泌尿系感染者病原菌的临床分布特点及耐药性检测  

Clinical distribution and drug resistance of pathogens in urinary tract infections

作　　者：翟如波[1] 李云慧[1] 孙跃岭[1] 梅旭[1] 邱广斌[1] 

机构地区：[1]中国人民解放军第二O二医院检验科,沈阳市110003

出　　处：《中华实验和临床感染病杂志（电子版）》2015年第6期63-67,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：辽宁省自然科学基金(No.2014020124)

摘　　要：目的回顾性分析本院泌尿系感染的病原菌分布及其对常用抗菌药物的耐药情况,为泌尿系感染的诊断和治疗提供依据。方法对本院2013年1月至2014年12月住院患者送检的晨起清洁中段尿标本进行分离培养,采用VITEK-2 Compact全自动微生物分析仪进行细菌鉴定及药敏试验。结果共检出泌尿系感染病原菌1 784株,居前4位依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌和肠球菌属,主要分布于泌尿外科、老年病内科、肾脏内科、神经内科,女性多于男性,60岁以上患者占69.6%。引起泌尿系感染肠杆菌科细菌中大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)检出率为57.8%,对阿米卡星、呋喃妥因、哌拉西林/他唑巴坦的敏感性强,耐药率低于8.5%,对于非产ESBLs株,Ⅱ、Ⅲ代头孢菌素、氨曲南、阿米卡星、呋喃妥因、哌拉西林/他唑巴坦均具有较强的敏感性;肺炎克雷伯菌中产ESBLs检出率为46.9%,对阿米卡星、哌拉西林/他唑巴坦具有较强的敏感性,耐药率分别为12.4%和11.3%,对于非产ESBLs株除复方新诺明、呋喃妥因均具有较强敏感性。变形杆菌属对头孢他啶、氨曲南、哌拉西林/他唑巴坦敏感性较强,阴沟肠杆菌对左氧氟沙星、阿米卡星、哌拉西林/他唑巴坦敏感性较强,产气肠杆菌对阿米卡星、哌拉西林/他唑巴坦敏感性较强,未检出耐亚胺培南、美罗培南的肠杆菌科菌株。铜绿假单胞菌对美罗培南、阿米卡星具有较好的抗菌活性,鲍曼不动杆菌多药耐药性严重,嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星、复方新诺明有较高的抗菌活性。屎肠球菌对青霉素类、氟喹诺酮类及呋喃妥因的耐药率高于粪肠球菌,葡萄球菌和肠球菌对万古霉素和利奈唑胺均敏感。结论泌尿系感染病原菌的种类和耐药性都在不断发生变化,进行持续性病原菌及耐药性主动监测,关注病原菌耐药性变化趋势,针对每�Objective To analyze the distribution and drug resistance of pathogens in urinary tract infections,retrospectively,and to provide a basis for the diagnosis and treatment of urinary tract infections.Methods Pathogens isolated from the urine specimens of inpatient in our hospital form January 2013 to December 2014 were cultured,pathogens identification and drug susceptibility test were performed by VITEK-2 Compact automatic microorganism analyzer.Results Total of 1 784 strains of pathogens were isolated,the top four pathogens were Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae and Enterococcus.Pathogens mainly distributed in urology,geriatrics department,nephrology and neurology.Female patients were more than male patients.69.6%of pathogens came from patients over 60 years old.The detected rates of E.coli producing ESBLs were 57.8%,the drug resistance rates of E.coli producing ESBLs to amikacin,nitrofurantoin and piperacillin/tazobactam were all lower than 8.5%.The drug susceptibility of E.coli no producing ESBLs to Ⅱ,Ⅲ generation cephalosporins,aztreonam,amikacin,nitrofurantoin and piperacillin/tazobactam were all high.The detected rates of K.pneumoniae producing ESBLs were 46.9%,the drug resistance rates of K.pneumoniae producing ESBLs to amikacin and piperacillin/tazobactam were12.4%and 11.3%.The drug susceptibility of K.pneumoniae non-producing ESBLs to all antibioticall were high except cotrimoxazole and nitrofurantoin.The drug susceptibility of Proteus to ceftazidime,aztreonam,piperacillin/tazobactam were high.The drug susceptibility of Enterobacter cloacae to levofloxacin,amikacin,piperacillin/tazobactam were high.The drug susceptibility of Enterobacter aerogenes to amikacin and piperacillin/tazobactam were high.No imipenem and meropenem resistant Enterobacteriaceae were detected.The drug susceptibility of P.aeruginosa to meropenem,amikacin were high.Acinetobacter baumannii were seriously multi-drug resistant.The drug susceptibility of Maltophilia seromonas to minocycline,levofloxacin and

关 键 词：病原菌 耐药性 多重耐药 泌尿系感染 

分 类 号：R446.5[医药卫生—诊断学]