自贡地区尿培养中分离菌的临床分布及耐药性分析

目的了解自贡地区泌尿道感染病原菌的临床分布及耐药情况,为临床合理使用抗菌药物提供参考。方法收集2017年自贡地区所有三级综合医院尿培养阳性菌株及药敏结果,采用WHONET5.6及SPSS19.0软件对数据进行分析。结果共分离出2063株细菌,其中其中革兰阳性菌占18.5%,革兰阴性菌占81.5%。前5位细菌中,大肠埃希菌排列第一,占53.4%,其次是肺炎克雷伯菌(9.3%)、屎肠球菌(6.3%)、粪肠球菌(6.2%)和铜绿假单胞菌(4.6%)。前5位分离菌的耐药结果为:大肠埃希菌及肺炎克雷伯菌对哌拉西林/三唑巴坦、头孢替坦、厄他培南、亚胺培南及阿米卡星的耐药率均较低(<5%),其中产超广谱β-内酰胺酶(ESBLs)菌的检出率分别为50.4%和35.4%;屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、莫西沙星及红霉素耐药率高(>90%),但对奎奴普丁/达福普汀及万古霉素的耐药率低(<10%),对利奈唑胺的耐药率为0;而粪肠球菌对青霉素、氨苄西林、呋喃妥因及利奈唑胺耐药率低(<5%),对万古霉素的耐药率为0;铜绿假单胞菌对常见抗菌药物耐药率较低,其中亚胺培南的耐药率为16.0%,而阿米卡星的耐药率最低,为3.2%。不同性别间病原菌谱特点为:男性中前5位细菌为大肠埃希菌、肺炎克雷伯菌、粪肠球菌、铜绿假单胞菌和屎肠球菌,而女性为大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌和奇异变形菌。病原菌的年龄分布以71~80岁和61~70岁为主,未成年组前3位细菌为大肠埃希菌、屎肠球菌和肺炎克雷伯菌,而成年组和老年组前3位细菌均为大肠埃希菌、肺炎克雷伯菌和粪肠球菌。不同性别间大肠埃希菌和肺炎克雷伯菌对氨苄西林/舒巴坦、头孢唑林、头孢他啶、头孢曲松、氨曲南、妥布霉素、环丙沙星及左氧氟沙星的耐药率差异均有统计学意义(P<0.05),而屎肠球菌、粪肠球菌和铜绿假单胞菌对常见抗菌药物的耐药率无性别差异(P>0.05)。结论自贡地区泌尿道感染病原菌以大肠埃希菌为主,不同性别、不同年龄组间患者的病原菌谱及耐药谱存在差异。本地区屎肠球菌耐药严重,应尽早目标性抗感染治疗。

Clinical distribution and drug resistance of isolated bacteria in urine culture in Zigong area

Objective To understand the clinical distribution and drug resistance of pathogens of urinarytract infections in Zigong area, and provide reference for clinical rational use of antibiotics. Methods The drugsusceptibility results of positive strains in urine culture from the third-class comprehensive hospital of Zigong districtin 2017 were collected, and data were analyzed by WHONET 5.6 and SPSS 19.0 software. Results A total of2,063 strains of bacteria were isolated, of which 18.5% were Gram-positive bacteria, and 81.5% were Gram-negativebacteria. Among the top five bacteria, Escherichia coli ranked first (53.4%), followed by Klebsiella pneumoniae (9.3%),Enterococcus faecium (6.3%), Enterococcus faecalis (6.2%) and Pseudomonas aeruginosa (4.6%). The results of drugresistance of the top five isolates were as follows: the resistant rates of Escherichia coli and Klebsiella pneumoniae topiperacillin/tazobactam, ceftitan, ertapenem, imipenem, and amikacin were low (<5%), the detection rates of extendedspectrumβ-lactamase producing (ESBLs) were 50.4% and 35.4%, respectively. The resistance rates of Enterococcusfaecium to penicillin, ampicillin, ciprofloxacin, levofloxacin, moxifloxacin and erythromycin were high (>90%), but theresistance rates to quinapudine/dafopudine and vancomycin were low (<10%), and the resistance rate to linazolaminewas 0. The resistance rates of Enterococcus faecalis to penicillin, ampicillin, furantoin and linazolamin were low (<5%),and the resistance rate to vancomycin was 0. The resistance rates of Pseudomonas aeruginosa to common antimicrobialagents were low, and the resistance rates to imipenem were 16% and that to amikacin was the lowest (3.2%). Thecharacteristics of pathogenic bacteria between sexes are as follows: the top five bacteria in male were Escherichia coli,Klebsiella pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa and Enterococcus faecium, while in women,Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis and Proteus mirabilis. The agedistribution of pathogenic bacteria was mainly 71~80 years and 61~70 years old. The first three bacteria in the minorgroup were Escherichia coli, Enterococcus faecium and Klebsiella pneumoniae, while the first three bacteria in the adultgroup and the aged group were Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis. The drug resistancerates of Escherichia coli and Klebsiella pneumoniae to ampicillin/sulbactam, cefazolin, ceftazidime, ceftriaxone,aztreonam, tobramycin, ciprofloxacin, and levofloxacin were significantly different between different sexes (P<0.05),but the resistance rates of Enterococcus faecium, Enterococcus faecalis and Pseudomonas aeruginosa to commonantimicrobial agents had no gender difference (P>0.05). Conclusion Escherichia coli was the main pathogen of urinarytract infection in Zigong area, and there were differences in the spectrum of pathogenic bacteria and drug resistancebetween different age groups and different sex groups. In this area, Enterococcus faecium resistance is serious, should betreated with targeted anti-infection treatment as early as