复杂性细菌性尿路感染病原菌构成及耐药性分析

目的 探讨复杂性细菌性尿路感染的病原菌分布及耐药性特点,为该病抗菌药物的合理使用提供参考.方法 回顾性分析108例复杂性尿路感染患者的临床资料及药敏试验结果.结果 108例尿液标本中共检出325株病原菌,其中218株(67.08％)为革兰氏阴性菌株,62株(19.08％)为革兰氏阳性菌株,另外45株(13.85％)为真菌;革兰氏阴性菌株中,大肠埃希菌占30.15％,其次为铜绿假单胞菌(16.00％)、阴沟肠杆菌(9.23％)以及肺炎克雷伯杆菌(7.69％);革兰氏阳性菌株中以金黄色葡萄球菌(7.08％)、粪肠球菌(5.54％)以及尿肠球菌(4.92％)多见.革兰阴性菌及阳性菌对头孢类、青霉素类、庆大霉素及喹诺酮类耐药性高,多在50％以上,革兰阴性菌对美罗培南及亚胺培南耐药率较低,均在20％以下甚至为0;革兰阳性菌对万古霉素、替考拉宁及利奈唑胺保持较高的敏感性,耐药性多在10％以下.结论 复杂性尿路感染的病原菌菌谱及耐药性均发生了显著变化,临床上应进行药敏试验选择敏感性高的抗菌药物,经验性用药时不宜选用常规的头孢类及喹诺酮类.

Composition and drug resistance of pathogens causing complicated urinary tract infections

Objectives To investigate the composition and drug resistance of pathogens causing the complicated urinary tract infections so as to provide guidance for reasonable use of antibiotics.Methods A retrospective analysis of clinical data and drug sensitivity test results of 108 patients with complicated urinary tract infections were made.Results 108 cases were detected in 325 urine samples of pathogens,including 218 strains of Gram-negative,coccus (67.08％),62 strains of Gram-positive coccus (19.08％),45 of the fungus(13.85％);Gram-negative strains of Escherichia coli accounted for 30.15％,followed by Pseudomonas aeruginosa (16.00％),Enterobacter cloacae (9.23％) and Klebsiella pneumoniae (7.69％).62 strains of Gram-positive coccus,staphylococcus aureus (7.08％),Enterococcus faecalis (5.54％) and urinary enterococci (4.92％) were commonly observed.The drug resistance rate of Gram-negative bacteria and positive bacteria to cephalosporins,penicillins,quinolones and gentamicin was as high as 50％,and the drug resistance rate of Gram-negative bacteria to meropenem and imipenem was less than 20％.The drug resistance rate of Gram-positive bacteria to vancomycin,teicoplanin and linezolid was less than 10％,and there was highly sensitive.Conclusions The complicated urinary tract infections bacterial spectrum and drug resistance have undergone significant changes,susceptibility testing should be carried out to select high sensitivity antibacterial drug clinically,it should not use a conventional cephalosporins and quinolones for empirical medication.