留置尿管相关尿路感染的病原菌特点及耐药性分析  

Analysis of Pathogens Characteristics and Drug Resistance of Indwelling Catheter- associated Urinary Tract Infections

作　　者：范地兵 马晋[1] 

机构地区：[1]四川省广元市第一人民医院泌尿科,四川广元628017

出　　处：《河北医学》2016年第2期253-256,共4页Hebei Medicine

基　　金：四川省卫生厅科研课题;(编号:F201893)

摘　　要：目的:观察留置尿管相关尿路感染的病原菌特点,分析其耐药性,为临床合理选择抗菌药物提供依据。方法:对2012年3月至2014年3月期间452例留置尿管患者尿液进行病原菌分离、培养鉴定,采用Kirby-Bauer纸片法进行药敏试验分析。结果:留置尿管患者尿路感染率为24.8%。病原菌中以革兰阴性菌为主,占55.7%,明显高于革兰阳性菌的33.6%和真菌的10.7%,差异有统计学意义(P<0.05)。大肠埃希菌、表皮葡萄球菌和白色假丝酵母菌分别是最主要的革兰阴性菌、革兰阳性菌和真菌,分别占26.0%、16.0%和5.3%。大肠埃希菌对阿莫西林、替卡西林、哌拉西林耐药率均在70%以上,而对美罗培南、亚胺培南、阿莫西林/克拉维酸相对敏感,耐药率在30%以下。表皮葡萄球菌对青霉素、红霉素、和苯唑西林的耐药率较高,达80%以上;对利福平、米诺环素、氨苄西林、夫西地酸和呋喃妥因较为敏感,耐药率在20%以下,未发现对万古霉素、替考拉宁株。白色假丝酵母菌均未对伊曲康唑、制霉菌素、两性霉素B和氟康唑耐药。结论:留置尿管相关尿路感染以革兰阴性菌为主,耐药严重,临床医师应根据药敏试验结果,合理选择抗菌药物。Objective： To observe the distribution of pathogenic bacteria in indwelling catheter- associated urinary tract infections,and analyze its drug resistance so as to supply clinical basis for reasonable choice of antimicrobial drugs. Method： From March 2012 to March 2014,452 cases of urinary samples in indwelling catheter- associated urinary tract infection patients were cultured,and tested drug- resistance with Kirby- Bauer method. Result： The rate of indwelling catheter- associated urinary tract infection was24. 8%,of which Gram- negative bacteria was most common bacteria,accounting for 55. 7%,significantly higher than Gram- positive bacteria with 33. 6% and fungi with 10. 7%（ P〈0. 05）. Escherichia coli,Staphylococcus epidermidis and Candida albicans were the most important Gram- negative bacteria,Gram- positive bacteria and fungi,accounting for 26. 0%,16. 0% and 5. 3%,respectively. Escherichia coli showed high resistance to amoxicillin,ticarcillin,piperacillin,and resistance rates were all above 70%,while sensitive to meropenem,imipenem,amoxicillin / clavulanate,and resistance rates were below 30%. Staphylococcus epidermidis showed high resistance to penicillin,erythromycin,and oxacillin,and resistance rates were higher than80%,sensitive to rifampin,minocycline,ampicillin,fusidic acid and nitrofurantoin,and resistance rates were lower than 20% and no drug resistance to vancomycin and teicoplanin. Candida albicans did not exhibit resistance to itraconazole,nystatin,amphotericin B and fluconazole. Conclusion： Indwelling catheter- associated urinary tract infections mainly infect with Gram- negative bacteria,and drug resistance phenomenon is serious,clinical doctors should choose antimicrobial drugs reasonably based on susceptibility test results.

关 键 词：留置尿管相关尿路感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]