2016—2018年北京某三甲医院中段尿培养的病原菌构成与耐药性分析

目的 分析2016年1月—2018年12月北京积水潭医院住院患者中段尿标本病原菌构成及耐药性，为临床合理使用抗菌药物提供依据。方法 采用VITEK 2 compact全自动细菌鉴定药敏仪进行细菌鉴定和药敏分析，应用WHONET 5.6软件进行数据分析。结果 3490株中段尿培养病原菌，其中革兰阴性菌2097株(60.1%)，最常见的是大肠埃希菌(32.8%)、肺炎克雷伯菌(5.5%)、铜绿假单胞菌(5.4%)和奇异变形菌(3.4%)；革兰阳性菌1323株(37.9%)，最常见的是屎肠球菌(12.5%)、粪肠球菌(8.5%)、表皮葡萄球菌株(3.0%)和无乳链球菌(2.0%)。女性患者大肠埃希菌检出率明显高于男性(45.8%对19.9%)，但铜绿假单胞菌在男性患者中占比高于女性(7.6%对3.3%)。大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率为56.3%和58.5%；产ESBLs株对头孢菌素、喹诺酮类、四环素、磺胺类抗菌药物敏感率<50.0%；肠杆菌科细菌对碳青霉烯类抗菌药物高度敏感，为88.5%~100.0%。非发酵菌群中铜绿假单胞菌对大部分抗菌药物敏感率>70.0%。革兰阳性菌对万古霉素、替考拉宁和利奈唑胺高度敏感，为89.0%~100.0%。结论 大肠埃希菌和肠球菌是尿路感染主要病原菌，临床可依据病原菌分布特点及药物敏感性进行早期用药。

Surveillance of antibiotic resistance of the urine samples isolated from a tertiary hospital in Beijing during 2016—2018#br#

Objective To analyze the distribution and antibiotic resistance of the pathogens isolated from urine samples in Beijing Jishuitan Hospital during 2016 to 2018 for the purpose to improve rational use of antimicrobial agents. Methods The VITEK 2-compact system was used for the identification of pathogens and antimicrobial susceptibility testing. The WHONET 5.6 software was used for data analysis. Results A total of 3,490 strains of pathogens were detected from urine culture specimens, of which 60.1% (2,097/3,490) were Gram negative bacteria, including E. coli (32.8%), K. pneumoniae (5.5%), P. aeruginosa (5.4%), and P. mirabilis (3.4%). 37.9% (1,323/2,097) of the isolates were Gram positive bacteria, including E. faecium (12.5%), E. faecalis (8.5%), S. epidermidis (3.0%), and S. agalactiae (2.0%). E. coli strains isolated from female patients were more than those from male patients(45.8% vs 19.9%), but P. aeruginosa strains isolated from male patients were more than those from female patients (7.6% vs 3.3%). ESBLs were produced in 56.3% of the E. coli and 58.5% of K. pneumoniae isolates. ESBLs producing strains showed higher resistance rates (>50.0%) to cephalosporins, quinolones, tetracyclines, and sulfonamides. Enterobacteriaceae isolates were highly sensitive to carbapenems (88.5% to 100.0%). P. aeruginosa strains were relatively sensitive to most of antimicrobial agents (sensitive rates >70.0%). Gram positive cocci remained highly sensitive to vancomycin, teicoplanin, and linezolid (89.0% to 100.0%). Conclusion E. coli and Enterococcus are the major pathogens of urinary tract infections. Clinics may conduct early medication according to the pathogenic bacterial distribution and drug sensitivity. Conclusion E. coli and Enterococcus are the major pathogens of urinary tract infections. Clinics may conduct early medication according to the pathogenic bacterial distribution and drug sensitivity.