泌尿系感染病原菌的分布及大肠埃希菌的耐药性分析  

Analysis on distribution of pathogens and drug resistance of escherichia coli isolated from urinary tract infection

作　　者：袁星[1] 胥振国[1] 曹雷 YUAN Xing;XU Zhenguo;CAO Lei(Department of Clinical Laboratory,the Eighth People's Hospital of Hefei City,Hefei 238000,China)

机构地区：[1]合肥职业技术学院医学院,安徽合肥238000 [2]合肥市第八人民医院检验科

出　　处：《华北理工大学学报（医学版）》2019年第1期27-31,共5页Journal of North China University of Science and Technology：Health Sciences Edition

基　　金：安徽省级精品资源共享课程建设项目(编号:2016gxk125);安徽省教育厅重点科研项目建设项目(编号:KJ2018A0831)

摘　　要：(1)目的调查2017年医院泌尿系感染病原茵的分布和优势致病菌大肠埃希菌的耐药性及其药敏特征,为临床科室合理选用抗菌素进行抗感染治疗提供依据。(2)方法按全国临床检验中心操作规程鉴定菌种,以K-B纸片法进行药敏试验,按CLSI标准判断结果,应用WHONET 5.6软件分析医院住院及门诊泌尿系感染患者中段尿培养的结果及尿路感染的优势致病菌大肠埃希菌对常用抗生素的耐药性。(3)结果 2017年临床泌尿道标本共检出328株病原菌,泌尿外科、康复科和肾内科分离菌所占比率分别为37.2%、12.8%、10.7%。泌尿系感染检出大肠埃希菌占检出细菌总数的44.2%以上,其次为肠球菌属。大肠埃希菌对美罗培南、亚胺培南、阿米卡星、头孢哌酮/舒巴坦、呋喃妥因和哌拉西林/他唑巴坦耐药率较低,分别为0.7%、1.4%、6.2%、6.9%、7.6%和9.7%,而对其他抗生素的耐药率多数超过50%。另外,大肠埃希菌中ESBLs(+)的检出率为57.2%,ESBLs(+)细菌对头孢菌素的耐药率普遍高于ESBLs(-)细菌(P <0.01)。(4)结论泌尿道感染中的大肠埃希菌检出率及产酶率不断增高,监测细菌的耐药性有助于临床科室根据药敏试验结论选用抗菌药物,以防滥用抗生素。Objective To research the distribution of the pathogens in urinary tract infection and drug-tolerance variation of escherichia coli in our hospital in 2007 and to provide reference for the clinical therapy of infections.Methods By applying K-B method susceptibility test and ESBLs test to escherichia coli infected urinary samples which were collected from January to December in 2017,results were analyzed based on WHONET 5.6 software when clinical isolates were analyzed retrospectively.Results A total of 328 strains of pathogens species were collected in 2007.The percentage of isolated bacteria in urology,department of rehabilitation medicine and nephrology were 37.2%、12.8%、10.7% respectively.The detection rate of escherichia coli in 2017 was 44.2%,and the next rate was enterococcus.Escherichia coli have a low drug tolerance rate for meropenem,imipenem,amikacin,cefoperazone/sulbactam,nitrofurantoin and piperacillin/tazobactam wich were 0.7%、1.4%、6.2%、6.9%、7.6%and 9.7% dividedly.As for other commonly used antibiotics,the rates were most over 50%.Besides,the detectable rates of E.coli with ESBLs was 57.2%,ESBLs(+)bacterium showed a upward detection rate and generally had a higher drug tolerance rate than that of ESBLs(-)bacterium,which had statistically significance(P<0.01).Conclusion With an increasing detection rate and enzyme-producing rate of escherichia coli in urinary tract infection,surveillance of bacterial resistance be of great importance to rational selection of antibiotics based on susceptibility test and preventing the abuse of antibiotics.

关 键 词：泌尿道感染 大肠埃希菌 耐药性 超广谱Β-内酰胺酶 

分 类 号：R691.3[医药卫生—泌尿科学] R969.3[医药卫生—外科学]