危重症患者尿路感染大肠埃希菌的耐药性分析  

Drug resistance of Escherichia coli causing urinary tract infections in critically ill patients

作　　者：牛素平[1] 陈炜[1] 赵磊[1] 王锁柱[1] 甄洁[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院重症医学科,北京100038

出　　处：《中华医院感染学杂志》2015年第2期315-317,共3页Chinese Journal of Nosocomiology

基　　金：首都医学发展科研基金资助项目(SF2009/1-11);北京市卫生局重大科研基金资助项目(2005-32)

摘　　要：目的分析综合ICU危重症患者大肠埃希菌致尿路感染菌群特点及耐药性,为临床经验用药提供依据。方法对2007年1月-2012年8月综合ICU送检尿液培养大肠埃希菌阳性菌株进行鉴定和耐药分析,细菌鉴定采用美国Walkaway-40全自动细菌鉴定仪及VETIK全自动细菌鉴定仪,药敏试验除头孢哌酮/舒巴坦采用K-B纸片扩散法,其余均采用MIC法,分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及非产ESBLs大肠埃希菌的构成比及耐药率。结果尿培养共分离出大肠埃希菌303株,其中产ESBLs菌株107株,占35.31%,非产ESBLs菌株196株,占64.69%;大肠埃希菌对氨苄西林、头孢呋辛、哌拉西林、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、头孢噻肟、环丙沙星、庆大霉素、头孢唑林的耐药率均>70.0%,对阿米卡星、哌拉西林/他唑巴坦、头孢替坦、亚胺培南耐药率<30.0%,同时,产ESBLs菌与非产ESBLs菌对部分抗菌药物的耐药性存在明显差异。结论危重症患者尿路感染大肠埃希菌耐药性较为严重,但阿米卡星、头孢替坦、哌拉西林/他唑巴坦、亚胺培南等仍是较为敏感的抗菌药物,可作为经验性用药。OBJECTIVE To analyze the characteristics of critically ill patients with urinary tract infections caused by Escherichia coli in general ICU and observe the drug resistance so as to provide evidence for clinical empirical medication.METHODS From Jan 2007 to Aug 2012,the bacterial identification was performed for the E.coli strains cultured positive from the submitted urine specimens obtained from the general ICU by using Walkaway-40 automatic bacterial identification system of the United States and VETIK automatic bacterial identification system,the drug susceptibility testing for cefoperazone-sulbactam was conducted by means of K-B disk diffusion method,and the MIC method was employed for the rest of antibiotics;the constituent ratios of the extended-spectrumβ-lactamases（ESBLs）-producing E.coli and non-ESBLs-producing E.coli and the drug resistance rates were observed.RESULTS A total of 303 strains of E.coli have been cultured from the urine specimens,including 107（35.31%）strains of ESBLs-producing E.coli and 196（64.69%）strains of non-ESBLs-producing E.coli.The drug resistance rates of the E.coli to ampicillin,cefuroxime,piperacillin,levofloxacin,sulfamethoxazole-trimethoprim,cefotaxime,ciprofloxacin,gentamicin,and cefazolin were more than 70.0%;the drug resistance rates to amikacin,piperacillin-tazobactam,cefotetan,and imipenem were less than 30.0%;the ESBLs-producing and non-ESBLsproducing strains varied significantly in the drug resistance to some of the antibiotics.CONCLUSIONThe drug resistance of the E.coli causing urinary tract infections in the critically ill patients is serious,however,amikacin,cefotetan,piperacillin-tazobactam,and imipenem remain the sensitive antibiotics,which can be used for empirical medication.

关 键 词：大肠埃希菌 尿路感染 重症监护 耐药性 

分 类 号：R378.21[医药卫生—病原生物学]