187例医院内尿路感染病原分布和抗生素耐药分析

目的 :了解医院内尿路感染的病原分布和对抗生素的耐药情况及其比较与院外尿路感染的差别 ,企图以此指导临床用药。方法 :收集 187例医院内尿路感染和同期住院的 14 5例院外尿路感染进行比较。结果 :医院内尿路感染的优势菌依次为 :大肠埃希菌 2 8.2 4 % ,肠球菌 2 1.37% ,念珠菌 14 .89% ,克雷伯杆菌 8.0 2 % ,假单胞菌 7.2 5 %和链球菌 4 .96 %。其中医院内念珠菌的感染率较院外显著升高 (P <0 .0 1)。有尿路操作者中大肠埃希菌 33.33% ,肠球菌 16 .92 % ,念珠菌 16 .4 1%和假单胞菌8.2 1%。其中念珠菌和假单胞菌的感染率显著高于无尿路操作者 (P <0 .0 5 ,P <0 .0 1)。在院内感染者中 ,大肠埃希菌对环丙沙星和头孢哌酮的耐药性 ,肠球菌对青霉素的耐药性药明显高于院外感染者 (P <0 .0 5 ,P <0 .0 5 ,P <0 .0 5 )。结论 :院内尿路感染中有较多尿路操作和广谱抗生素的使用史 ,念珠菌的感染率明显升高 ,细菌对抗生素耐药的情况较多 ,应注意调整治疗方案。

Study of the Pathogens and Antibiotic Resistance in 187 Cases with Nosocomial Urinary Tract Infections

Objective: To determine the difference in bacterial distribution and antibiotic resistance between hospital and community-acquired urinary tract infection (UTI). Methods: A total of 187 resident patients with hospital-acquired UTI were compared with 145 clinical isolates with community-acquired UTI. Results: The most common pathogens in hospital-acquired UTI are: Escherichia coli 28.24%, Enterococcus 21.37%, Candida 14.89%, Klebsiella 8.02%, Pseudomonas 7.25% and Streptococcus 4.96%. Candida infection was more common in nosocomial infection than in community-acquired UTI ( P <0.01).The bacterial distribution in patients with urinary tract operation was: Escherichia coli 33.33%, Enterococcus 16.92%, Candida 16.41% and Pseudomonas 8.21%. The incidence of Candida and Pseudomonas infection was extremely higher in those with urinary tract operation than those without operation ( P <0.05, P <0.01). The antibiotic resistance of Escherichia coli to ciprofloxacin and cefuperazone, and Enterococcus to penicillin was significantly higher in nosocomial infection( P <0.05, P < 0.05, P <0.05). Conclusion: In nosocomial UTI, the urinary tract operation and the usage of broad-spectrum antimicrobial agents were common and the incidence of Candida infection and antibiotic resistance was high, so these would be useful in the management of UTI.