输尿管软镜碎石术后感染病原菌分析  

Pathogens causing postoperative infections in patients undergoing flexible ureteroscope lithotripsy

作　　者：邓金平[1] 卢毅[1] 莫启旺 张晓[1] 竹青[1] 

机构地区：[1]嵊州市人民医院外四科,浙江嵊州312400

出　　处：《中华医院感染学杂志》2016年第10期2314-2316,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划基金资助项目(2011KYA027)

摘　　要：目的探讨复杂性肾或输尿管上段结石经输尿管软镜碎石术后感染病原菌分布及其耐药性,以降低术后感染率。方法选取2013年1月-2015年8月医院输尿管软镜碎石术后感染的复杂性肾或输尿管上段结石患者36例,取清洁尿液进行细菌培养及药敏分析;采用WHONET 5.6软件进行病原菌分布及耐药性分析。结果 36例患者共检出病原菌134株,其中革兰阴性菌94株占70.15%,革兰阳性菌40株占29.85%;革兰阴性菌中检出超广谱β-内酰胺酶(ESBLs)菌19株,革兰阳性菌中检出耐甲氧西林金黄色葡萄球菌(MRSA)2株;革兰阴性菌对哌拉西林、亚胺培南等抗菌药物的敏感率<10.0%,革兰阳性菌包括MRSA对万古霉素、替考拉宁的耐药率均为0。结论革兰阴性菌是复杂性肾或输尿管上段结石经输尿管软镜碎石术后主要病原菌,耐药性较强,临床应结合药敏结果合理用药。OBJECTIVE To explore the distribution and drug resistance of pathogens causing postoperative infections in patients with complex renal or upper ureteral calculi who underwent flexible ureteroscope lithotripsy so as to reduce the incidence of postoperative infections.METHODS A total of 36 complex renal or upper ureteral calculi patients complicated with postoperative infections who underwent the flexible ureteroscope lithotripsy from Jan2013 to Aug 2015 were enrolled in the study,the clean urine specimens were collected for bacterial culture,the drug susceptibility testing was performed,and the distribution and drug resistance of pathogens were analyzed by using WHONET 5.6software.RESULTS A total of 134 strains of pathogens were isolated from the 36 patients,including 94（70.15%）strains of gram-negative bacteria and 40（29.85%）strains of gram-positive bacteria;totally 19 strains of extended-spectrumβ-lactamases（ESBLs）-producing bacteria were detected from the gram-negative bacteria;2strains of methicillin-resistant Staphylococcus aureus（MRSA）were detected from the gram-positive bacteria.The drug susceptibility rates of the gram-negative bacteria to piperacillin,imipenem were less than10.0%;the drug resistance rates of the gram-positive bacteria including MRSA to vancomycin and teicoplanin were 0.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the postoperative infections in the patients with complex renal or upper ureteral calculi who undergo the flexible ureteroscope lithotripsy and are highly drug-resistant,and it is necessary to reasonably use antibiotics based on the results of drug susceptibility testing.

关 键 词：复杂性 肾脏 输尿管 结石 输尿管软镜碎石 病原菌 耐药性 

分 类 号：R693.4[医药卫生—泌尿科学]