泌尿系结石患者尿培养分离致病菌菌种与药物敏感性分析  

The analysis of the species and antibiotics sensitivity of the urological pathogens isolated from nephrolithiasis patients

作　　者：肖楠 王利君 段宁 祝天阳 李润青 赵秀英 XIAO Nan;WANG Li-Jun;DUAN Ning(Depatment of Clinical Laboratory, Beij ing Tsinghua Changgung Hospital, Beijing 102218, China)

机构地区：[1]北京清华长庚医院检验科,北京102218

出　　处：《中国实验诊断学》2018年第6期999-1002,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的为了提高泌尿外科对泌尿系结石患者预防性使用抗生素的针对性和有效性,总结北京清华长庚医院泌尿外科泌尿系结石患者泌尿系感染致病菌的菌种谱和药敏谱。方法对我院2015年1月1日到2017年6月30日泌尿外科所有泌尿系统结石患者的尿液细菌培养阳性结果进行回顾性研究。结果前十位致病菌共660株,分别是大肠埃希菌(233株,35.3%)、粪肠球菌(113株,17.1%)、奇异变形杆菌(58株,8.8%)、肺炎克雷伯菌(55株,8.3%)、铜绿假单胞菌(48株,7.3%)、屎肠球菌(43株,6.5%)、表皮葡萄球菌(36株,5.5%)、无乳链球菌(33株,5.0%)、溶血葡萄球菌(22株,3.3%)和鲍曼不动杆菌(19株,2.9%)。检出产超广谱β内酰胺酶的肠杆菌科细菌214株,耐甲氧西林的葡萄球菌17株,耐碳青霉烯的阴性杆菌20株,耐万古霉素的肠球菌2株。对革兰阴性菌和阳性菌的药物敏感性按照菌种所占比例进行了加权敏感性计算(Sw)。针对阴性菌的最高Sw药物是亚胺培南(IMP,92.6%)和阿米卡星(AMK,92.8%)(P=1.0),其次是哌拉西林/他唑巴坦(TZP)和头孢哌酮/舒巴坦(SCF)。针对阳性菌的Sw显示,替加环素(TGC)、万古霉素(VAN)、利奈唑胺(LZD)的Sw均在99%以上,其次是呋喃妥因(NIT)(75%)。结论针对我院泌尿系结石患者尿路感染致病菌中高比例产ESBLs菌和肠球菌的现状,当尿液沉渣镜检提示阴性菌时,使用IMP、TZP或SCF疗效较好。如果提示阳性球菌则头孢菌素收效不佳,除VAN、TGC和LZD外,NIT是比较稳妥的用药选择。Objective To improve the effectiveness of prophylactic antibiotics,we retrospectively studied the urine culture results of nephrolithiasis patients.Methods During Jan 2015 to Jun 2017,we enrolled all the urine culture results of the nephrolithiasis patients from the department of urology in a tertiary teaching hospital,Beijing,China.Results Top 10 urological infection pathogens were Escherichia.coli（233 isolates,35.3%）,Enterococcus faecalis（113 isolates,17.1%）,Proteus mirabilis（58 isolates,8.8%）,Klebsiella pneumoniae（55 isolates,8.3%）,Pseudomonas aeruginosa（48 isolates,7.3%）,Enterococcus faecium（43 isolates,6.5%）,Staphylococcus epidermidis（36 isolates,5.5%）,Streptococcus agalactiae（33 isolates,5.0%）,Staphylococcus haemolyticus（22 isolates,3.3%）and Acinetobacter Bauman（19 isolates,2.9%）.214 isolates of enterobacteriaceae bacillus producing extended spectrum beta lactamases were identified.17 methicillin-resistant staphylococcus,20 carbapenems-resistant enterobacteriaceae bacillus and 2 vancomycin-resistant enterococcus were isolated.Weighted sensitivity（Sw）of antibiotics were calculated according to the numbers of isolates.The antibiotics against Gram-negative（GN）bacillus with the highest Sw were imipenem（92.6%）and amikacin（92.8%）（P=1.0）.βlactams/βlactamase inhibitors were the second highest Sw antibiotics.The antibiotics against Gram-positive（GP）coccus with the highest Sw were tigecycline,vancomycin and linezolid,whose Sws were all higher than 99%.The second highest Sw was that of nitrofurantoin（75%）.Conclusion Since there were high propotions of bacillus producing ESBLs and enterococcus spp.isolated from the nephrolithiasis patients in our hospital,cephalosporins alone maybe not a good choice.If the urinary sediment staining informed a GN bacillus,amikacin,imipenem andβlactams/βlactamase inhibitors could be prophylactic antibiotics.If the urinary sediment staining informed a GP coccus,besides vancomycin,tigecycline and linezolid,nitrofuranto

关 键 词：泌尿系结石 尿培养 泌尿系感染菌种 药敏 

分 类 号：R446.5[医药卫生—诊断学]