泌尿系感染菌群分布及耐药性分析  

Distribution and drug resistance of bacteria causing urinary tract infection

作　　者：卓树洪[1] 叶晓光[1] 廖云珍[1] 罗润齐[1] 

机构地区：[1]广州医科大学附属第二医院感染科,广州510260

出　　处：《中华生物医学工程杂志》2016年第1期76-80,共5页Chinese Journal of Biomedical Engineering

摘　　要：目的：了解本院泌尿系感染致病菌的菌群分布及耐药性情况，为临床合理应用抗菌药物提供依据。方法回顾性分析本院2012年1月至2014年12月泌尿系感染患者的中段尿细菌培养阳性菌株的分布及耐药性，并对常见细菌的药敏试验进行对比统计分析。结果共分离培养出菌株2986例，其中革兰阴性杆菌1885株（63.13%），革兰阳性球菌624株（20.90%），真菌454株（15.20%）。革兰阴性杆菌中主要有大肠埃希菌1199株（40.15%），其中产ESBL酶623株，占51.96%；肺炎克雷伯菌188株（6.30%），产ESBL酶95株，占50.53%；革兰阳性球菌中粪肠球菌202株（6.76%），屎肠球菌190株（6.36%），葡萄球菌188株（6.30%）；真菌中绝大多数为念珠菌，共449株（15.04%），其余为酵母样真菌，5株（0.17%）。泌尿系感染中产超广谱β-内酰胺酶（ESBL）大肠埃希菌和肺炎克雷伯菌菌株共同敏感的抗菌药物有亚胺培南、美罗培南、阿米卡星、头孢西丁，对喹诺酮类均高度耐药；对主要的革兰阳性球菌共同敏感的抗菌药物有万古霉素、替考拉宁、利奈唑胺，对真菌敏感的药物有5-氟胞嘧啶、伏立康唑、氟康唑、两性霉素B。结论泌尿系感染仍以革兰阴性杆菌为主，且菌种呈现多样化，具有较高的耐药率，临床应高度重视合理应用抗菌药物，防止抗菌药物的滥用及新耐药菌株的产生。Objective To investigate the distribution and drug resistance of bacteria causing urinary tract infection in our hospital,and to provide evidence for rational clinical use of antibiotics. Methods The distribution and drug resistance of the positive bacteria isolates from mid-stream urine specimens of patients with urinary tract infection,who were hospitalized in our hospital between June 2012 and December 2014,were analyzed retrospectively. Susceptibility testing of common bacteria were compared and statistically analyzed. Results A total of 2 986 strains were isolated and cultured,including Gram-negative bacilli（GNB）（1 885,63.13%）,Gram-positive cocci（GPC）（624,20.90%）and fungi（454, 15.20%）. The GNB strains were mainly consisted of E. coli（1 199,40.15%）and Klebsiella pneumoniae （188,6.30%）,producing extended spectrum beta-lactamases （ESBLs）[（623,51.96%） and （95, 50.53%）,respectively. The GPC strains were consisted of enterococcus faecalis（202,6.76%）,enterococcus faecium （190,6.36%） and staphylococcus （188,6.30%）. The fungi strains were mainly consisted of candida（449,15.04%）and saccharomycetes（5,0.17%）. The E. coli and Klebsiella pneumoniae strains producing ESBLs in urinary tract infection were sensitive to Imipenem, Meropenem, Amikacin and Cefoxitin,but were highly resistant to Quinolones. Most GPC strains were sensitive to Vancomycin, Teicoplanin and Linezolid,while fungi strains were sensitive to 5-Fluorocytosine,Voriconazole,Fluconazole and Amphotericin B. Conclusion GNB,with a variety of strains and a high antibiotic resistance rate,were the most common pathogens in urinary tract infection. Rational use of antibiotics should be paid high attention,in order to prevent abuse of antibiotics and production of new drug-resistant strains.

关 键 词：泌尿系感染 耐药性 菌群分布 

分 类 号：R691.3[医药卫生—泌尿科学]