尿路感染分离菌1126株耐药性监测  

Observation of bacteria drug resistance in urinary tract infection

作　　者：钮博[1] 刘群[1] 李梅[1] 李峰[2] 陈黎忠[1] 王敏[1] 

机构地区：[1]蚌埠医学院第二附属医院检验科,安徽蚌埠233040 [2]蚌埠医学院第一附属医院检验科,安徽蚌垃233004

出　　处：《蚌埠医学院学报》2010年第8期820-822,共3页Journal of Bengbu Medical College

基　　金：蚌埠医学院自然科学研究资助项目(BY0540)

摘　　要：目的：监测尿路感染患者尿液中分离的病原菌组成及耐药状况。方法：对1126株尿培养分离菌进行鉴定和耐药性分析,特殊耐药株细菌的检测均采用K-B法,并按照CLSI2006年版标准判断敏感率、中介率及耐药率。结果：1126株尿路感染分离菌中大肠埃希菌512株（45.5%）,凝固酶阴性葡萄球菌属208株（18.5%）,肠球菌属112株（9.9%）,白色念珠菌61株（5.4%）,变形杆菌55株（4.9%）,肺炎克雷伯菌52株（4.6%）以及阴沟肠杆菌、铜绿假单胞菌（棒状杆菌4株、鲍曼不动杆菌等）。其中产超广谱β-内酰胺酶细菌检出率大肠埃希菌为48.0%,肺炎克雷伯菌38.6%,铜绿假单胞菌9.5%,耐甲氧西林凝固酶阴性葡萄球菌78.5%,耐万古霉素肠球菌1.8%,高耐庆大霉素的肠球菌80.4%;仅在大肠埃希菌检出1.4%头孢菌素酶株。碳青霉烯类仍是对G^-杆菌（除嗜麦芽窄食单胞菌与黄杆菌）抗菌作用最强的一类抗生素,头孢哌酮/舒巴坦、哌拉西林/他巴唑坦、头孢吡肟等对G^-菌亦有很好的抗菌活性;G^＋菌耐药率普遍较高,仅对万古霉素保持较好的敏感。结论：大肠埃希菌和凝固酶阴性葡萄球菌是尿路感染的主要病原菌。各种病原菌耐药率呈上升趋势,碳青霉烯类和万古霉素分别对G^-杆菌和G^＋球菌抗菌最好、最强的一类抗生素,值得临床关注。Objective：To monitor the composition and drug resistance of the pathogenic bacteria isolated from the urine of patients with urinary tract infections.Methods：One thousand one hundred and twenty-six drug-resistant bacteria isolated from urine were identified and analyzed,and the special drug-resistant strains were detected by K-B method.The sensitivity rate,intermediate rate and drug resistance rate were determined in accordance with CLSI 2006 standard.Results：Of the 1 126 strains isolated from patients with urinary tract infection,E.coli-based strains accounted for 45.5%（512/1 126）,coagulase-negative Staphylococci 18.5%（208/1 126）,Enterococcus 9.9%（112/1 126）,Candida albicans 5.4%（61/1 126）,Mycetozoan 4.9%（55/1 126）,Klebsiella pneumoniae 4.6%（52/1 126）,and the others were Enterobacter cloacae and Pseudomonas aeruginosa（Corynebacterium 4,such as Acinetobacter baumannii）.The detection rate of ESBLs was 48.0% in E.coli,38.6% in Klebsiella pneumoniae,9.5% in Pseudomonas aeruginosa,78.5% in methicillin-resistant staphylococcus aureus,1.8% of vancomycin resistant enterococcal and 80.4% of high level aminoglikozyde resistance.Only 1.4% of Ampc was detected in E.coli strains.Carbapenems was still the most effective antibiotics for gram-negative bacteria（except maltophilia S.m and Flavobacterium）.Cefoperazone/sulbactam,piperacillin/tazobactam and cefepime also presented good antibacterial activity.The resistance rate of Gram-positive bacteria was relatively high,only maintaining good sensitivity to vancomycin.Conclusions：Enterobacteriaceae and coagulase-negative staphylococci are the main pathogens for urinary tract infections.The resistant rate of a variety of pathogens tends to rise.Carbon penicillins and vancomycin are the best and strongest antibiotics for gram-negative bacilli and gram-positive cocci respectively,which is worth clinical attention.

关 键 词：尿路感染 细菌 耐药性 微生物敏感性试验 

分 类 号：R691.3[医药卫生—泌尿科学]