658例尿培养病原菌分布及耐药性分析

目的分析湖南省人民医院尿路感染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2007年1月1日至2008年12月31日从尿标本中分离的菌株进行分析。结果共分离菌株658株,其中革兰阳性菌172株(26.1%),革兰阴性菌466株(70.8%),真菌20株(3.0%)。分离量最多的为大肠埃希菌,共336株(51.1%),其次为肺炎克雷伯菌49株(7.4%)和变异链球菌48株(7.3%)。门急诊的大肠埃希菌构成比(89.0%)高于住院患者(63.4%),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(P0.05)。大肠埃希菌和肺炎克雷伯菌对喹诺酮类耐药率为28.6%～56.3%,对第3代头孢菌素的耐药率为38.7%～65.8%,革兰阳性球菌对喹诺酮类和第3代头孢菌素的耐药性均在50.0%以上,对万古霉素耐药率为11.0%。结论尿培养阳性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有所增多;门急诊患者的大肠埃希菌分离率高于住院患者;致病菌对喹诺酮类和第3代头孢菌素的耐药情况严重。

Analysis of the distribution and antibiotic resistance of the pathogen isolated from mid-stream urine of 658 patients

Objective To investigate the bacterial distribution and resistant to antibiotic in culture--positive urine. Methods 658 culture--positive patients from Jan. 1,2007 to Dec. 31,2008 were analyzed so as to provide the reference of pathogens for the reasonable use of antibiotic drugs in clinic. Results （1）658 pathogenic strains were isolated, among which there were 172 strains of gram positive bacilli（26.1% ）, 466 strains of gram negative bacilli（70. 8%） and 20 strains of fungus（3.0 %）. Enterococcus rised from 3.4 0% to 7. 70%（p = 0. 112）, but the differences do not have statistical significance. The proportion of gram negative bacilli（especially the E. colt） of the emergency patients and out-patients is lower than that of the patients, and the proportion of K. pneumonia and gram positive bacteria is lower than that of the patients, with the differences having statistical significanee（P〈70.05）. （2）The resistance rates of E. colt and K. pneumonia to quinclones were 28.6%- 56.3% ,and the resistance rates to the 3rd generation of cephalosporin were 38.7% --65.8 %, respectively. The resistance rates of gram positive cocci to quinolones and the 3rd generation of eephalosporin are both higher than 50%, with the rate of 11.0% to Vancomycin. Conclusion Gram negative bacilli such as E. eoli and K. pneumonia were predominant organism in urinary tract infections, but the proportion of gram positive bacteria increased in the recent years. The overall and severe bacterial resistance in urinary tract infections need to be concerned and antibiotic rational use of antibiotic drugs should be emphasized.