肾结石合并尿路感染的菌谱及耐药性分析  

Analysis of bacteria spectrum and drug resistance in patients with renal calculi complicated with urinary tract infection

作　　者：何朝辉[1] 王航涛 唐福才 雷汉祺 HE Zhao-hui WANG Hang-tao TANG Fu-cai LEI Han-qi(Department of Urology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院泌尿外科,广东广州510120

出　　处：《现代泌尿外科杂志》2017年第10期738-742,共5页Journal of Modern Urology

基　　金：广州市科技计划项目(No.201510010272)

摘　　要：目的探讨广州医科大学附属第一医院泌尿外科肾结石合并尿路感染的感染率、病原菌分布及耐药性,为临床合理用药提供依据。方法收集广州医科大学附属第一医院泌尿外科2009年1月至2016年12月肾结石合患者中段尿培养资料,统计并分析菌谱和耐药性的变化。结果从14 063份肾结石患者中段尿标本中分离致病菌3 280株,阳性率为23.3%。肾结石合并尿路感染主要致病菌为大肠埃希菌(47.13%),肺炎克雷伯菌(8.35%)、粪肠球菌(8.14%)、奇异变形杆菌(7.10%)和铜绿假单胞菌(4.97%)。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和奇异变形杆菌对阿米卡星、哌拉西林/他唑巴坦、亚胺培南耐药率≤10%,鲍曼不动杆菌对头孢吡肟、亚胺培南耐药率≥20.00%。粪肠球菌、屎肠球菌和凝固酶阴性葡萄球菌对万古霉素和替考拉宁的敏感率为100%。结论大肠埃希菌是肾结石患者合并尿路感染的主要致病菌,对青霉素类、喹诺酮类、第3代头孢菌素、磺胺类抗菌药物耐药率较高;对阿米卡星、β-内酰胺酶抑制剂复合制剂、亚胺培南等药物敏感。Objective To collect and analyze the pathogenic bacteria distribution and drug resistance in kidney stone pa- tients with urinary tract infection （UTI）,in order to provide information for the rational use of preoperative antimicrobial drugs and to reduce the resistance rate. Methods The clinical data of hospitalized patients diagnosed with kidney stones and UTI during Jan. 2009 and Dec. 2016 in our center were reviewed. Pathogenic bacteria and drug resistance were analyzed. Results A total of 3 280 （23.3%） strains of bacteria were isolated from 14 063 urine samples. E. coli was the predominant isolate （ 47.13%）, followed by Klebsiella pneumoniae （8.35%）, Enterococcus faecalis （8.14%）, Proteus mirabilis （ 7.10%）, and Pseudomonas aeruginosa （4.79%）. Resistance rate of E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis against amikacin, piperacillin/tazobactam, and imipenem was less than 10 ~. Resistance rate of acinetobacter baumannii against cefepime and imipenem was more than 20.00%. The sensitive rate of Enterococcus faecalis,Enterococcus faecium, and coagulase staphylococcus to vancomycin and linezolid was 100%. Conclusions E. coli is the predominant uropathogen of urinary tract infection in patients with kidney stones. It is highly resistant against penicillin,quinolones,third-generation cephalosporins, and sulfonamides, while sensitive to amikacin, beta-lactamase inhibitor, and imipenem.

关 键 词：肾结石 尿路感染 尿培养 菌普分析 耐药性 

分 类 号：R692.4[医药卫生—泌尿科学]