1172株门诊尿液培养病原细菌分布及药物敏感性分析  

Analysis of species distribution and antibiotic susceptibility trends of 1.172 bacterial uropathogens isolated in urine cultures on an outpatient basis

作　　者：张涤华[1] 廖康[2] 钟小晴 王欣[1] 邱亚桂 郑勋华[1] 李剑波[1] 许元文[1] 李广然[1] 阳晓[1] 黄锋先[1] Zhang Dihua;Liao Kang;Zhong Xiaoqing;Wang Xin;Qiu Yagui;Zheng Xunhua;Li Jianbo;Xu Yuanwen;Li Guangran;Yang Xiao;Huang Fengxian(Department of Nephrology,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Clinical Laboratory,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肾内科,广州510080 [2]中山大学附属第一医院检验科,广州510080

出　　处：《中华肾脏病杂志》2020年第7期519-525,共7页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81970429);广东省自然科学基金(2019A1515011956);广东省重点实验室运行经费(2017B030314019);广东省重点实验室(2002B60118)。

摘　　要：目的对门诊患者尿液培养分离病原细菌分布及其药物敏感性进行分析,指导临床抗菌药物选择,为门诊及社区尿路感染患者提供针对性治疗。方法回顾性分析20年间(1998年1月至2018年12月)门诊患者尿液培养检验结果,对分离获得的主要病原细菌分布、体外培养药物敏感性及变化趋势进行分析。结果剔除相同患者的重复菌株后,共分离获得病原细菌1172株,其中革兰阴性菌991株(84.6%),革兰阳性菌181株(15.4%);主要革兰阴性病原菌为大肠埃希菌(60.8%)和肺炎克雷伯菌(8.1%),主要革兰阳性病原菌为粪肠球菌(4.6%)。20年间除大肠埃希菌检出比例显著增加,由50.8%上升至63.2%(χ^2=7.978,P=0.046),其他主要病原菌谱分布比例无显著变化(均P>0.05)。大肠埃希菌产超广谱β-内酰胺酶(ESBLs)菌株比例显著上升(P<0.05),大肠埃希菌对阿莫西林克拉维酸钾、氨曲南、头孢他啶、环丙沙星及舒巴坦+头孢哌酮耐药率呈显著上升趋势(均P<0.05),对三唑巴坦+哌拉西林、阿米卡星、亚胺培南及呋喃妥因维持较高敏感率(95.0%、95.7%、97.9%和91.1%)。20年间肺炎克雷伯菌产ESBLs菌株比例亦呈显著上升趋势(P<0.05),对三唑巴坦+哌拉西林、阿米卡星和亚胺培南维持较高敏感率(79.1%、88.0%和80.3%)。革兰阳性菌中粪肠球菌对氨苄西林、呋喃妥因、青霉素G敏感率100.0%;革兰阳性菌中未检出万古霉素耐药菌株。结论1998-2018年间门诊患者尿培养病原菌以大肠埃希菌和肺炎克雷伯菌为主的革兰阴性菌对部分抗生素如二代/三代头孢菌素、新氟喹酮类药物耐药率呈上升趋势,对三唑巴坦+哌拉西林、阿米卡星、亚胺培南、呋喃妥因维持较高敏感性。门诊及社区尿路感染治疗过程中,应结合病原菌耐药情况及患者病情制订个体化的治疗方案,以遏制耐药菌的扩散和流行。Objective To assess the bacterial profiles and antimicrobial susceptibility patterns in uropathogens,and help to inform the empiric treatment decisions for urinary tract infection in outpatient settings.Methods A single institutional retrospective analysis was performed on positive urine cultures from outpatient settings between January 1998 and December 2018.To analyze changes over time,trends analysis were undertaken on bacterial profiles,antimicrobial susceptibility and resistance.Results A total of 1.172 pathogenic bacteria were isolated after exclusion of duplicate strains originated from the same patient,including 991(84.6%)Gram-negative bacterial strains and 181(15.4%)Gram-positive strains.The most common Gram-negative uropathogens were Escherichia coli(60.8%)and Klebsiella pneumonia(8.1%).Enterococcus faecalis(4.6%)was the predominant Gram-positive strain.The detection rate of Escherichia coli increased significantly,from 50.8%to 63.2%(χ^2=7.978,P=0.046),and no significant difference was observed in the distribution of major uropathogenic bacteria over the 20 years(all P>0.05).The proportion of extended-spectrumβ-lactamase(ESBLs)producing strains increased significantly across the 20 years(P<0.05).The resistance rates of Escherichia coli to amoxicillin and clavulanate potassium,aztreonam,ceftazidime,ciprofloxacin and sulbactam+cefoperazone increased significantly(all P<0.05).All the isolates sustained high susceptibility to tazobactam+piperacillin,amikacin,imipenem and nitrofurantoin(95.0%,95.7%,97.9%and 91.1%).Similar to those of Escherichia coli,Klebsiella pneumoniae remained a high and stable sensitivity to tazobactam+piperacillin,amikacin and imipenem during the 20 years(79.1%,88.0%and 80.3%).However,the proportion of ESBLs producing strains increased significantly(P<0.05).Among Gram-positive bacteria isolates,the sensitivity rates of Enterococcus faecalis to ampicillin,nitrofurantoin and penicillin G were 100.0%.No vancomycin resistant strain was detected in Gram-positive bacteria.Conclusions From

关 键 词：细菌感染 泌尿道感染 微生物敏感性试验 抗感染药 尿液培养 门诊 

分 类 号：R691.3[医药卫生—泌尿科学] R446.5[医药卫生—外科学]