The ECO.SENS Project: a prospective, multinational, multicentre epidemiological survey of the prevalence and antimicrobial susceptibility of urinary tract pathogens--interim report

The ECO.SENS Project is the first international survey to investigate the prevalence and susceptibility of pathogens causing community-acquired, uncomplicated urinary tract infections (UTIs) in women. At 240 centres in 17 countries, female patients presenting with symptoms of uncomplicated UTIs were asked to provide a urine sample for testing for the presence of leucocytes and bacteria. The bacteria were identified and their susceptibility to 12 antibiotics commonly used in the treatment of UTIs was determined. The objective of the survey was to collect 5000 urine samples to obtain approximately 3500 isolates of defined uropathogens. This interim report includes the results from 1960 urine samples, 75% of which contained a uropathogen. Escherichia coli accounted for the majority (80%) of uropathogens isolated in all 17 countries. The rates of resistance among E. coli strains were: ampicillin and sulphamethoxazole, 30%; trimethoprim alone or with sulphamethoxazole, 15%; nalidixic acid, 6%; ciprofloxacin, 3%; amoxycillin-clavulanic acid, mecillinam, cefadroxil, nitrofurantoin and fosfomycin, < or =2%. The use of ampicillin, sulphonamides and trimethoprim alone or with sulphamethoxazole needs to be reconsidered. The seemingly rapid increase in quinolone resistance among community-acquired E. coli in some of the countries gives cause for concern.     

An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project

The ECO.SENS study is the first international survey to investigate the prevalence and susceptibility of pathogens causing community-acquired acute uncomplicated urinary tract infections (UTIs). Midstream urine samples were taken for culture and for testing for the presence of leucocytes from 4734 women not older than 65 years presenting with symptoms of acute UTI at 252 community health care centres in 17 countries. Recognized urinary tract pathogens were identified and the susceptibility to 12 antimicrobials determined. Pathogens were present in 3278 (69.2%) patients, Escherichia coli accounting for 77.0% of isolates. In E. coli, 42% of the isolates were resistant to one or more of the 12 antimicrobial drugs investigated. Resistance was most common to ampicillin (29.8%) and sulfamethoxazole (29.1%), followed by trimethoprim (14.8%), trimethoprim/sulfamethoxazole (14.1%) and nalidixic acid (5.4%). Resistance in E. coli to co-amoxiclav, mecillinam, cefadroxil, nitrofurantoin, fosfomycin, gentamicin and ciprofloxacin was <3%. However, co-amoxiclav resistance was apparent in Portugal (9.3%) as was resistance to the quinolones, nalidixic acid and ciprofloxacin, in Portugal (11.6% and 5.8%, respectively) and Spain (26.7% and 14.7%, respectively). Overall, Proteus mirabilis were less resistant to ampicillin (16.1%) and more resistant to trimethoprim (25.5%) than E. coli, whereas Klebsiella spp. were more resistant to ampicillin (83.5%) and fosfomycin (56.7%). 'Other Enterobacteriaceae' were more resistant to the broad spectrum beta-lactams (ampicillin 45.9%, co-amoxiclav 21.3% and cefadroxil 24.6%), nitrofurantoin (40.2%) and fosfomycin (15.6%). In Staphylococcus saprophyticus resistance development was rare. Overall, antimicrobial resistance was lowest in the Nordic countries and Austria and highest in Portugal and Spain.     

The resistance ofEscherichia coli strains isolated from community-acquired urinary tract infections

Urinary tract infections (UTIs) are the most common infections caused byEscherichia coli. Most recent research demonstrates that antibiotic resistance has reached a critical point throughout the world, as increased use of antibiotics among nonhospitalized patients encourages the growth of drug-resistant pathogens among that population. The goal of this study was to determine the antimicrobial drug resistance ofE coli strains isolated from community-acquired UTIs in 5 different regions in Turkey. The minimum inhibitory concentrations of ciprofloxacin, gentamicin, sulfamethoxazole, trimethoprim, trimethoprim-sulfamethoxazole, and ampicillin and forE coli were determined with the agar dilution method. Among the 480 strains isolated, 8.3% were resistant to ciprofloxacin, 3.3% to gentamicin, 35.4% to sulfamethoxazole, 33.3% to trimethoprim, 27.9% to trimethoprim-sulfamethoxazole, and 40.8% to ampicillin. These results show that the antibiotics currently most effective againstE coli are ciprofloxacin and gentamicin. Local epidemiologic trends should be considered when prescribing antibacterial therapy. More research in bacterial gene mapping will be necessary to elucidate the influence of regional antimicrobial drug use and resistance in epidemiologic trends among the general population.     

社区获得性尿路感染菌群分布及耐药性分析

目的调查本地区社区获得性尿路感染(CAI)患者的菌群分布及耐药情况,促进临床合理选用抗菌药物。方法参照临床检验操作规程留取患者的中段尿进行培养、鉴定,药敏试验采用纸片扩散法。结果分离CAI病原菌263株,其中排名第1位的是大肠埃希菌,占64.3%,第2位的是肠球菌,占12.5%。大肠埃希菌的药敏结果显示对青霉素类、氟喹诺酮类抗生素的耐药率较高。结论本地区CAI的菌群分布不断发生变迁,细菌的耐药率有升高趋势。     

临床标本分离病原菌种类及耐药分析

目的 对本院2005～2006年临床分离的924株病原菌种进行药敏试验和耐药分析.方法 革兰阳性球菌及阴性杆菌采用MicroScan细菌鉴定药敏检测系统板进行细菌鉴定和药敏试验.结果 革兰阴性杆菌占优势(67.86%),主要为大肠埃希菌(14.07%)、铜绿假单胞菌(13.53%)、肺炎克雷伯菌(11.04%)、表皮葡萄球菌(6.79%)、金黄色葡萄球菌(4.52%).各种常见病原菌对抗生素存在不同程度的耐药.结论 阳性球菌对万古霉素100%敏感,对青霉素100%耐药,治疗阴性杆菌感染首选亚胺硫霉素(76.1%敏感),其次是丁胺卡那霉素(71.7%敏感).建议临床医生根据实验室结果合理使用抗生素.     

Clinical investigation of isolated bacteria from urinary tracts of hospitalized patients and their susceptibilities to antibiotics

Complicated urinary tract infections (UTIs) are often difficult to treat, partly because of the existence of isolated antibiotic-resistant strains. Even though the definition of UTI is determined by the quantity of cultured bacteria, it has been unclear if the quantity of cultured UTI bacteria affects their susceptibility to antimicrobial agents. Also, the gram stain is generally performed to assume the causative bacteria and their quantity before culture results can be obtained; therefore, we could start to use effective antibiotics if the relationship between bacterial quantity and resistance to antimicrobial agents were clear. We studied patients diagnosed as having complicated UTIs at the Urological Department in Kobe University Hospital between June 2002 and March 2003 and analyzed the relationships between the quantity of cultured bacteria and their antimicrobial MICs for antibiotics. The most commonly isolated bacteria were Serratia marcescens, Pseudomonas aeruginosa, Enterococcus faecalis, Escherichia coli, Staphylococcus epidermidis, Stenotrophomonas maltophilia, and methicillin-resistant Staphylococcus aureus. There was no significant correlation between the quantity of cultured bacteria and antimicrobial MICs in all the bacteria and antibiotics that we tested, suggesting that resistant phenotype, but not inoculum of the organism, did determine resistance to antibiotics. In conclusion, our investigation suggested the total number of isolated bacteria in urine culture did not determine the MICs and that inoculum of the bacteria might be important for this determination.     

1995-2004年下呼吸道感染病原菌变迁

目的了解1995—2004年湘雅医院呼吸科下呼吸道感染住院患者病原菌及其药敏变迁情况。方法对呼吸病房下呼吸道感染住院患者痰菌（或支纤镜吸取分泌物）培养阳性标本结果进行回顾性统计分析。结果分离出细菌2158株，其中革兰阴性杆菌占84．9％，病原菌主要为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌；革兰阳性球菌占15．1％，主要病原菌为金葡菌和肺炎链球菌。20世纪90年代中后期和2000年以后相比革兰阴性杆菌有所减少，而革兰阳性球菌有所增加。药敏试验结果提示主要革兰阴性杆菌对美罗培南、头孢哌酮-舒巴坦均较敏感。铜绿假单胞菌对阿米卡星耐药率也低，对头孢噻肟、头孢曲松耐药率较高；肺炎克雷伯菌对头孢他啶也较敏感，对头孢哌酮、头孢噻肟、头孢曲松耐药率较铜绿假单胞菌低；主要革兰阳性球菌对阿奇霉素、红霉素、青霉素及克林霉素耐药率均较高。其中金葡菌对万古霉素均敏感；肺炎链球菌对美罗培南、左氧氟沙星耐药率低。结论近10年下呼吸道感染病原菌以革兰阴性杆菌为主，但有逐渐减少的趋势。主要病原菌对部分抗菌药物的耐药率有逐渐增高的趋势，临床应合理应用抗菌药，以延缓细菌耐药性的产生。     

手外科专科医院感染病原菌分布及耐药性分析

目的分析江苏省无锡市第九人民医院2011年临床分离出的细菌构成及耐药性情况。方法回顾性分析医院2011年临床标本培养分离出的病原菌的分布、构成和耐药性。结果 2011年临床标本培养分离出533株病原菌,分离率位于前5位的病原菌是:金黄色葡萄球菌(25.69%),大肠埃希菌(15.20%),铜绿假单胞菌(14.63%);鲍曼不动杆菌(10.69%)和肺炎克雷伯菌(9.94%)。金黄色葡萄球菌对万古霉素、利奈唑胺敏感性较好,但对其他常用抗菌药敏感性不佳;肠杆菌科对亚胺培南和哌拉西林/他唑巴坦敏感性较好,对其他药物敏感性不佳;假单胞菌属对常用药物的敏感性高于不动杆菌属,它们对哌拉西林/他唑巴坦敏感性较好。结论手外科专科医院分离病原菌对常用药的耐药率较高,临床医师应熟悉常见分离菌的耐药情况,根据抗菌药物敏感性试验,合理选用抗菌药物,减少耐药菌株的产生。     

Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey

OBJECTIVES: To determine the risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection (UTI). METHODS: The study was performed with isolates from community-acquired UTIs collected from 15 centres representing six different geographic regions of Turkey. All microbiological procedures were carried out in a central laboratory. Multivariate analysis was performed for detection of risk factors for resistance. Use of quinolones more than once within the last year, living in a rural area, having a urinary catheter, age >50 and complicated infections were included in the model as variables and logistic regression was performed. RESULTS: A total of 611 gram-negative isolates were studied: 321 were isolated from uncomplicated UTI and 290 were isolated from complicated UTI. E. coli was the causative agent in 90% of the uncomplicated UTIs and in 78% of the complicated UTIs (P < 0.001). Seventeen percent of E. coli strains isolated from uncomplicated cases and 38% of E. coli strains isolated from complicated UTI were found to be resistant to ciprofloxacin. In multivariate analysis, age over 50 [odds ratio (OR): 1.6; confidence interval (CI): 1.08-2.47; P = 0.020], ciprofloxacin use more than once in the last year (OR: 2.8; CI: 1.38-5.47; P = 0.004) and the presence of complicated UTI (OR: 2.4; CI: 1.54-3.61; P < 0.001) were found to be associated with ciprofloxacin resistance. Detection of strains of E. coli producing extended-spectrum beta-lactamase (ESBL) enzymes was two times more common in the patients who received ciprofloxacin than those who did not (15% versus 7.4%). CONCLUSIONS: The increasing prevalence of infections caused by antibiotic-resistant bacteria makes the empirical treatment of UTIs more difficult. One of the important factors contributing to these high resistance rates might be high antibiotic use. Urine culture and antimicrobial susceptibility testing are essential in Turkey for patients with UTI who have risk factors for resistance, such as previous ciprofloxacin use. Fluoroquinolone-sparing agents such as nitrofurantoin and fosfomycin should be evaluated as alternative therapies by further clinical efficacy and safety studies.     

Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Poland

Worldwide data show that there is increasing resistance among urinary tract pathogens to conventional drugs. The aim of this study was to obtain data on susceptibility patterns of pathogens responsible for urinary tract infections (UTIs) in Poland to currently used antimicrobial agents. A multicentre study of 141 pathogens from hospital-acquired infections and 460 pathogens from community-acquired infections was carried out between July 1998 and May 1999. The most prevalent aetiological agent was Escherichia coli (73.0%), followed by Proteus spp. (8.9%) and other species of Enterobacteriaceae (9.6%). Few community infections were caused by Gram-positive bacteria (2.2%). Gram-positive cocci were isolated more frequently from a hospital setting (14.1%) and the most common were Enterococcus spp. (8.5%). Pseudomonas aeruginosa was found only among hospital isolates and was responsible for 10.7% of infections. E. coli isolates from both community and hospital infections were highly susceptible to many antimicrobial agents with the exception of those isolates producing extended-spectrum beta-lactamases (ESBLs). Of all Enterobacteriaceae tested, 38 strains (6.9%) were capable of producing ESBLs.     

儿科心脏重症监护病房患儿呼吸道感染病原菌的分布及耐药性研究

目的：探讨儿科心脏重症监护病房（CICU）呼吸道感染常见病原菌的分布及耐药情况,为临床合理选用抗菌药物提供参考。方法回顾性分析该医疗中心2011年1月至2012年12月1350例 CICU 下呼吸道感染患儿痰液标本培养及药敏检测结果。结果1350例痰标本中,共培养获得病原菌490株,其中革兰阴性杆菌288株（58．78％）,革兰阳性球菌140株（28．57％）,真菌62株（12．65％）。革兰阴性杆菌以肺炎克雷伯菌为主（62株,占12．65％）,其次为卡他布兰汉菌、铜绿假单胞菌、大肠埃希菌。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）菌株阳性率分别为73．33％和66．13％。革兰阳性球菌以金黄色葡萄球菌为主（65株,占13．27％）,其次为肺炎链球菌。耐甲氧西林金黄色葡萄球菌（MRSA）占24．62％。结论金黄色葡萄球菌、肺炎链球菌、肺炎克雷伯菌为 CICU 患儿呼吸道感染的主要病原菌,且存在多重耐药菌感染,根据病原菌种类及药敏结果合理应用抗菌药物是有效控制危重病患儿感染和减少耐药菌株产生的重要手段。     

新生儿科下呼吸道感染病原菌分布及耐药性分析

目的探讨新生儿科下呼吸道感染病原菌分布及耐药情况,为I临床合理用药提供依据。方法对2009年1月1日-2012年12月31日入住新生儿科且下呼吸道感染患儿送检的5486份分泌物标本中分离出的998株病原菌种类及其药物敏感性（药敏）试验结果进行整理并加以分析。结果998例培养阳性的下呼吸道分泌物标本中,分离出的主要病原菌分别为肺炎克雷伯菌231株（23．1％）,大肠埃希菌212株（21．2％）,金黄色葡萄球菌194株（19．4％）,阴沟肠杆菌84株（8．4％）。肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌对青霉素类抗生素普遍耐药,但与酶抑制剂联用可以降低其耐药率,肺炎克雷伯菌对第3代头孢菌素类抗生素的耐药率较高,达78．4％;大肠埃希菌和阴沟肠杆菌对第3代头孢菌素类抗生素的耐药率低于肺炎克雷伯菌（分别为46．7％和46．5％）;有7株（3．0％）肺炎克雷伯菌和1株（1．2％）阴沟肠杆菌对亚胺培南耐药,23株（13．6％）肺炎克雷伯菌、1株（0．7％）大肠埃希菌和1株（2．5％）阴沟肠杆菌对厄他培南耐药。97．0％的金黄色葡萄球菌对青霉素耐药,但金黄色葡萄球菌对苯唑西林耐药率较低（11．0％）,未检出耐万古霉素的金黄色葡萄球菌。结论新生儿科住院患儿下呼吸道感染的病原菌以口杆菌为主,以肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌为主要病原菌。主要病原菌对常用抗生素耐药率均较高。临床应根据其药敏试验结果合理选择抗生素,避免抗生素滥用导致多重耐药菌株的产生。     

重症监护病房患者感染病原细菌的耐药性分析

目的:监测重症监护病房感染病原菌的分布及药敏情况,为临床用药提供参考。方法:收集我院2005年6月至2006年5月一年间分离自ICU的683株非重复菌株,细菌的鉴定及药敏采用MicroScan Walkaway40全自动系统。结果:革兰阴性非发酵菌是ICU感染的重要病原菌,占55.8%。分离数排前五位的病原菌为鲍曼不动杆菌(23.9%)、铜绿假单胞菌(18.4%)、金黄色葡萄球菌(17.4%)、大肠埃希菌(7.8%)和肺炎克雷伯菌(6.9%)。鲍曼不动杆菌对多种药物的耐药率大于70%,仅对哌拉西林/他唑巴坦、头孢吡肟、亚胺培南、氨曲南及头孢他啶的敏感性相对较好,其中泛耐菌株约占5%。铜绿假单胞菌对亚胺培南的耐药率达到72%。此外,几乎全部金葡菌为甲氧西林耐药株(99%),耐药情况严重,仅对复方磺胺甲噁唑的耐药率较低,尚未检出万古霉素耐药菌株。结论:ICU感染病原菌多重耐药现象严重,细菌耐药性监测对指导临床选药具有重要意义。     

2010年武汉同济医院细菌耐药性监测

目的分析武汉同济医院2010年临床分离菌对常用抗菌药物的耐药情况。方法采用纸片扩散法(K-B法)进行抗菌药物敏感性试验,E试验检测肺炎链球菌对青霉素和头孢曲松以及葡萄球菌对万古霉素的最低抑菌浓度(MIC),用WHO-NET5.4统计软件进行数据分析。结果 2010年该院5 287株临床分离菌中,革兰阳性球菌1 476株,占27.9%,革兰阴性杆菌3 149株,占59.6%,真菌662株,占12.5%。门诊病人前5位分离菌依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金葡菌和流感嗜血杆菌,住院病人前5位分离菌依次为大肠埃希菌、金葡菌、铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌。MRSA和MRCNS的检出率分别为63.3%和74.7%;产ESBLs大肠埃希菌和克雷伯菌属的检出率分别为80.1%和55.6%,产酶株耐药性明显高于非产酶株;检出对万古霉素和(或)替考拉宁耐药的肠球菌属11株,经PCR检测均为VanA型。屎肠球菌耐药率均明显高于粪肠球菌(P<0.05);青霉素不敏感肺炎链球菌(PNSSP)分离率为33.0%(非脑脊液标本);铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为18.5%和14.3%,不动杆菌属对亚胺培南和美罗培南耐药率在50%以上;流感嗜血杆菌产β内酰胺酶阳性率为31.9%,除对氨苄西林和甲氧苄啶-磺胺甲口恶唑敏感率较低外,对其他抗菌药物敏感率均在75%以上。结论临床常见病原菌仍以革兰阴性杆菌为主,与该院往年监测数据相比,本年度分离的病原菌对多数抗菌药物耐药性呈上升趋势,多重耐药情况严重,出现少数耐万古霉素肠球菌属及多重耐药革兰阴性杆菌,应引起临床重视。     

综合重症监护病房下呼吸道感染病原菌变迁及耐药状况分析

目的了解下呼吸道感染病原菌的变迁、主要流行病原菌的耐药状况,为临床合理应用抗生素提供依据。方法细菌的分离、鉴定及常用抗生素的敏感、耐药试验。结果病原菌以革兰阴性菌为主,占62.76%,革兰阳性菌次之,占28.12%,真菌占9.12%;位于前5位的病原菌依次为铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、鲍氏不动杆菌、表皮葡萄球菌;亚胺培南对主要的革兰阴性(G-)菌具有较好的敏感性,哌拉西林/他唑巴坦对铜绿假单胞菌有较好的敏感性;革兰阳性(G+)菌主要为耐甲氧西林金黄色葡萄球菌(MRSA),成为病原菌的第3位,对万古霉素100.0%敏感。结论目前下呼吸道感染病原菌中多药耐药比例逐年增加,针对产超广谱β-内酰胺酶(ESBLs)菌株建议选用碳青霉烯类,对MRSA推荐用万古霉素。     

肝胆外科病人感染病原菌分布及耐药性研究

目的研究肝胆外科病人感染病原菌种类及其耐药性,为临床合理使用抗菌药物提供参考。方法采用细菌分离培养和药敏试验方法,对某医院肝胆外科病房1 200份送检标本进行细菌鉴定及药敏试验。结果从1 200份标本中共检出病原菌720株,检出率60%。在检出的病原菌中,革兰阴性杆菌占60%,其中肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌居前3位;革兰阳性球菌占40%,主要包括金黄色葡萄球菌、肠球菌和表皮葡萄球菌等。药敏试验表明,检出的病原菌普遍耐药,革兰阳性球菌只对万古霉素全部敏感,革兰阴性杆菌只对亚胺培南敏感。结论肝胆外科病人感染病原菌主要是革兰阴性杆菌,其次是革兰阳性球菌,这些病原菌普遍耐药。     

重症监护病房患者下呼吸道感染细菌分布及耐药性监测

目的对重症监护病房（ICU）患者下呼吸道感染病原菌分布及耐药性进行监测分析,为临床合理用药提供依据。方法对我院2007—2009年ICU患者下呼吸道感染痰液标本所分离的病原菌,进行菌种和耐药情况回顾性统计分析。结果3年来,共分离出病原菌483株,其中革兰阳性菌89株,占18．4％,革兰阴性菌331株,68．5％,真菌63株,占13．1％。排名前几住的依次为铜绿假单胞菌,金黄色葡萄球菌,鲍曼不动杆菌,嗜麦芽窄食单胞菌,肺炎克雷伯菌,大肠埃希菌。铜绿假单胞菌对亚胺培南耐药率达31．6％,胞曼不动杆菌、肺炎克雷伯菌、大肠埃希菌对亚胺培南敏感率均达100％;金黄色葡萄球菌耐甲氧西林金黄色葡萄球菌（MRSA）分离率较高,占65．3％,未发现对万古霉素耐药菌株。结论加强ICU感染管理以及病原菌耐药情况的监测,合理使用抗菌素十分重要。     

Susceptibility of Recent Bacterial Isolates to Cefdinir and Selected Antibiotics among Children with Urinary Tract Infections

Background: Cefdinir, an extended‐spectrum cephalosporin administered orally, is approved by the U.S. Federal Drug Administration for treatment of skin and respiratory tract infections. During the last two years at the authors' institution, this agent has been used as an off‐label treatment for urinary tract infections in children. Objectives: To evaluate antimicrobial susceptibility testing data in children to determine whether there is support for this prescribing practice. Methods: In this retrospective study (2003–2004), the authors compared the susceptibility patterns of urinary pathogens to cefdinir and selected antibiotics in children who were evaluated for urinary tract infections in an urban tertiary academic pediatric emergency department. Pathogens (community acquired vs. opportunistic or nosocomial) were categorized as susceptible, indeterminate, or resistant on the basis of antibiotic susceptibility breakpoints. The frequency of these categorizations for individual drugs was determined. Results: Seven hundred five isolates were recovered from urine during the study period. Pathogens isolated most frequently were Escherichia coli, Klebsiella spp, and Proteus spp. Of 431 isolates retained in the data set, 412 (95.6%) were susceptible to cefdinir. This rate was comparable or superior to rates observed for other antibiotics: 49.4% for ampicillin, 84.9% for trimethoprim–sulfamethoxazole, 88.4% for cefazolin, 93.3% for nitrofurantoin, 94.2% for ticarcillin–clavulanate potassium, 97.5% for gentamicin, and 97.7% for ceftriaxone. Cefdinir, however, had lower activity (64.7%) against 17 bacterial isolates categorized as opportunistic or nosocomial pathogens. Conclusions: Cefdinir provides good coverage against common pathogens responsible for urinary tract infections in children and compares favorably with other oral and parenteral antibiotics that are used in the empiric treatment of this infection.     

2013-2019年无菌体液病原菌分布及耐药性分析

目的 了解本院2013年3月至2019年3月临床分离的脑脊液及其他无菌体液病原菌的分布及耐药情况。方法 收集和统计2013年3至2019年3月脑脊液及其他无菌体液标本分离的病原菌分布及耐药性特点,运用WHONET5.6软件进行菌株分布及药敏结果分析。结果 共分离病原菌1 450株,革兰阳性菌806株(55.6%);革兰阴性菌556株(38.3%);真菌88株(6.1%)。常见病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、粪肠球菌。无菌体液标本中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为35.8%和75.4%,未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。肠球菌属中屎肠球菌对除四环素外的大多数抗菌药物耐药率明显高于粪肠球菌。产超广谱内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为60.6%和65.9%,除肺炎克雷伯菌对亚胺培南耐药率大于10.0%,其他肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感。多重耐药鲍曼不动杆菌和铜绿假单胞菌检出率分别为65.3%和12.7%。结论 应加强常见耐药菌的监测,尤其是耐碳青霉烯类肠杆菌科细菌和多重耐药鲍曼不动杆菌应引起高度关注,根据药敏试验结果合理使用抗菌药物,加强耐药菌感染控制,以减少耐药菌株产生。     

老年人胆道感染85例临床分析

目的：探讨老年人胆道感染的临床病原学特点及细菌耐药状况，指导临床合理用药。方法：回顾性分析1999年1月-2003年5月85例老年胆道感染胆汁标本中病原学的检出。结果：85份标本中有58份胆汁培养有细菌生长，阳性率为68．2％(58／85)，其中混合感染标本占17．2％(10／58)，分离细菌70株，革兰阴性杆菌57株占81．4％，主要为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌。革兰阳性球菌13株占18．6％，主要为肠球菌属和金黄色葡萄球菌。分离的革兰阴性杆菌对亚胺培南、头孢吡肟、头孢他啶等敏感性较高，可作为老年重症胆道感染的首选用药，而对庆大霉素、环丙沙星有较高的耐药性．不宜作为老年胆道感染患者的经验性治疗用药。结论：对老年胆道感染病原学的监测，有利于选择有效的抗菌药物．减少治疗的盲目性。