医院获得性尿路感染病原学及耐药性分析  

Etiology of hospital-acquired urinary tract infections and analysis of drug resistance

作　　者：王长娴[1] 孔庆芳[1] 陈建明 叶南圆[1] 

机构地区：[1]东南大学附属中大医院感染管理科 [2]检验科,江苏南京210009

出　　处：《中华医院感染学杂志》2013年第19期4820-4822,4825,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(81070571)

摘　　要：目的探讨医院获得性尿路感染的病原谱及其耐药现状,为临床治疗提供依据。方法回顾性分析2008年4月-2011年12月住院患者送检尿标本阳性病原菌及其耐药性,病原菌的鉴定和药敏试验采用VITEK-2全自动微生物鉴定仪,真菌培养鉴定采用真菌显色培养基,药敏试验采用ATB-真菌药敏试验试剂条。结果从医院获得性尿路感染患者中分离病原菌476株,大肠埃希菌最多占27.1%;其他病原菌依次为真菌、肠球菌属、肺炎克雷伯菌、奇异变形菌、鲍氏不动杆菌、金黄色葡萄球菌,分别占23.7%、15.3%、6.9%、6.1%、3.8%、3.2%;119株大肠埃希菌中70.6%为产超广谱β-内酰胺酶(ESBLs)菌,大肠埃希菌对碳青霉烯类、阿米卡星和呋喃妥因、头孢替坦耐药率<6.0%,对头孢菌素类药物耐药率均>50.0%;大肠埃希菌对哌拉西林耐药率为84.4%,但对哌拉西林/他唑巴坦耐药率仅为3.6%;对左氧氟沙星、环丙沙星、氨苄西林和氨苄西林/舒巴坦的耐药率均>80.0%;肺炎克雷伯菌和奇异变形菌耐药性与大肠埃希菌相似;肠球菌属对万古霉素、替考拉宁、利奈唑胺耐药率<10.0%,粪肠球菌、屎肠球菌对呋喃妥因耐药率分别为29.4%、58.8%;对喹奴普汀/达福普汀耐药率二者有所不同,粪肠球菌耐药率为76.5%、屎肠球菌为9.1%。结论引起医院获得性尿路感染的病原菌对临床常用喹诺酮类耐药严重,应引起注意,提供系统、全面的病原菌耐药对于临床治疗具有一定的指导意义。OBJECTIVE To investigate the spectrum and evaluate the antibiotic resistance of the pathogens isolated from hospital-acquired urinary tract infections（HAUTI）. METHODS A retrospective analysis of data from positive urine samples processed at microbiological laboratory was studied from Apr 2008 to Dec 2011. The identification of the bacteria isolated and susceptibility tests were checked by the automatic system ASM Vitek 2 （Biomerieux, France）. The fungi were cultured and identified by CHROM agar, and susceptibility testings were measured by ATB-fungus stripes. RESULTS A total of 476 strains acquired from HAUTI were studied. The most common isolated pathogens were Escherichia coli （27.1%） , followed by fungi （23.7%） Enterococcus spp（15.3 ~）, Kleb- siella pneumoniae （6.9%）, Proteus mirabilis （6. 1%）, Acinetobacter baumannii （3.8%）. Among 119 E. coli , 70.6% of strains produced ESBLs. Carbapenems（including imipenem, meropenem and ertapenem）, amikacin, nitrofurantoin and cefotetan were the most active agents against E. coli （resistance rates^6~）. The resistance rate to cephalosporins was more than 50. 0~/6o, piperacillin（84. 40//00）, piperacillin-tazobactam （3. 6G）; the drug resistance rates to levofloxaein, ciprofloxacin, ampicillin, ampicillin-sulbactam were more than 80. 0%. Similar resistances were also found in Klebsiella pneumonia and Proteus rnirabilis. High susceptibility of Enterococcus spp, to vancomycin, teicoplanin and linezolid were found （resistance rate〈10 %）. The resistance rates of Entero- coccus faecalis and Enterococcus faecium to nitrofurantoin were 29.4% and 58. 8% ,kespectively however, the resistance rates to quinupristin-dalfopristin were 76.5 % and 9.1%, respectively. CONCLUSION The pathogens causing hospital-acquired urinary tract infections are highly resistant to the commonly used fluonoquenolones. Continuous and systematic surveillance of antibiotic resistance should be performed to guide the clinical treatment.

关 键 词：医院获得性尿路感染 药敏试验 耐药性 

分 类 号：R378[医药卫生—病原生物学]