女性泌尿系统细菌性感染的菌种构成与耐药性分析

目的 了解我国女性泌尿系统细菌性感染患者菌种分布及耐药性.方法 采用纸片法、稀释法或浓度梯度琼脂扩散试验(E试验)检测最小抑菌浓度,测定细菌对抗生素的敏感性,使用WHONET 5.4软件进行分析,对卫生部全国细菌耐药性监测网所属86家三级甲等医院于2006年6月1日至2007年5月31日分离的临床女性泌尿系统细菌性感染尿培养菌株进行分析.结果 共收集6071株病原菌,其中细菌5958株,分离量最多的依次为大肠埃希菌3529株(59.23%)、肠球菌属细菌938株(15.74%)和肺炎克雷伯菌394株(6.61%);大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶的发生率分别为35.7%和34.0%,两者对氟喹诺酮类药物的耐药率分别约为70%和40%.屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌,粪肠球菌、屎肠球菌对万古霉素的耐药率分别为0.9%、3.8%,对替考拉宁的耐药率分别为2.7%、4.8%;表皮葡萄球菌导致的女性泌尿系统细菌性感染较金黄色葡萄球菌多,两者对头孢西丁的耐药率分别为79.1%和75.0%,未发现对糖肽类中介或耐药的金黄色葡萄球菌,表皮葡萄球菌对替考拉宁的中介率为4.9%.随着患者年龄的增长,致病菌对喹诺酮类药物的耐药率呈增加的趋势;重症监护室(ICU)的致病菌耐药率高于普通病房和门、急诊.结论 我国女性泌尿系统感染主要致病菌耐药现象严重,临床抗菌药物不合理应用需要加以纠正,参照细菌敏感性选择抗菌药物具有非常重要的意义.

Bacterial composition and resistance from urinary tract infections in females

Objective To determine the bacterial composition and antibacterial resistance in female urinary tract infections (UTI) in China. Methods The disc diffusion test, minimum inhibition concentration (MIC), test or E-test was used to detect the antimicrobial susceptibility in 86 tertiary hospitals in China from June 1, 2006 to May 31, 2007. WHONET 5.4 was applied for data analysis. Results A total of 6071 pathogenic germs were collected from urine cultures of UTI female patients in the surveillance period, which included 5958 bacterial isolates. Escheriehia coll 3529 strains (59. 23% ), Enterococcus spp 938 strains (15.74%) and Klebsiella pneumoniae 394 strains (6.61%) were the most common pathogens. Escherichia coli and Klabsiella pneumoniae had 35.7% and 34. 0% extended spectrum beta-lactamases (ESBL) positive rates, and their resistant rates to quinolones were about 70% and 40%, respectively. Enterococcus faecium was much more resistant to almost all the antibiotics than Enterococcus faecabs. 0. 9% Escherichia faecalis and 3.8% Escheriehia faecium were resistant to vancomycin, whereas 2.7% and 4. 8% were resistant to teieoplanin. Staphylococcus epdermidis was more common in UT1 than Staphylococcus aureus, 79. 1% and 75.0% of the isolates being methiciUin-ressitant Staphylococcus epdermidis(MRSE) or methicillin-ressitant Staphylococcus aureus (MRSA), respectively. No vancomycin intermediate or resistant staphylococcus was detected, but 4. 9% teicoplanin intermediate rate was found in Staphylococcus epdermidis. The resistant rates to quinolones increased with the patient age. Condnsions Bacterial resistance in UTI in Chinese females is a severe problem, which could be resulted from antimierobial irrational use. In the selection of antimicrobial agents in the treatment of UTI, doctors should refer to the results of bacterial resistant surveillance.