复杂尿路感染常见致病菌的分布及抗菌药物的应用

目的探讨导致复杂尿路感染的常见致病菌的分布并分析抗菌药物的应用现状。 方法对2014年6月～2015年6月于某院接受治疗的1 215例复杂尿路感染病例进行回顾性分析，并探究抗菌药物的应用状况。 结果病原菌分类中革兰阴性菌、革兰阳性菌及真菌分别为840、260和115株，各占全部菌群的69.14%、21.40%和9.47%（χ² = 16.32、P = 0.0000）；本研究共提取革兰阴性菌840株，其中大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌为主要菌群，共675株（占80.36%）；3种菌株对庆大霉素、环丙沙星、青霉素以及除头孢他啶之外的3代头孢耐药率均高于50%，但对亚胺培南、阿米卡星、头孢哌酮舒巴坦的耐药性均低于10%。革兰阳性菌260株，其中粪肠球菌、尿肠球菌为主要菌群，共204株（占78.46%）。其中粪肠球菌、尿肠球菌对万古霉素、替考拉宁、利奈唑胺均无耐药性，高浓度庆大霉素、环丙沙星的耐药性均较高。 结论复杂尿路感染的主要致病菌群为革兰阴性菌，目前较为有效、耐药性较强的抗菌药包括氨苄西林/克拉维酸、头孢哌酮、头孢曲松、阿米卡星、氨曲南、亚胺培南和美罗培南。

The distribution of pathogens and antimicrobial drugs application in complex urinary tract infection

ObjectiveTo investigate the distribution of pathogens and antimicrobial drugs application in complex urinary tract infection. MethodsThe clinical data of 1 215 cases with complicated urinary tract infection in our hospital from June 2014 to June 2015 were analyzed, retrospectively, while the application status of antimicrobial drugs were analyzed. ResultsThere were 840 Gram-negative bacteria, 260 Gram-positive bacteria and 115 fungi in pathogenic bacteria, accounted for 69.14%, 21.40% and 9.47%, respectively. The percentage of Gram-negative bacteria was significantly higher than that of the other two bacteria groups, with significant differences (χ² = 16.32, P = 0.0000). Total of 840 strains of Gram-negative bacteria were collected, including E. coli, Klebsiella pneumoniae, Proteus mirabilis as main flora, a total of 675 (80.36%) strains. The drug resistance rate of 3 strains to gentamicin, ciprofloxacin and penicillin and 3 generation cephalosporins except for ceftazidime were higher than 50%, which were less than 10% to the imipenem, amikacin, cefperazone-sulbactam. There were 260 strains of Gram-positive bacteria, including Fecal enterococcus, Urine enterococcus as main flora, both for a total of 204 strains, accounting for 78.46%. Vancomycin, teicoplanin, linezolid had no drug resistance to Enterococcus. The high concentration of gentamicin, ciprofloxacin had high resistance to Enterococcus. ConclusionsThe main pathogenic bacteria of complex urinary tract infection are Gram-negative bacteria, while ampicillin/clavulanic acid, cefoperazone and ceftriaxone, amikacin, aztreonam and imipenem and meropenem were all effective.