泌尿系感染病原菌及其耐药性分析

目的了解泌尿系感染患者病原菌的分布及其对常用抗菌药物的耐药情况。方法对门诊和住院患者的尿培养结果进行回顾性分析,尿培养菌株的鉴定、药敏分析和统计分析采用VITEK-AMS 60全自动微生物仪。结果共分离到细菌286株,其中G-菌205株,占71.68%,G+菌81株,占28.32%;菌株数居前6位的细菌依次为大肠埃希菌(166株,占58.04%)、肠球菌(53株,占18.53%)、凝固酶阴性葡萄球菌(15株,占5.24%)、肺炎克雷伯菌(11株,占3.85%)、真菌(10株,占3.50%)和淋病双球菌(8株,占2.80%)。分离病原菌产ESBLs率为53.30%,MRS率70.58%,HLAR率60.95%,未发现VRE菌株。大肠埃希菌对亚胺培南100%敏感,对呋喃坦啶、哌拉西林/三唑巴坦和头孢吡肟较敏感,G-杆菌对氨苄西林、优立新、庆大霉素和头孢唑林的耐药率均在60.00%以上;G+球菌对万古霉素100%敏感,对呋喃妥因较敏感,肠球菌对庆大霉素、青霉素、苯唑西林和左氧氟沙星的耐药率均在77.36%以上。结论大肠埃希菌和肠球菌为泌尿系感染的主要病原菌,病原菌的耐药率较高,临床医生应根据尿培养和药敏试验结果合理使用抗菌药物。

Analysis of the distribution and drug resistance of pathogens responsible for urinary tract infections

Objective To ascertain the distribution of pathogens responsible for urinary tract infections among patients at this hospital and their drug resistance to routinely used antibiotics.Methods Urine cultures from outpatients and inpatients were statistically analyzed.Bacteria were identified,susceptibility testing was performed,and statistical analysis was done with the VITEK-60 automated microbial ID system.Results Two hundred and eighty-six strains of bacteria were isolated.Of these strains,205 were Gram-negative(71.68%) and 81 were Gram-positive(28.32%).Accounting for the top 6 strains isolated were Escherichia coli(166 strains,58.04%),Enterococcus(53 strains,18.53%),coagulase-negative Staphylococcus(15 strains,5.24%),Klebsiella pneumoniae(11 strains,3.85%),fungi accounted(10 strains,3.50%),and Neisseria gonorrhoeae(8 strains,2.80%).Of the strains,53.30% were ESBL-producing ones,70.58% were MRS,60.95% were HLAR,and 0 were VRE.E.coli was 100.0% sensitive to imipenem,followed by nitrofurantoin and piperacillin/tazobactam and cefepime.Resistance of Gram-negative bacilli to ampicillin,ampicillin/sulbactam,gentamicin,and cefazolin was greater than 60.00%.Gram-positive cocci were 100.0% sensitive to vancomycin,followed by nitrofurantoin.Resistance of Enterococcus to gentamicin,penicillin,oxacillin,and levofloxacin was greater than 77.36%.Conclusion E.coli and Enterococcus were the pathogens mainly responsible for urinary tract infections in this hospital.Pathogens had a particularly high resistance rate.Clinicians should choose suitable antibiotics based on the results of urine cultures and drug sensitivity tests.