血液病患者中段尿培养病原菌分布特点及耐药性分析  

An Analysis of Distribution Characteristics and Drug Resistance of Pathogenic Bacteria in Midstream Urine in Patients with Hematological Diseases

作　　者：杨哲 蒋虔 徐建民 王文彩 曾利军 王华美 姜铮 陈建魁 尹秀云 YANG Zhe;JIANG Qian;XU Jianmin;WANG Wencai;ZENG Lijun;WANG Huamei;JIANG Zheng;CHEN Jiankui;YIN Xiuyun(Department of Clinical Laboratory,The Fifth Medical Center,Chinese PLA General Hospital,Beijing 100071)

机构地区：[1]中国人民解放军总医院第五医学中心检验科,北京100071

出　　处：《标记免疫分析与临床》2021年第1期15-19,共5页Labeled Immunoassays and Clinical Medicine

基　　金：艾滋病和病毒性肝炎等重大传染病防治,军队细菌性传染病病原谱流行规律及变异研究(编号:2018ZX10713003-001-016)。

摘　　要：目的探讨解放军总医院第五医学中心(南院区)2016年至2019年血液科住院患者中段尿培养病原菌分布特点和耐药性分析,为临床经验用药提供依据。方法选取我院2016年1月至2019年12月血液科住院患者送检的中段尿标本,采用梅里埃VITEK 2全自动微生物分析系统进行细菌鉴定和药敏试验,将筛选出的118例阳性标本进行病原菌分布及耐药性分析。结果118例阳性标本中,革兰阴性杆菌占58.48%、革兰阳性球菌占35.60%、念珠菌占5.92%。病原菌以大肠埃希菌(31.36%)、屎肠球菌(17.80%)、肺炎克雷伯菌(12.71%%)、粪肠球菌(11.86%)多见。大肠埃希菌、肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株分别占48.60%、40.00%。大肠埃希菌对呋喃妥因、哌拉西林/他唑巴坦、亚胺培南、阿米卡星和美罗培南的敏感率较高,为82.90%~97.20%;对左氧氟沙星、环丙沙星、头孢唑啉的敏感率较低,只有32.40%。21株屎肠球菌中,耐万古霉素屎肠球菌占38.10%,对替加环素、利奈唑胺的敏感率均为100%。屎肠球菌的耐药率高于粪肠球菌。结论血液病患者泌尿系统感染病原菌种类较多,大肠埃希菌和屎肠球菌是感染的最主要病原菌,不同病原菌耐药率有差异,但屎肠球菌感染率较多且对万古霉素的耐药比率偏高,应该引起血液科临床医师高度重视。临床应积极进行清洁中段尿培养及药物敏感试验,根据药敏结果合理选择抗菌药物进行治疗。Objective To investigate the distribution and drug resistance of pathogens from midstream urine cultures of inpatients in the hematology department from 2016 to 2019 in the Fifth Medical Center of PLA General Hospital(South Hospital District),so as to provide a knowledge basis for clinical experience in drug use.Methods We selected midstream urine samples from inpatients in hematology department from January,2016 to December,2019 in our hospital,and 118 cases of positive samples were screened for pathogenic bacteria distribution and then went through a drug resistance analysis.The bacterial identification and drug susceptibility testing were carried out by VITEK 2 Automatic Microbiological Analysis System.Results Of the 118 positive specimens,Gram-negative bacilli accounted for 58.48%,while Gram-positive cocci accounted for 35.60%,and Candida accounted for 5.92%.The most common pathogens were Escherichia coli(31.36%),Enterococcus faecium(17.80%),Klebsiella pneumoniae(12.71%)and Enterococcus faecalis(11.86%).ESBLs producing strains of Escherichia coli and Klebsiella pneumoniae accounted for 48.60%and 40.00%,respectively.Escherichia coli was more sensitive to nitrofurantoin,piperacillin/tazobactam,imipenem,amikacin,and meropenem,ranging from 82.90%to 97.20%,while the sensitivity rates to levofloxacin,ciprofloxacin and cefazolin were only 32.40%.Among the 21 strains of Enterococcus faecium,vancomycin resistant Enterococcus faecium accounted for 38.10%.The sensitivity rates to tigecycline and linezolid were 100%.The drug resistance rate of Enterococcus faecium was higher than that of Enterococcus faecalis.Conclusion There are many kinds of pathogenic bacteria in urinary tract infection.Escherichia coli and Enterococcus faecium are the main pathogens of infection,and the drug resistance rate of different pathogens bacteria is different.It is necessary to carry out the clean midstream urine culture and drug sensitivity test actively in clinical practice,and reasonably select correct drugs to treat urinary tract infecti

关 键 词：血液病 中段尿培养 泌尿系感染 病原菌 耐药性 

分 类 号：R372[医药卫生—病原生物学]