皖南地区1831例中老年糖尿病合并尿路感染病原菌分布、耐药情况及治疗对策  

Epidemiology and antimicrobial resistance profiles of pathogens causing urinary tract infections( 1831 cases) and treatment analysis in middle and aged people with diabetes mellitus in southern Anhui province

作　　者：高家林[1] 张魏[2] 刘春生[3] 朱玉[4] 张斌华[1] 夏礼斌 陈月平[1] 邢春燕[1] 王勇[1] 

机构地区：[1]皖南医学院弋矶山医院内分泌科,芜湖安徽241001 [2]皖南医学院弋矶山医院微机中心,芜湖安徽241001 [3]皖南医学院弋矶山医院检验科,芜湖安徽241001 [4]皖南医学院公共卫生学院流行病与卫生统计学教研室,安徽芜湖241002

出　　处：《中国临床药理学与治疗学》2016年第6期678-683,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家自然科学基金项目(81200632,81471002);安徽省高校优秀青年人才计划资助项目

摘　　要：目的:分析中老年糖尿病合并尿路感染患者病原菌分布和耐药情况,为临床用药提供参考。方法:对2012年1月-2016年5月本地区5 429例中段尿培养及药敏标本数据进行汇总,分析病原菌株分布,根据病原菌谱,分析各类菌株耐药情况。利用Cochran-Armitage趋势检验分析产ESBL菌(ESBL^+)及主要病原菌分布的年度变化趋势。结果:送检中段尿标本5 429例次,分离出病原菌1 977株,分离率36.41%。检出主要革兰氏阴性(G^-)菌,依次为大肠埃希菌(653株,占总菌株数33.03%)、肺炎克雷伯菌肺炎亚种(105,5.31%)、奇异变形杆菌(36,1.82%)、铜绿假单胞菌(35,1.77%)、弗氏柠檬酸杆菌(26,1.32%);药敏提示,前两种主要病菌株对复方新诺明、喹诺酮类抗菌药、头孢菌素均呈现不同程度耐药。主要革兰氏阳性(G^+)菌,依次为粪肠球菌(379,19.17%)、屎肠球菌(183,9.25%)、表皮葡萄球菌(136,6.87%)、溶血葡萄球菌(97,4.91%)、金黄色葡萄球菌(31,1.57%);药敏提示前两菌株对左氧氟沙星、阿奇霉素不同程度耐药。真菌主要为白色假丝酵母菌(56,2.83%)、光滑假丝酵母菌(55,2.78%)。ESBL^+大肠埃希菌和ESBL^+肺炎克雷伯菌检出率分别为55.89%及36.19%。ESBL^+大肠埃希菌检出率从2012到2016年,呈现逐渐下降趋势(P<0.05)。G^+菌中,除屎肠球菌、表皮葡萄球菌分布表现出逐年下降趋势外(P<0.05),其余三种G^+菌株及主要G^-菌无明显年度变化趋势(P均>0.05)。结论:中老年糖尿病合并尿路感染患者主要病原菌依次为大肠埃希菌、粪肠球菌、屎肠球菌、表皮葡萄球菌和肺炎克雷伯菌,病原菌耐药菌谱广,耐药率高,合理选用抗菌药物至关重要。AIM： To provide reference for clinical rational using of antibiotics by analyzing the distribution of pathogenic bacteria and drug resistant bacteria in middle aged and elderly diabetic patients with urinary tract infection. METHODS： From Jan 2012 to May 2016, 5 429 cases of midstream urine culture samples and drug susceptibility data in southern Anhui province were collected, and the pathogens of isolation rate and drug resistance were analyzed. The Cochran Armitage trend test were used to analyze the annual distribution trends of the ESBL positive （ESBL^＋） or other pathogens. RESULTS ： From the 5 429 cases of urine specimens, 1 977 strains of bacteria were isolated; the isolation rate was 36.41%. Detected strain, mainly gram positive （G^-） bacteria, were Escherichia coli （E. coli, 653 strains, accounted for the total isolates 33.03% ）, Klebsiella pneumoniae subsp, pneumoniae（ KPP, 105, 5.31% ）, Singular deformation （36, 1.82% ）, Bacillus and Pseudomonas aeruginosa bacteria （35, 1.77% ）, Citrobacter acid bacilli （26, 1.32% ）. And drug resistance test showed that, the two main pathogens possessed stably resistance to Paediatric Compound Sulfamethoxazole, Quinolones, Cephalosporin. The distribution of G^＋ bacteria were E. faecalis （379, 19.17% ）, E. faecium （183, 9.25% ）, Staphylococcus epidermidis （ SAP, 136, 6.87% ）, Staphylococcus haemolyticus （97, 4.91% ）, Staphylococcus aureus （31, 1.57% ）. The former two G^＋ bacteria had serious drug resistance to Ofloxacin and Azithromycin. Fungi were mainly distributed in Candida albicans （56, 2.83% ） , Candida albicans （55, 2.78% ）. The drug resistant strains were relatively rare. The isolation rate of ESBL^＋ E. coli and Kpp were 55.89% and 36.19% respectively, and the annual isolation rates of ESBL. E. coli Show a downtrend of year after year （P 〈 0.05 ）. Among the five G^＋ strains, the annual isolation rates of Enterococcus Faecium and SAP also showed a downtrends （ All P 〈 0.05 ）, where

关 键 词：糖尿病 尿路感染 中段尿 病原菌分布 耐药率 抗菌素 

分 类 号：R587[医药卫生—内分泌]