我院2007-2009年尿培养病原菌分布及耐药性分析

目的监测与分析尿路感染患者的病原菌分布及对抗菌药物的耐药性变化，为临床合理使用抗菌药物提供依据。方法采用VITEK-32及MicroScan Walkaway40系统对送检尿培养标本中的细菌进行鉴定及药敏试验，应用上海新和软件公司的微生物软件进行数据统计分析。结果2007－2009年间我院送检的5329份尿培养标本中，阳性标本3109份，阳性率为57．7％。共分离出1253株革兰氏阴性杆菌，占40．3％；963株革兰氏阳性菌，占31．0％；893株念珠菌，占28．7％。尿路感染的病原菌以革兰氏阴性菌为主，尤以大肠埃希菌最为常见，占21．2％；而在革兰阳性菌中以肠球菌属为主，占19．7％，屎肠球菌次之，占10．7％；真菌感染的数量亦明显增加，其中光滑念珠菌居首位，占7．O％。病原菌对各种抗菌药物耐药差异性较大，表现为多药耐药；产超广谱B-内酰胺酶的大肠埃希菌、肺炎克雷伯菌和奇异变形菌的检出率分别为52．3％、58．8％和40．94％。结论尿路感染的病原菌阳性率高，其中以革兰氏阴性菌为主。病原菌对各种抗菌药物耐药差异性较大，表现为多药耐药。及时总结分析泌尿系感染的病原菌分布及耐药性，对于控制耐药菌株传播，指导临床合理选用抗菌药物具有十分重要的意义。

Pathogens and antibiotic resistance surveillance of urine culture in the Third People's Hospital of Chengdu from 2007 to 2009

Objective To monitor and analyze the pathogens and antibiotic resistance of urine culture in our hospital in 2007-2009,and to provide new evidence for clinicians to reasonable choose the antibiotics. Methods All pathogens in the urine culture samples were identified and done susceptibility by VITEK-32 or MieroScan Walkaway-40 Automated Microbial System. The distribution and drug resistance of the isolated bacteria was analyzed by Shanghai Xinhe software. Results Three thousand and one hundred and nine pathogens were isolated from 5329 urine samples, and the positive rate was 57. 7%. Gram-negative bacilli accounted for 40. 3%, and Escherichia coli is the majority（ 21.2% ）. Gram-positive cocci accounted for 31.0% and Enterococcus were the most （19.7 % ）, Enterococcus faecium came next（ 10. 7%）. Fungi accounted for 28. 7 % and among which Candida glabrata was the most. The resistance to antibiotics was quite different, manifesting multi-resistance. The detection rates of extended spectrum β-lactamases-producing among Escherichia coli, Klebsiella penumoniae and Proteus were 52. 3 %, 58. 8% and 40. 94%, respectively. Conclusions The detection of pathogens is high in this hospital and most of them are Gram-negative bacilli. The resistance to antibiotics is quite different and often multi-resistant. It＇s of great significance to monitor and analyze the pathogens and antibiotic resistance of urine culture to control resistant strains and indicate the choice of antibiotics in clinic.