplanin, both with resistance rates of 0. The susceptibility rate of Enterobacteriaceae to imipenem was 100%. From 2006 to 2008, the detection rate of extend-spectrum ?茁-lactamases ESBLs -producing Escherichia coli in outpatient increased year by year, from 28.7% to 43.3% (P<0.05), whereas no significant change was found in inpatients. The detection rate of (ESBLs)-producing Escherichia coli in inpatients was significantly higher than that in outpatients (P<0.05). The detection rate of ESBLs-producing Escherichia coli was 23.6%. The antimicrobial resistance rate in elderly patients was significantly higher than that in overall antimicrobial resistance rate (P<0.05). Conclusions The predominant bacteria of UTI are still gram-negative bacteria, main of which is Escherichia coli. Bacteria are resistant to a variety of antibiotics. Approximate selection of antibiotics in clinical practice should be made on the basis of susceptibility test results.     

Clinical studies of efficacy of imipenem/cilastatin sodium against urinary tract infections with ureterocutaneostomy]

Clinical efficacy of IPM/CS against urinary tract infections (UTI) was evaluated on 19 patients with malignancies (bladder tumor: 15, prostate cancer: 3, uterus cancer: 1) and 1 patient with a benign disorder (ureter stenosis) who had undergone ureterocutaneostomy between January, 1988 and December, 1990. Their ages ranged from 42 to 79 years. Postoperatively, they had UTI with pyuria of greater than or equal to 5/hpf and bacteriuria of greater than or equal to 10(4)/ml. IPM/CS was administered at a dose of 0.5 g (0.25g/0.25 g) twice a day through intravenous drip infusion. Its efficacy was evaluated according to the UTI criteria for clinical evaluation as ruled by the Japanese Society of Chemotherapy. Overall clinical value was rated "excellent" in 4 (20%), "moderate" in 9 (45%) and "poor" in 7 (35%) cases for a total of 65%. The efficacy by types of infection was 33% and 70.6% in the group of single infection and in the group of mixed infection, respectively. As to bacteriological efficacy 34 of the 38 strains (89.5%) isolated were eradicated following its administration. The eradication rate was 84.6% for P. aeruginosa, and 84.6% for E. faecalis. Microbes which appeared after its dosing amounted to 6 classes of 17 strains, 6 NFB strains of which were identified. As a side effect, elevation of serum GPT (5%) was noted. Regardless of the underlying conditions (malignant diseases and ureterocutaneostomy), clinical efficacy of IPM/CS was appreciable. In addition, the MIC for (P. aeruginosa, E. faecalis) of IPM/CS was lower than that of PIPC.