复杂性尿路感染致病菌的耐药性新趋势

目的 探讨复杂性尿路感染致病菌和耐药性的变化。方法 分析从1995年到2001年住院治疗的260例培养阳性的复杂性尿路感染致病菌分布及其对抗生素敏感性。结果 革兰阴性杆菌占77.3％,其中大肠杆菌占44.2％;革兰阳性球菌占16.9％,其中肠球菌占11.6％;真菌占5.8％。大肠杆菌对氨苄西林耐药率最高,达84.1％;对羟氨苄西林/克拉维酸耐药率(21.3％)明显低于对氨苄西林的耐药率(P<0.05);对阿米卡星耐药率明显低于对庆大霉素的耐药率(4.9％比54.3％,P<0.01);致病大肠杆菌对喹诺酮耐药,耐药率为50％-78％;对SMZ/TMP耐药性也高达62.3％。结论 大肠杆菌仍是住院复杂性尿路感染的主要致病菌,但肠球菌、克雷白杆菌、阴沟肠杆菌常见等细菌的比例有所增加。这些细菌耐药性高,部分呈多重耐药,应尽量根据细菌药敏试验调整抗生素。

New trend in antimicrobial resistance of pathogens causing hospitalized complicated urinary tract infection

Objective To investigate the antimicrobial resistance of pathogens causing complicated urinary tract infection. Methods Distribution and resistance of pathogens in 260 culture-positive hospitalized complicated urinary tract patients from 1995 to 2001 were analyzed. Results Gram-negative bacilli accounted for 77. 3% , with 44. 2% of E. Coli. Gram-positive cocci accounted for 16. 9% , with 11. 6% of Enterococci; and fungi accounted for 5. 8%. E. Coli had the highest resistance rate of 84. 1% for ampicillin. Resistance rate of E. Coli to amoxicillin/clavulate(21. 3% ) was significantly lower than that to ampicillin alone ( P < 0. 05) . Resistance rate of E Coli to amikacin was significantly lower than that to gentamycin(4. 9% vs 54. 3% , P < 0. 01). Great proportion of E Coli was resistant to fluroquinolones with resistance rate ranging between 50% and 78%. The resistance rate to SMZ/TMP was as high as 62. 3%. Conclusions E Coli is still the major pathogen in complicated urinary tract infection in hospitalized patients. There is a tendency toward increased proportion of Klebsiella and other enterobacteriae. A substantial proportion of pathogens are resistant to antibiotics, some being multi-resistant strains. Antimicrobial therapy should be initiated under the guidance of anti-microbial sensitivity test if possible.