2014-2019年某医院尿路感染病原菌分布及耐药情况

目的 分析某医院2014-2019年尿培养产生的病原菌分布及耐药情况,为临床正确应用抗菌药物提供依据。方法 收集2014-2019年尿培养发现的病原菌资料,对其分布、药敏结果进行分析。结果 共分离出病原菌2 363株,革兰氏阴性菌为1 480株(62.6%),革兰氏阳性菌为502株(21.2%),真菌381株(16.1%);大肠埃希菌检出率最高,占所有检出病原菌总数的37.7%,对多数头孢类药物、喹诺酮类药物耐药率在40%以上,近6年无明显变化;对酶抑制剂、碳青霉烯类的耐药率近6年无明显增高,在6%以下,仍处于较低水平。肺炎克雷伯菌、奇异变形杆菌中ESBL菌株分别为49%、50%,大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌对亚胺培南的耐药率分别为0.8%、1.4%、2.4%;铜绿假单胞菌对亚胺培南、氨曲南的耐药率分别为11%、14%。屎肠球菌对多种抗菌药物的耐药率高于粪肠球菌,均对利奈唑胺、替考拉宁、万古霉素有较高的敏感性。表皮葡萄球菌对苯唑西林、青霉素的耐药率分别为60%、86.7%;对万古霉素敏感率为100%。真菌对伊曲康唑的耐药率最高为17.6%,未出现对5-氟胞嘧啶耐药真菌。结论 本研究尿培养中以革兰氏阴性菌为主,主要为大肠埃希菌,临床上可将头孢他啶、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦作为初始经验用药。

Distribution and drug resistance of pathogenic bacteria in urinary tract infection in a hospital from 2014 to 2019

Objective To analyze the distribution and drug resistance of pathogenic bacteria generated from urine culture in a Hospital from 2014 to 2019, so as to provide basis for the correct clinical application of antimicrobial agents.Methods The pathogenic bacteria found in urine culture from 2014 to 2019 were collected, and their distribution and drug sensitivity were analyzed.Results Totally 2 363 strains of pathogenic bacteria were isolated, including 1 480 (62.6%) strains of gram-negative bacteria, 502 (21.2%) strains of gram-positive bacteria, and fungi 381 (16.1%); the detection rate of Escherichia coli was the highest, accounting for 37.7% of the total number of pathogens detected. The drug resistance rate of most cephalosporins and quinolones was above 40%, with no significant change in the last six years. The drug resistance rate of enzyme inhibitors and carbapenems has not increased significantly in the past six years and is still at a low level, below 6%. The ESBL strains in Klebsiella pneumoniae and Proteus singular were 49% and 50% respectively, and the drug resistance rates of Escherichia coli, Klebsiella pneumoniae and Proteus singular to imipenem were 0.8%, 1.4% and 2.4% respectively. The drug resistance rates of Pseudomonas aeruginosa to imipenem and amtriaxone were 11% and 14% respectively. The drug resistance rate of Enterococcus faecalis was higher than that of enterococcus faecalis, and all of them were more sensitive to linezolid, tekoranin and vancomycin. The drug resistance rates of Staphylococcus epidermidis to benzoxicillin and penicillin were 60% and 86.7% respectively. The sensitivity to vancomycin was 100%. The highest resistance rate of fungi to itraconazole was 17.6%, and no resistance to 5-fluorocytosine was found.Conclusion The results of this study showed that gram-negative bacteria were dominant in urine culture, mainly Escherichia coli, and cefoperazine, piperacillin/tazobactam and cefoperazone/sulbactam could be used as initial empirical drugs in clinical practice.