社区获得性急性尿路感染病原菌药敏试验结果分析  

Analysis of antimicrobial susceptibility of bacterial pathogens in community acquired acute urinary tract infection

作　　者：史俊艳[1] 赵锐[2] 马小军[3] 玛依努尔 周迥[3] 徐英春[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院检验科微生物室,100730 [2]北京电力医院检验科 [3]中国医学科学院北京协和医学院北京协和医院感染管理办公室,100730 [4]新疆乌鲁木齐中医院

出　　处：《中国感染与化疗杂志》2010年第3期188-193,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的对北京协和医院和北京电力医院社区获得性急性尿路感染病原菌的特点及药敏结果进行分析比较,为该病治疗提供依据。方法收集社区获得性尿路感染病例91例分离的病原菌,用纸片扩散法作药敏试验。采用WHONET5.4软件分析结果。结果引起急性尿路感染主要的病原菌是大肠埃希菌,占76.9%。大肠埃希菌对哌拉西林的耐药率最高,为51.4%;对磺胺甲口恶唑-甲氧苄啶、环丙沙星、左氧氟沙星和庆大霉素的耐药率分别为44.3%、41.1%、37.1%和37.1%;对β内酰胺酶抑制剂复方制剂、头孢菌素类以及米诺环素的耐药率均不超过25%。本组患者中分离的70株大肠埃希菌中未检测到对头孢美唑、亚胺培南、美罗培南及阿米卡星耐药的菌株。2所医院分离的大肠埃希菌药敏结果存在差异,这种差异可能为患者存在不同的基础性疾病以及菌株产ESBLs与否所致。结论社区获得性急性尿路感染的病原菌主要是大肠埃希菌,但产ES-BLs的大肠埃希菌较前增多。产ESBLs大肠埃希菌对磺胺甲口恶唑-甲氧苄唑、氟喹诺酮类及氨基糖苷类药物的耐药率较高。不同医院分离菌的耐药率有差别,可能与患者基础疾病发生率的不同有关。Objective To analyze the antimicrobial susceptibility of pathogens in community acquired acute urinary tract infections in PUMCH and DLH.Methods The clinical data of 91 cases of community acquired acute urinary tract infections in the two hospitals were retrospectively reviewed. Susceptibility testing was conducted according to Kirby-Bauer method as recommended by CLSI. The data were analyzed with WHONET 5.4 software. Results E. coli was the most common bacteria （76.9%） in community acquired acute urinary tract infections. The resistance rate of E. coli to piperacillin was the highest. The prevalence of resistant E. coli to sulfamethoxazole-trimethoprim,ciprofloxacin,levofloxacin and gentamicin was 44.3%,41.1%,37.1%,37.1%,respectively. Lower than 25% of these strains were resistant to enzyme inhibitors,cephalosporins or minocycline. No isolate was resistant to cefmetazole,impenem,meropenem or amikacin. The susceptibility pattern was different between the 2 hospitals. The resistance of E. coli isolates was dependent on the presence of underlying diseases and ESBLs production. Conclusions The main pathogen in community acquired acute urinary tract infections is E. coli. ESBLs-producing E. coli strains are increasing. These ESBLs-positive isolates are highly resistant to trimethoprim-sulfamethoxazole,fluoroquinolones and aminoglycosides. The variable resistance pattern in different hospitals may be associated with underlying diseases.

关 键 词：大肠埃希菌 急性尿路感染 社区获得性 病原菌 敏感性 

分 类 号：R446.5[医药卫生—诊断学] R691.3[医药卫生—临床医学]