尿路感染的病原菌种类及耐药性分析

目的探讨尿路感染的病原菌种类,分析其耐药性,提高尿路感染的临床治疗水平。方法对386例尿路感染患者的清洁中段尿细菌培养及耐药性结果进行回顾性调查分析。结果清洁中段尿细菌培养阳性率为23.8%。其中大肠埃希菌占62.0%,克雷伯菌占13.0%,变形杆菌占6.5%,假单胞菌占5.4%,葡萄球菌占7.6%,肠球菌占5.4%。产超广谱β-内酰胺酶(ESBLs)菌平均检出率为11.6%。革兰阴性杆菌对复方新诺明、氨苄西林和环丙沙星的耐药率较高,对亚胺培南、阿米卡星、头孢三嗪的耐药率低。革兰阳性球菌对红霉素、青霉素耐药率高,对万古霉素敏感率为100%。产ESBLs大肠埃希菌及肺炎克雷伯菌对氨基糖苷类、第三代头孢菌素和氨苄西林耐药率较高,而对亚胺培南及酶抑制剂的复合药敏感。结论引起尿路感染的主要病原菌为大肠埃希菌;临床上要特别重视尿路感染的病原菌检查及药敏试验,合理使用抗生素,以减少产ESBLs细菌的产生,提高治愈率。

Analysis on Pathologic Bacteria and Drug Resistance of Urinary Tract Infection

Objective: To survey the kinds of pathogens and resistance, and to raise the level of diagnosis and treatment of urinary treat infection (UTI).Method: 386 cases of UTI were analysed retrospectively.Results: The positive rate of cleaning urine cultivation was 23.8%.Among them,Escherichia coli was 62.0%, Klebsiella pneumoniae was 13.0%, Proteus was 6.5%,Pseudomonas was 5.4%,Staphylococcus was 7.6%,and Enterococcus was 5.4%, 11.6% bacteria tested produced extended-spectrum β-lactamases (ESBLs). The drug resistance rate (DRR) of gram negative bacteria to trimoxazole, ampicillin and ciprofloxacin was high, and was low to imipenem,amikacin and rocephin. The DRR of gram positive bacteria to erythromycin, penicillin was high, but was low to vancomycin. The DRR of ESBLs-producing Escherichia coli and Klebsiella pneumoniae to aminoghycosides, the third generation cephalosporin, and ampicillin was high, but was low to imipenem and compounds preparation of enzyme inhibitor.Conclusion: The main pathogen of UTI is Escherichia coli. More attention should be paid on pathologens and resistance detection in UTI. It is high time to rational use antimicrobial in order to prevent ESBLs-producing bacteria and raise cure rate of UTI.