输尿管结石患者梗阻段上、下尿路病原菌分布与耐药性分析  

Distribution and drug resistance of pathogens isolated from upper and lower ureter of stone obstruction in patients with ureteral calculi

作　　者：王帅彬[1] 何有华[1] 余凯远[1] 冯骎 杨文学 木海琦[1] 

机构地区：[1]温州医科大学附属第二医院泌尿外科,325027

出　　处：《中华全科医师杂志》2018年第3期210-212,共3页Chinese Journal of General Practitioners

摘　　要：回顾性分析2016年1—12月422例手术治疗输尿管结石患者结石梗阻段上、下尿路病原学检验及药敏试验结果。上尿路尿液标本共分离出病原菌29株（6.9%），其中革兰阴性菌22株（75.9%），革兰阳性菌3株（10.3%），真菌4株（13.8%）；下尿路尿液标本共分离出病原菌48株（11.4%），其中革兰阴性菌37株（77.1%），革兰阳性菌11株（22.9%）。仅梗阻段上尿路尿培养阳性20例，仅梗阻段下尿路尿培养阳性39例，梗阻段上、下尿路尿培养阳性菌株相同的7例，菌株异种2例。尿培养阳性菌株感染率依次为大肠埃希菌、奇异变形杆菌、肺炎克雷伯菌、粪肠球菌、屎肠球菌。革兰阴性菌对喹诺酮类药物耐药率高于头孢类药物，大肠埃希菌对头孢类药物耐药率达到36.7%～63.3%，对环丙沙星和左氧氟沙星等抗菌药物的耐药率86.7%～100.0%。肠球菌属对红霉素的耐药率均为100.0%。提示，输尿管结石梗阻导致部分常规中段尿培养阴性；革兰阴性菌为输尿管结石患者的主要感染菌，大肠埃希菌对氟喹诺酮类抗菌药物的耐药率较高。Four hundred and twenty two patients with ureteral calculi undergoing surgical treatment from January 2016 to December 2016 were enrolled in the study. Urine samples were taken from upper and lower ureter of stone obstruction, pathogen examination and drug susceptibility tests were performed. Twenty nine strains of pathogens were isolated from the upper segment of ureter with a detection rate of 6.9% ; 22 strains were gram-negative bacteria （75.9%） and 3 strains were gram-positive bacteria （ 10.3% ） and 4 strains were fungi （ 13.80/0 ）. Forty eight strains of pathogenic bacteria were isolated from the lower segment with a detection rate of 11.4% ; 37 strains were gram-negative bacteria （77.1%）, 11 strains were gram- positive bacteria （22.9%） , no fungi was isolated. In 20 cases the positive results were obtained only from upper ureter urine samples, and in 39 cases the positive results were obtained only from lower segment samples. The same pathogens were detected from both upper and lower ureter of stone obstruction in 7 cases, and different pathogens were identified in 2 cases. The most common pathogens were Escherichia coli, followed by Proteus mirabilis, Klebsiella pneumoniae, Enterococcus faecalis and Enterococcus faecium. The resistance to quinolones in gram-negative bacteria was higher than that to cephalosporius. The resistance rate of Escherichia coli to cephalosporin was 36.7% -63.3%, that to ciprofloxaein and levofloxacin was 86.7% - 100.0% ; the resistance rate of Enterococcus to erythromycin was 100.0%. It is suggested that ureteral calculi obstruction may lead to negative culture results of conventional mid-stream urine samples. It is of clinical value to investigate the distribution and antibiotic resistance of pathogens both from upper and lower segments of ureter in patients with ureteral calculi.

关 键 词：输尿管结石 输尿管梗阻 泌尿道感染 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R693.4[医药卫生—临床医学]