尿脓毒血症与复杂性尿路感染病原学特点及耐药性对比研究  

Etiological characteristics and antibiotics resistance analysis between urosepsis and complicated urological tract infection

作　　者：胡明 韩福郎 徐勋 张湛英 关礼贤 冯权尧 Hu Ming;Han Fulang;Xu Xun;Zhang Zhanying;Guan Lixian;Feng Quanyao(Department of Urology,Nanhai Hospital Affiliated to Southern Medical University,Foshan 528200,China)

机构地区：[1]南方医科大学附属南海医院泌尿外科,佛山528200 [2]南方医科大学附属南海医院检验科,佛山528200

出　　处：《新医学》2018年第4期265-269,共5页Journal of New Medicine

基　　金：佛山市卫计局医学科研基金(20180271)

摘　　要：目的探讨尿脓毒血症与复杂性尿路感染的病原学特点以及耐药性,为两者抗感染治疗提供可靠依据。方法收集83例尿脓毒血症患者(尿脓毒血症组)以及629例复杂性尿路感染患者(复杂性尿路感染组),对尿液标本进行细菌培养,分离并鉴定病原菌,记录其来源及类型。对分离出的病原菌进行药敏试验,对患者的病原菌分布及其耐药性特点进行分析及比较。结果尿脓毒血症组83例患者的尿培养结果中,检出病原菌59例(71.1%),其中革兰阴性菌48株、革兰阳性菌3株、真菌8株。复杂性尿路感染组629例患者的尿培养结果中,检出革兰阴性菌516株(82.0%),革兰阳性菌76株(12.1%)、真菌37株(5.9%)。尿脓毒血症组中大肠埃希菌和真菌检出率均高于复杂性尿路感染组(P均<0.05)。尿脓毒血症组和复杂性尿路感染组尿培养中产超广谱β-内酰胺酶大肠埃希菌检出率分别为48.8%和61.6%。2组尿培养大肠埃希菌均对阿米卡星、哌拉西林钠-他唑巴坦、头孢哌酮钠-舒巴坦、美罗培南及亚胺培南较为敏感,尤其是碳氢酶烯类药物。2组尿培养大肠埃希菌对抗菌药物的耐药率比较差异均无统计学意义(P均>0.05)。结论尿脓毒血症和复杂性尿路感染病原菌均以革兰阴性杆菌为主,尤其是大肠埃希菌,治疗应根据尿培养及药敏试验结果,合理使用抗菌药物。建议将哌拉西林钠-他唑巴坦、头孢哌酮钠-舒巴坦作为尿脓毒血症患者的首选用药。Objective To analyze the etiological characteristics and antibiotic resistance between urosepsis and complicated urological tract infection,aiming to provide reliable evidence for the treatment of these diseases.Methods Clinical data of 83 patients diagnosed with urosepsis and 629 cases of complicated urological tract infection were retrospectively collected.The urine samples were collected for bacterial culture to isolate and identify the pathogens.The source and type of the pathogens were analyzed.The isolated pathogens were subject to drug susceptibility test.The pathogen distribution and drug resistance characteristics were analyzed and statistically compared.Results In the urosepsis group(n=83),the detection rate of pathogens in the urine samples was 71.1%(n=59)including 48 strains of gram-negative bacteria,3 strains of gram-positive bacteria and 8 strains of fungi.In the complicated urological tract infection group(n=629),516 strains(82.0%)of gram-negative bacteria,76 strains(12.1%)of gram-positive bacteria and 37 strains(5.9%)of fungi were detected.In the urosepsis group,the detection rates of Escherichia coli and fungi were significantly higher compared with those in the complicated urological tract infection group(both P<0.05).The detection rates of extended-spectrumβ-lactamase-producing Escherichia coli in the urosepsis group was 48.8%and 61.6%in the complicated urological tract infection group.In the urine samples of both groups,Escherichia coli had low resistance to amikacin,piperacillin/tazobactam,cefoperazone/sulbactam,meropenem and imipenem,especially carbapenemes.No significant difference was noted in antibiotics resistance for Escherichia coli in the urine samples between two groups(all P>0.05).Conclusions The main pathogens of both urosepsis and complicated urological tract infection are gram-negative bacteria,especially Escherichia coli.The antibiotics treatment of these two diseases should be determined strictly according to the outcomes of bacterial culture and drug susceptibility test.Piper

关 键 词：尿脓毒血症 复杂性尿路感染 病原学 耐药性 

分 类 号：R459.7[医药卫生—急诊医学] R691.3[医药卫生—治疗学]