神经内科患者导尿管相关性尿路感染病原菌的耐药性分析  

Antimicrobial resistance of pathogenic bacteria causing catheter-related urinary tract infections

作　　者：程晓玲[1] 黄宏耀[2] 程伟[1] 吴磊[1] 黄豫军[1] 李婉秋[1] 

机构地区：[1]湖北医药学院附属随州市中心医院神经内科,湖北随州441300 [2]湖北医药学院附属随州市中心医院检验科,湖北随州441300

出　　处：《中华医院感染学杂志》2013年第22期5597-5598,5601,共3页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅基金资助项目(2009jx4669)

摘　　要：目的了解医院神经内科患者导尿管相关性尿路感染(CAUTIs)病原菌的种类及耐药特征,为临床抗菌药物应用提供临床参考数据。方法采集神经内科2009年1月-2012年6月218例尿路感染患者的尿液标本,细菌培养与计数按照临床微生物学检验常规方法进行;菌种鉴定采用MicroScan AutoSCAN4自动微生物鉴定系统进行;药敏试验采用WHO指定的纸片扩散法,药敏数据统计运用WHONET 5.5软件分析。结果 218例尿路感染患者送检标本培养出249株病原菌,其中大肠埃希菌检出最多,占37.3%,其次依次为凝固酶阴性葡萄球菌、粪肠球菌、铜绿假单胞菌、肺炎克雷伯菌,分别占13.3%、11.6%、11.2%、9.6%;除了革兰阴性杆菌对碳青霉烯类抗菌药物、革兰阳性球菌对糖肽类抗菌药物100.0%敏感外,其他病原菌对临床抗菌药物均产生了比较严重的耐药性;耐甲氧西林葡萄球菌检出20株,检出率为42.6%;产ESBLs菌检出51株,检出率为43.6%。结论神经内科医护人员应及早拔除导尿管,消除感染源,重视CAUTIs的病原学检查,参照药敏结果规范用药,避免盲目使用药物,有效控制导尿管相关性尿路感染,提高临床治愈率。OBJECTIVE To understand the species of pathogenic bacteria causing catheter-related urinary tract infections （CRUTIs） in patients of neurology department and analyze the characteristics of drug resistance so as to provide evidence for use of susceptible antibiotics for anti-infection therapy. METHODS The infective urine specimens were collected with the use of aseptic technique , then the bacterial culture and counting were performed by the routine methods of the clinical laboratory microorganisms, the bacterial identification was carried out by using the MicroScan AutoSCAN4, the drug susceptibility testing was performed with the use of disk diffusion method specified by WHO, and the result of drug susceptibility testing was statistically analyzed by using WHONET5.5 software. RESULTS Of totally 249 strains of pathogens causing urinary tract infections in 218 patients, the detection rate of Escherichia coli was 37. 3%, the coagulase-negative Staphylococcus 13. 3%, the Enterococcus faecalis 11. 6%, the Pseudomonas aeruginosa 11. 2%, the Klebsiella pneumoniae 9. 6%. The pathogens causing CRUTIs were highly resistant to all clinically used antibiotics except for carbapenems and glycopeptides to which the gram-negative bacilli and gram-positive cocci remained 100% of suseeptibility; totally 20 strains of methicillin-resistant Staphylococcus were detected with the detection rate of 42.6%,, and 51 strains of ESBLs-producing bacteria were detected with the detection rate of 43.6%. CONCLUSION It is suggested that the medical staff of neurology department should withdraw the urethral catheter in a timely manner, eradicate the infection sources, focus on the etiological examination of CRUTIs, reasonably use antibiotics based on result of drug susceptibility testing, and avoid of abuse of antibiotics so as to effectively control of the CRUTIs and improve the clinical cure rate.

关 键 词：导尿管相关性尿路感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]