2014～2016年尿路感染的病原菌及耐药分析  

Analysis of the pathogenic bateria and drug resistance in patients with urinary tract infection from 2014 to 2016

作　　者：张伟[1] 金炎[1] 黄敏[1] 郝莹莹[1] 柳欣琦[1] 李静[1] 田季平 邵春红[1] Zhang Wei,Jin Yan,Huang Min,Hao Yingying,Liu Xinqi,Li Jing,Tian Jiping,Shao Chunhong.(Clinical Laboratory of Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021,Chin)

机构地区：[1]山东大学附属省立医院临床医学检验部,济南250021

出　　处：《新医学》2018年第6期416-420,共5页Journal of New Medicine

基　　金：国家自然科学基金(81401696);山东省科技发展计划项目(2016GSF201078)

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日至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 2Compact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年版判读结果,使用WHONET 5.6软件统计分析。结果共收集非重复尿液标本7 118份,分离非重复菌株2 546株,阳性率35.8%。分离菌株以革兰阴性杆菌为主(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20.0%。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,细菌耐药形势严峻,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 and drug resistance in patients diagnosed with urinary tract infection from 2014 to 2016, aiming to provide reference for clinical diagnosis and treatment. Methods The clean-catch midstream urine were collected and conventionally cultured from patients with urinary tract infection and the isolated bacteria were identified by the automatic VITEK 2 Compact and VITEK-MS. The antimicrobial susceptibility of staphylococcal strains was tested by using VITEK 2 Compact. The antimicrobial susceptibility of other strains was evaluated by using disk diffusion method. All the data were analyzed by WHONET 5.6 software according to the CLSI 2016 breakpoints. Results A total of 7 118 non-repetitive clinical samples and 2 546 strains were collected from patients with urinary tract infection. The positive rate was 35.8%. Gram-negative bacilli accounted for 76.0%. The first five bacteria were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae,Enterococcus faecium and Pseudomonas aeruginosa. The ESBL positive rates of E.coli and Klebsiella pneumoniae were 52.8% and 45.5%, respectively. Enterobacteriaceae possessed a relatively high sensitivity to imipenem, meropenem, amikacin, piperacillin/tazobactam and cefoperazone/sulbactam, and the resistance rates were below 10%. The percentage of Pseudomonas aeruginosa strains to all the antibiotics was below 20% except levofloxacin （33.0% ） . The percentage of Enterococcus faecium resistant to most antibiotics was higher than that of Enterococcus faecalis. Seven Enterococcus sp. were found to be resistant to vancomycin and teicoplanin. Conclusion E.coli is the predominant pathogen in urinary tract infection. Drug resistance becomes a challenge. Extensive attention should be diverted to strengthen the surveillance for drug resistance and improve the rational use of antibiotics.

关 键 词：尿路感染 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R691.3[医药卫生—临床医学]