社区女性膀胱炎患者致病菌群分布特点及治疗对策  

Distribution of pathogenic bacteria in women with cystitis in community and treatment strategies

作　　者：李世强[1] 智静涛[1] 侯建平[1] 张祺[1] 吴宪伟[1] Li Shiqiang;Zhi Jingtao;Hou Jianping;Zhang Qi;Wu Xianwei(Department of Urology, Liangxiang Hospital, Beijing 102400, China)

机构地区：[1]北京市房山区良乡医院泌尿外科,102400

出　　处：《国际泌尿系统杂志》2019年第3期494-498,共5页International Journal of Urology and Nephrology

基　　金：北京首都卫生发展科研专项项目(2014-4-7072)。

摘　　要：目的对社区女性膀胱炎患者细菌分布特点进行调查,并评价使用不同抗生素治疗效果。方法选取2015年1月至2017年1月在本院门诊治疗的膀胱炎女性患者157例。治疗前留取清洁中段尿行细菌学培养,分析病原菌分布特点;并随机分为磷霉素治疗组和对照组,磷霉素治疗组口服磷霉素氨丁三醇散,对照组服用常规抗感染药物,比较两组患者服药后第3、7天后的疗效、检测指标和RhoA/Rho激酶浓度的变化情况。结果157例患者的尿培养均显阳性,分离出以大肠埃希菌为主的革兰阴性菌共144株(91.7%),以球菌为主的革兰阳性菌13株(8.3%)。在治疗3d后磷霉素治疗组患者的疗效好于对照组,差异有统计学意义(P<0.05),而7d后疗效比较差异无统计学意义(P>0.05)。磷霉素治疗组除排尿总量外,各检测指标和RhoA/Rho激酶浓度在治疗后均有下降趋势,比较差异有统计学意义(P<0.05)。磷霉素治疗组的Chaol、辛普森指数和各类细菌的相对丰度均显著低于对照组,比较差异有统计学意义(P<0.05)。结论社区女性膀胱炎主要病原是以大肠埃希菌为主的革兰氏阴性菌,磷霉素氨丁三醇散可作为一线药物治疗女性膀胱炎。Objective To investigate the bacterial distribution characteristics of female cystitis patients in the community and evaluate the effect of using different antimicrobial agents. Methods Female patients with cystitis from January 2015 to January 2017 in our hospital were selected to receive clean midstream bacteriological culture before treatment to analyze the distribution characteristics of pathogens, and were randomly divided into fosfomycin treatment group and routine treatment. In the fosfomycin-treated group, the fosfomycin tromethamine was scattered, and in the conventional treatment group, according to the conventional anti-infective drugs, the curative effect, the detection index, and the concentration of RhoA/Rho kinase were compared between the two groups after the third and seventh days after taking the drugs. Results The urine cultures of 157 patients were all positive. A total of 144 gram-negative bacteria (91.7%) were isolated with Escherichia coli and 13 were gram-positive (8.3%). After 3 days of treatment, the efficacy of the fosfomycin-treated group was better than that of the conventional treatment group (P<0.05), but the curative effect was similar after 7 days (P>0.05), and the concentration of RhoA/Rho kinase decreased after treatment (P<0.05). In addition to the total amount of urinary excretion in the fosfomycin-treated group, other testing indicators and RhoA/Rho kinase concentrations were lower than those in the conventional treatment group (P<0.05). The Chaol, Simpson index and the relative abundance of all types of bacteria of the fosfomycin-treated group was significantly lower than that of the conventional treatment group (P<0.05). Conclusions The main pathogen of female cystitis in the community is Gram-negative bacteria mainly composed of Escherichia coli, which can be used as the first-line drug for the treatment of female cystitis.

关 键 词：膀胱炎 女性 机会致病菌感染 

分 类 号：R694.3[医药卫生—泌尿科学]