上海周浦地区2016年至2020年尿路感染者病原体分布情况及耐药性检测  

Distribution and drug resistance of pathogens in urinary tract infections in Zhoupu area, Shanghai during 2016 to 2020

作　　者：孔娜娜 张培燕 杨德平 金慧敏 郑江花 KONG Nana;ZHANG Peiyan;YANG Deping;JIN Huimin;ZHENG Jianghua(Dpartment of Clinical Laboratory,Zhoupu Hospital,Shanghai University of Medicine and Health Science,Shanghai Pudong New District,Shanghai 201318,China)

机构地区：[1]上海市浦东新区(上海健康医学院附属)周浦医院医学检验科,上海201318

出　　处：《诊断学理论与实践》2021年第1期93-97,共5页Journal of Diagnostics Concepts & Practice

基　　金：国家自然科学基金面上项目(81372318);上海市浦东新区卫生和计划生育委员会领先人才培养计划(PWRL2017-07)。

摘　　要：目的:分析本地区尿路感染(urinary tract infection, UTI)患者病原体的构成分布及其耐药特征,为提高临床UTI的诊治水平、合理选用抗生素提供依据。方法:采用回顾性调查方法,对2016年7月至2020年6月我院UTI患者送检的晨起清洁中段尿进行分离培养,确定病原体分布情况及其对常用抗生素的耐药情况。结果:收集的3 543份清洁中段尿标本中共分离出病原体810株,检出率为22.9%,其中革兰阴性菌558株(68.9%);革兰阳性球菌113株(14.0%);支原体128株(15.8%);真菌11株(1.4%)。细菌以大肠埃希菌(337株,41.6%)和肺炎克雷伯菌(67株,8.3%)为主,而在检出的支原体中,解脲支原体(Ureaplasma urealyticum,UU)有86株(10.6%)。大肠埃希菌的占比从2016年的34.9%上升至2020年的57.3%,占比逐年上升。大肠埃希菌和变形杆菌对氨基糖苷类和碳青霉烯类抗生素敏感性较强,耐药率均低于5%;肺炎克雷伯菌对头孢曲松和左氧氟沙星的耐药率较高,分别为58.3%和55.2%;屎肠球菌对青霉素、氨苄西林、左氧氟沙星全耐药,均高于粪肠球菌对以上这些抗生素的耐药率,粪肠球菌对左氧氟沙星和莫西沙星的耐药率较高,分别为73.3%和64.4%;金黄色葡萄球菌和肠球菌对磺胺类、糖肽类及常用广谱抗生素敏感,耐药率均低于5%;UU对环丙沙星的耐药率为69.9%,但对米诺环素和强力霉素敏感。结论:上海周浦地区UTI患者所分离出的病原体以革兰阴性杆菌为主,大肠埃希菌占比逐年升高;所有分离病原体对目前临床常用的抗生素均有不同程度的耐药性,需引起临床注意;定期对本地区UTI病原体进行监测,对指导临床用药有重要意义。Objective: To study the distribution and drug resistance of pathogens in urinary tract infections(UTI), and to provide evidence for rational treatment of the disease. Methods: The results of bacterial culture from morning cleancatch mid-streamurinein the patients with UIT during July 2016 to June 2020 were retrospectively analyzed to determine the distribution and drug resistance of pathogens. Result A total of 3 543 specimens were collected, 810 strains of pathogens were isolated, and the positive rate was 22.9%, including 558 strains of Gram-negative bacteria(68.9%), 113 strains of Gram-positive cocci(14.0%), 128 strains of Mycoplasma(15.8%), 11 strains of fungi(1.4%). The majority of bacteria strains were Escherichia coli(337 strains, 41.6%) and Klebsiella pneumoniae(67 strains, 8.3%). Ureaplasma urealyticum(UU) accounted for 10.6%(86 strains) inisolated mycoplasma. Escherichia coli and Proteusisolates were sensitive to aminoglycoside and carbapenem antibiotics and the resistant rates were lower than 5%;Klebsiella pneumoniae was resistant to ceftriaxone and levofloxacin and its′ resistant rates were 58.3% and 55.2%, respectively.All Enterococci strains were resistant to penicillin, ampicillin, gentamicin, and levofloxacin, which had higher resistance rates than those in Enterococcus faecalis;Enterococcus faecalis had high resistant rates to levofloxacin and moxifloxacin(73.3% and 64.4%,respectively). Staphylococcus aureus and Enterococcus were sensitive to sulfonamides, glycopeptides and common broadspectrum antibiotics, and the resistant rates were lower than 5%. The drug resistant rate of UU to ciprofloxacin was 69.9%,and UU was sensitive to both minocycline and doxycycline. Conclusions: The majority of pathogens isolated from UTI patients in Zhoupu District of Shanghai is Gram-negative bacilli, which shows different degree of resistance to common antibiotics. Therefore, the regular monitoring of UTI pathogenic bacteria is important to determine how to choose antibiotics in clinical practice.

关 键 词：尿路感染 病原体 抗生素 耐药性 

分 类 号：R372[医药卫生—病原生物学]