泌尿系统感染分离的病原菌分布及耐药性分析

目的了解合肥市第二人民医院泌尿系统感染病原菌分布和耐药谱变迁情况,为临床泌尿系统感染治疗提供实验室依据。方法细菌鉴定、药敏试验采用ATB EXPRESSION半自动微生物分析仪检测,ELBLs按CLSI推荐的确诊试验检测检测。结果泌尿系统感染的主要病原菌是大肠埃希菌270株(占37.4%)、肠球菌190株(占26.3%)、真菌91株(占9.8%)、变形杆菌属35株(占4.8%),葡萄球菌属31株(占4.3%)、克雷伯菌29株(4.0%);2011年分离的大肠埃希菌对头孢他啶、头孢噻肟耐药性及产超广谱β-内酰胺酶(ESBLs)菌株的检出率较高于2010年,两者比较差异有统计学意义(P<0.05)。大肠埃希菌对青霉素类和头孢菌素类耐药性较高,对碳青酶烯类保持较高敏感性,对哌拉西林/他唑巴坦和阿米卡星耐药性较低;肠球菌对红霉素、四环素、利福平均有较高的耐药性,且屎肠球菌对左氧氟沙星、喹奴普汀/达福普汀、环丙沙星、呋喃妥因、氨苄西林、庆大霉素(高浓度)、青霉素及链霉素(高浓度)耐药性高于粪肠球菌,两者比较差异有统计学意义(P<0.05)。结论引起泌尿系统感染的病原菌分布较广,耐药性也较严重,且个体耐药谱不同,临床医师应积极送检,根据个体耐药谱,合理选用抗生素治疗。

Pathogenic Bacteria Distribution with Urinary System Infection and Their Drug Resistance

Objective To investigate the urinary system infection pathogenic bacteria distribution and drug resistance spectrum in our hospital and provide the bases for clinical diagnoses and treatment by experience.Methods Pathogens were identified and drug sensitivity were tested with ATB EXPRESSION semi-automatic microorganism analyzer,ESBLs were detected with the confirmatory test recommended by CLSI.Results 270 stains(37.4%) of Escherichia Coli was isolated,it was the major pathogen,which followed by Enterococcus(190 stains,26.3%),Fungus(35 stains,9.8%),Proteus(35 stains,4.8%),Staphylococcus(31 stains,4.3%),Klebsiella pneumonia(29 stains,4.0%﹚.The detection rate of the isolated Escherichia Coli with drug resistance to ceftazidime,cefotaxime and ESBLs were higher as compared to the results in 2010(P>0.05).Escherichia coli was with high drug resistance to penicillin and Cephalosporins,while the drug sensitive was high for carbapenem,Amikacin and piperacillin/tazobactam.The drug resistance of Enterococcus was high for erythromycin,tetracycline,rifampicin,but the drug resistance of Enterococcus Faecium for Levofloxacin,Kui Nu tianeptin/Dafoe Putin,Ciprofloxacin,Nitrofurantion,Ampicillin,gentamicin(high concentration),Penicillin and streptomycin(high concentration) was higher than Enterococcus faecalis which was significant difference among them(P>0.05).Conclusion Pathogens that cause the urinary system infection distribute widely,the drug resistance of pathogens is serious and individual dug resistance spectrum different,so clinicians should sent samples to clinical lab actively and select reasonable antibiotic treatment according to individual drug resistance spectrum.