中段尿培养阳性病原菌分布及耐药性分析  

Distribution of and analysis of drug resistance of mid-stream urine culture-positive pathogens

作　　者：李芬[1] 杜希林[1] 李亮[1] 熊雪松[1] LI Fen;DU Xi-lin;LI Liang(Department of Clinical Laboratory,Huaiyin Hospital of Huai’an City,Huai’an 223300,China)

机构地区：[1]淮安市淮阴医院检验科,江苏淮安223300

出　　处：《中国实验诊断学》2020年第11期1799-1803,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨中段尿培养阳性病原菌分布及耐药分析,为临床合理用药提供依据。方法收集2016年1月1日至2018年12月31日中段尿培养阳性病例,菌株鉴定与药敏试验采用迪尔DL-96Ⅱ细菌鉴定分析系统,结果判读依据美国临床实验室标准化研究所CLSI(2016年)标准。结果中段尿培养阳性标本主要来源于泌尿外科336株(48.98%);686株阳性病原菌中,革兰阴性菌620株(90.38%)、革兰阳性菌25株(3.64%)、侵袭性真菌41株(5.98%),居前4位的检出菌为:大肠埃希菌372株(54.23%),肺炎克雷伯菌57株(8.31%)、奇异变形杆菌26株(3.79%)、铜绿假单胞菌28株(4.08%);大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌对氨苄西林耐药率最高,达61.54%-100%,对氨苄西林/舒巴坦、头孢呋辛、头孢曲松、庆大霉素、环丙沙星、左氧氟沙星、复方新诺明耐药性较高,达21.05%-62.9%,对头孢他啶、头孢吡肟耐药性达3.51%-28.76%,对头孢西丁、阿米卡星、替卡西林/克拉维酸耐药性较低,均小于16%,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药性低于5%,对亚胺培南和美罗培南耐药性最低,均小于2%;铜绿假单胞菌对所列抗菌药物耐药性较低,均小于11%。2016-2018年大肠埃希菌对所列抗菌药物耐药性差异无统计学意义(P>0.05);产ESBL阳性组,除替卡西林/克拉维酸、哌拉西林/他唑巴坦、头孢西丁、亚胺培南、美罗培南外,抗菌药物耐药性明显高于非产ESBL组;产ESBL和非产ESBL两组大肠埃希菌对替卡西林/克拉维酸、头孢哌酮/舒巴坦、亚胺培南、美洛培南、阿米卡星、呋喃妥因、米诺环素耐药性差异无统计学意义(P>0.05),对氨苄西林、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢呋辛、头孢曲松、头孢他啶、头孢吡肟、头孢西丁、庆大霉素、环丙沙星、左氧氟沙星、复方新诺明耐药性差异有统计学意义(P<0.05)。结论大肠埃希菌是中段尿培养的重要检出菌,�Objective To investigate the distribution and analysis of drug resistance of mid-stream urine culture-positive pathogens,so as to provide a reliable basis for rational drug use.Methods The positive cases of mid-stream urine culture were collected from January 1,2016 to December 12,2018.The strain identification and the drug sensitivity test were mainly performed by the DL-96Ⅱbacteria analyzer.And the results were judged according to CLSI standard(2016).Results The positive cases of mid-stream urine culture were mainly from urology,accounted for 336(48.98%);The 686 pathogens were made up 620(90.38%)gram-negative bacillus,25(3.64%)gram-positive cocci and41(5.98%)aggressive fungi.The top four of total 686 pathogens were consisted by 372(52.39%)E.coli,57(9.44%)K.peumoniae,26(3.79%)P.mirabilis and 28(4.08%)P.aeruginosa;The resistance rate of ampicillin to E.coli,K.peumoniae and P.mirabilis was the highest,which were up 61.54 to 100 percent,which of cefoperazone/sulbactam,cefuroxime,cefatriaxone,gentamicin,cyclopaede,levofloxacin,dortimoxazole were up 21.05 to 62.9 persent,ceftazidime and cefepime were up 3.51 to 28.76 percent.Then the resistance rate of cefoxitin,amikacin,ticarcilin/clavulanic acid were all below 16 percent,which of piperacillin/tazobactam and cefoperazone/sulbactam were all below 5 percent.And the resistance rate of imipenem and meropenem were the lowest,which were all below 2 percent;The resistant of all listed antibiotics to P.aeruginosa were lower,which all below 11 percent.There were no statistical differences of the resistance antibacterial drug to E.coli between 2016、2017 and 2018 years(P>0.05).Excepting ticarcilin/clavulanic acid,piperacillin/tazobactam,cefoxitin,imipenem and meropenem,the resistance rate of listed antibiotics to ESBL positive E.coli were absolutely higher than ESBL negative E.coli.There were no statistical differences of the resistance to antibiotics(ticarcilin/clavulanic acid,cefoperazone/sulbactam,imipenem,meropenem,amikacin,nitrofurantoin,minocycline)between ESBL posit

关 键 词：中段尿培养 病原菌分布 大肠埃希菌 耐药性分析 

分 类 号：R378[医药卫生—病原生物学]