658例尿培养阳性标本的病原菌分布及耐药性分析

目的：分析湖南省人民医院尿培养阳性标本的细菌分布及耐药状况，为临床合理选用抗菌药物提供依据。方法：采用回顾性调查方法, 对湖南省人民医院2007年1月1日至2008 年12月31日从尿标本中分离的病原菌进行分析。结果：(1)共分离菌株658株,其中革兰阳性菌172株,占26.14%；革兰阴性菌466株,占70.82%；真菌20株，占3.04%。分离量最多的菌种为大肠埃希菌，共336株（51.06% ）；其次为肺炎克雷伯菌49株（7.45%）和变异链球菌48株（7.29%）。按年份分布,大肠埃希菌分离率由2007年的68.91%下降到2008年的63.43％，肠球菌属分离率由2007年的3.37%上升2008年的7.67%,但差异无统计学意义(P＞0.05) 。按科室来源分布,门急诊的大肠埃希菌构成比（88.68%）高于住院患者,肺炎克雷伯菌和革兰阳性球菌的比例低于住院患者，差异均有统计学意义(P＜0.05)。(2)大肠埃希菌和肺炎克雷伯菌对喹诺酮类耐药率为28.57%～56.25%，对第3代头孢菌素的耐药率为38.78%～65.78%,革兰阳性球菌对喹诺酮类和第3代头孢菌素的耐药率均在50%以上，对万古霉素耐药率为11.05%。 结论：本院尿培养阳性标本的主要致病菌以大肠埃希菌为代表的革兰阴性杆菌为主, 但肠球菌等革兰阳性菌所占比例比上年有所增多; 门急诊患者的大肠埃希菌分离率高于住院患者,肠杆菌科和革兰阳性球菌对喹诺酮类、第3代头孢菌素的耐药性严重。

Distribution and antibiotic resistance of pathogen isolated from mid-stream urine of 658 patients

ObjectiveTo investigate the bacterial distribution and resistance to antibiotics in culture-positive urine, and to provide reference for rational use of antibiotics in clinical practice.MethodsDistribution and antibiotic resistance to pathogens in 658 culture-positive patients from Jan. 1, 2007 to Dec. 31, 2008 were analyzed. Results（1）Pathogenic strains from the 658 patients were collected from the urine specimen in the survey, which included Gram-negative bacilli (70.82%),Gram-positive cocci (26.14%) and fungi (3.04%). The distribution rate of Escherichia coli declined from 68.91% in 2008 to 63.43% in 2007(P＞0.05), and Enterococcus rose from 3.37% to 7.67% (P＞0.05),but the difference was not significant. The proportion of Gram-negative bacilli(especially the E.coli) from patients in the Emergency Department and Out-patient Department was higher than that from in-patients, and the proportion of K.pneumonia and Gram-positive bacteria was lower than in-patients, both with significant differences (P＜0.05).(2)The resistance rate of E. coli and K.pneumonia to quinolones was 28.57%-56.25%, and the resistance rate to 3rd generation cephalosporin was 38.78%-65.78%, respectively. The resistance rate of Gram-positive cocci to quinolones and 3rd generation cephalosporin was both higher than 50%, and was 11.05% to Vancomycin.ConclusionGram-negative bacilli such as E.coli and K.pneumonia are predominant organism in the urinary tract infections, but proportion of Gram-positive bacteria has increased in recent years. Attention needs to be paid to the overall and severe bacterial resistance in the urinary tract infections and rational use of antibiotics.