2006-2010年尿路感染病原菌分布及耐药性分析

目的 了解医院尿路感染病原菌分布特点及常见病原菌的耐药性,为临床合理选用抗菌药物提供帮助.方法 对2006年1月-2010年12月医院尿培养检出病原菌用MicroScan WalkAway系统辅以手工方法进行鉴定和药物敏感试验,并对所得结果进行统计分析.结果 5年共检出病原菌1456株,其中革兰阴性菌831株占57.1％、革兰阳性菌432株占31.0％、真菌173株占11.9％；检出最多的病原菌为大肠埃希菌占38.9％；革兰阳性菌中以肠球菌属为主,粪肠球菌和屎肠球菌最多见；真菌未见明显增多；屎肠球菌、铜绿假单胞菌的比例逐年小幅上升；大肠埃希菌、肺炎克雷伯菌和鲍氏不动杆菌对15种抗菌药物中的11种抗菌药物耐药率＞60.0％；阴沟肠杆菌和铜绿假单胞菌耐药率＞60.0％的也高达9种和5种；屎肠球菌对13种抗菌药物中的9种抗菌药物耐药率＞60.0％,溶血葡萄球菌和表皮葡萄球菌耐药率＞60.0％的也高达8种和7种;大肠埃希菌对头孢西丁的耐药率逐年小幅上升.结论 医院近5年泌尿道感染病原菌仍以大肠埃希菌为主,屎肠球菌、铜绿假单胞菌感染有上升趋势；细菌耐药情况严重,临床医师应根据药敏结果合理选用抗菌药物,减少耐药菌产生.

Distribution and resistance of pathogenic bacteria in urine culture from 2006 to 2010

OBJECTIVE To investigate the bacterial distribution and resistance to antibiotics in culture-positive urine and to provide evidence for clinical application of antibiotics.METHODS MicroScan Walkaway system was used to identify the bacteria,the drug resistance test was performed and the results were statistically analyzed.RESULTS A total of 1456 strains of the bacteria were isolated in 5 years,including 831 strains of gram negative bacteria(57.1%),432 strains of gram positive bacteria(31.0%) and 173 strains of fungi(11.9%).Escherichia coli were the most common.Enterococcus was the predominany pathogen of gram-positive bacteria,especially E.faecalis and E.faecium.No significant increase was detected in fungus,the proportion of E.faecium and Pseudomonas aeruginosa has increased slightly.Among the 16 kind of antibacterial used,E.coli,Klebsiella pneumoniae and Acinetobacter baumannii had higher than 60% resistance rate to 11 antibacterial;Enterobacter cloacae to 9 and P.aeruginosa to 5.Among 13 kind of antibacterial used,E.faecium had higher than 60% resistance rate to 9 antibacterial,Staphylococcus haemolyticus to 8 and S.epidermidis to 7.The resistance rate of E.coli against cefoxitin has increased slightly.CONCLUSION E.coli is the main pathogen of urine culture in our hospital in recent 5 years.The proportion of E.faecium and P.aeruginosa goes upward.Bacterial resistance is serious,so it is so important to apply antibiotics based on the antibiotic resistance of the bacteria as to reduce the resistant generation.