尿培养分级报告在尿路感染诊断中的应用

目的了解尿培养分级报告在尿路感染中的应用价值，为临床提供快速诊断和治疗依据。方法对3349例尿培养执行三级报告，一级报告：为直接涂片革兰染色；二级报告：经处理过的尿标本直接进行药敏；三级报告：按传统方法进行细菌鉴定、全自动细菌分析仪鉴定和药敏试验。结果一级报告：746株（22．3％）为阴性结果，1365株（40．7％）为阴性杆菌、1036株（31．0％）为阳性球菌、202株（6．0％）为真菌；二级报告与三级报告细菌符合率100．0％，药敏和全自动细菌分析仪药敏分析差异无统计学意义；尿路感染大肠埃希菌761株（55．7％）；其次为腐生葡萄球菌腐生亚种437株（42．2％）、粪肠球菌389株（37．5％）；肠杆菌科细菌除对亚胺培南保持100．O％敏感外，对其他抗菌药物耐药率均呈上升趋势；革兰阳性球菌耐药率也相当严重，仅万古霉素对革兰阳性球菌敏感率为100．0％（除屎肠球菌）。结论尿培养分级报告在尿路感染诊断中有重要诊断价值，尿路感染早期主要为肠杆菌科细菌，随着病程的发展伴随假丝酵母菌感染，尿标本直接药敏可为临床医师提供更快地合理使用抗菌药物。

Three-stage Reports Method Using in Clinical Diagnosis of Urinary System Infections

OBJECTIVE To study the three-stage reports method using in clinical diagnosis of urinary system infections,and its value in order to fasten the clinical diagnosis and treatment.METHODS A total of 3349 urines specimens used a sequential three-stage reports method to prospectively evaluate and determine the validity of direct antimicrobial agent susceptibility testing by traditional method and VITEK-32.The first report was by Gram stained,the second report by criteria for initiating direct susceptibility testing,and third report was by standardized disk diffusion method and VITEK-32.RESULTS From 3349 samples the Gram negativstained smears were 746(22.3%),Gram negative bacilli were 1365(40.7%) the Gram positive cocci were 1036(31.0%) and the fungi were 202(6.0%).Escherichia coli rated the top one(55.7%),followed with Staphylococcus saprophyticus subsp saprophyticus 437(42.2%),Enterococcus faecalis 389(37.5%),Proteus,Klebsiella pneumoniae,Pseudomones aeroginose,and fungi.Enterobacteriaceae were showed increasing drug resistance trend,but still sensitive to imipenem(100.0%).G+-cocci were also showed serious drug resistance trend,but still sensitive to vancomycin(100.0%)(except E.faesium).CONCLUSIONS Three-stage method using in clinical diepnosis of urinary system infections is very important.Enterobacteriaceae are the main infectious bacteria in urinary system infection.Rational use of antibiotics should be carried out according to urine culture result.