53 584 份尿培养病原菌分布及耐药性分析

目的 了解尿培养病原菌分布及耐药性，为临床经验性治疗尿路感染提供参考。方法 对2011年1月～2015年12月尿培养病原菌进行细菌鉴定及药敏分析，用WHONET 5.4 软件进行统计分析。结果 53 584 份标本检测出病原菌10 690 株，阳性率为19.95％；分离率前5位依次是大肠埃希菌、屎肠球菌、白色念珠菌、粪肠球菌及肺炎克雷伯菌，分别占36.00%、8.92%、7.56%、6.42%和6.17%。大肠埃希菌和肺炎克雷伯菌对亚胺培南耐药率分别为0.39%和4.00%，对头孢吡肟、头孢他啶、妥布霉素、氨曲南及哌拉西林/他唑巴坦耐药率为1.61%～21.39%，但对头孢呋辛和氨苄西林耐药率＞70.00％。铜绿假单胞菌对阿米卡星、庆大霉素、妥布霉素、头孢吡肟、哌拉西林/他唑巴坦、亚胺培南、左氧氟沙星和环丙沙星耐药率＜14.00％。屎肠球菌对万古霉素、利奈唑胺耐药率分别为2.46%、4.80%，粪肠球菌对多数抗菌药物耐药率明显低于屎肠球菌。结论 肠杆菌属、肠球菌属和白色念珠菌是尿培养主要病原菌，其中肠球菌属对利奈唑胺耐药率高于万古霉素，且已出现耐碳青酶烯类的肠杆菌。

Analysis of the distribution and drug resistance of pathogens in 53584 urine culture samples

Objective The study aimed to assess the distribution and drug resistance of pathogens in urine culture samples, and thus to provide a reference for the empirical treatment for urinary tract infection. Methods Pathogens isolated from urine specimens collected between January of 2011 and December of 2015 identified and analyzed for their drug susceptibility. The results were statistically analyzed by WHONET 5.4. Results A total of 10690 strains of pathogens were isolated from 53584 specimens, with a positive rate of 19.95%. The top five most common pathogens were Escherichia coli, Enterococcus faecium, Candida albicans, Enterococcus faecalis, and Klebsiella pneumoniae, accounting for 36.00%, 8.92%, 7.56%, 6.42%, and 6.17%, respectively. The drug resistances of isolated E. coli and K. pneumoniae against imipenem were 0.39% and 4.00%, ranged from 1.61% to 21.39% against cefepime, ceftazidime, aztreonam, tobramycin, and piperacillin-tazobactam, and were higher than 70.00% against cefuroxime and ampicillin. The drug resistances of Pseudomonas aeruginosa were less than 14.00% against amikacin, gentamicin, tobramycin, cefepime, piperacillin/tazobactam, imipenem, ciprofloxacin, and levofloxacin. The drug resistance of isolated E. faecium against vancomycin and linezolid were 2.46% and 4.80%, respectively. The drug resistances of isolated E. faecalis against most antibacterial agents were significantly lower than those of the E. faecium. Conclusion Enterobacteriaceae, Enterococcus, and Candida albicans are the main pathogens isolated from urine culture. The Enterobacteriaceae have higher resistant rate against linezolid than against vancomycin, and carbapenm-resistant strains has been detected.