2014-2016年尿路感染的病原菌及耐药分析  

Pathogens and drug resistance analysis of urinary tract infection from 2014 to 2016

作　　者：郭桂军 杜晓娜 邵春红[2] 

机构地区：[1]山东省乐陵市人民医院检验科,山东乐陵253600 [2]山东大学附属省立医院检验科,山东济南250021

出　　处：《医学检验与临床》2017年第7期17-20,23,共5页Medical Laboratory Science and Clinics

摘　　要：目的：了解近3年尿路感染患者病原菌构成及药物敏感性,为临床经验治疗提供参考依据.方法：收集2014年1月1日～2016年12月31日山东省立医院尿路感染患者的清洁中段尿进行常规培养,分离菌株采用VITEK 2 Compact和VITEK-MS进行鉴定,除葡萄球菌属采用VITEK 2 Compact测定其药物敏感性外,其余菌株均采用纸片扩散法.参照CLSI 2016版折点判读结果,使用whonet5.6软件统计分析.结果：共收集非重复尿液标本7118份,分离非重复菌株2546株,阳性率35.8％.分离菌株以革兰氏阴性杆菌为主（76.0％）,病原菌占前五位的分别为大肠埃希菌、 粪肠球菌、 肺炎克雷伯菌、 屎肠球菌和铜绿假单胞菌.大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶的阳性率分别为52.8％和45.5％.肠杆菌科细菌对亚胺培南、 美罗培南、 阿米卡星、 哌拉西林/他唑巴坦及头孢哌酮/舒巴坦保持较高的敏感性,耐药率均在10％以下.铜绿假单胞菌除对左氧氟沙星的耐药率为33.0％外,对其他抗菌药物的耐药率均低于20％.屎肠球菌对大多数测试药物的耐药率高于粪肠球菌,发现7例万古霉素和替考拉宁耐药的肠球菌.结论：尿路感染病原菌以大肠埃希菌为主,细菌耐药性呈增高趋势,应重视细菌耐药性监测并加强抗生素的合理使用.Objective： To investigate the pathogenic bacteria spectrum and antibiotic resbtance in patients with urinary tract infection during 2014 to 2016 and provide the basis for clinical treatment. Methods： The clean midstream urine from patients with urinary tract infection were conventionally cultured and the isolated bacteria were identified by the automatic VITEK 2 Compact and VtTEK-MS. The antimicrobial susceptibility of staphylococcal strains was tested by VITEK 2 Compact. The other strains were tested by disk diffusion method. All the data were analyzed by WHONET5.6 software according to CLSI 2016 breakpoints. Results： A total of 7118 non- repetitive clinical specimens and 2546 strains were collected from patients with urinary tract infi^cti0n~ The positive rate was 35.8%. Gram negative rods accounted for 76.0% . The first five bacteria were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Enterococcus faecium, and Pseudomonas aeruginosa The ESBL positive rate of E.coli and Klebsiella pneumoniae was 52.8% and 45.5%, respectively. Enterobacteriaceae maintained a high sensitivity＂ to imipenem, meropenem, amikacin, piperacillin/tazobactam and cefoperazone/sulbactam, the resistance rates were below 10%. The percentage ofPseudomonas aeruginosa strains to all the antibiotics tested was below 20% except levoiloxacin （33.0% ） . The percentage ofEnterococcus faecium resistant to most antibiotics tested was higher than that of Enterococcus faecalis. 7 Enterococcus sp. were found to be resistant to vancomycin and teicoplanin. Conclusion： E.coli is the predominant organism in urinary tract infection. Bacterial resistance showed a growing trend. We should pay more attention to strengthen the resistance surveillance and improve the rational use of antibiotics.

关 键 词：尿路感染 病原菌 耐药性 

分 类 号：R0[医药卫生]