清洁中段尿病原菌培养及药敏试验结果对急性肾盂肾炎患者抗菌药物合理使用的影响分析  

Analysis of the influence of pathogenic bacteria culture and drug sensitivity test in clean-voided midstream urine on the rational use of antibiotics in patients with acute pyelonephritis

作　　者：韩志梅[1] HAN Zhi-mei(Department of Clinical Laboratory,Dalian Friendship Hospital,Dalian 116001,China)

机构地区：[1]大连市友谊医院检验科,116001

出　　处：《中国现代药物应用》2021年第13期245-248,共4页Chinese Journal of Modern Drug Application

摘　　要：目的分析清洁中段尿病原菌培养及药敏试验结果对急性肾盂肾炎(APN)患者抗菌药物合理使用的影响。方法185例APN患者,采集其清洁中段尿进行病原菌培养和药敏试验,分析病原菌分布情况及病原菌对抗菌药物的敏感率。结果185例患者共检出病原菌116株,其中革兰阴性菌83株,占比71.55%;革兰阳性菌24株,占比20.69%;真菌9株,占比7.76%。药敏试验结果显示,革兰阴性菌中产超广谱β-内酰胺酶(ESBLs)大肠埃希菌仅对亚胺培南、美罗培南敏感率较高,对头孢菌素类抗菌药物基本耐药,产ESBLs肺炎克雷伯菌仅对亚胺培南完全敏感;革兰阳性菌中屎肠球菌、粪肠球菌对替加环素、万古霉素、利奈唑胺敏感率较高,均>90%。结论APN患者病原菌分布以革兰阴性菌、革兰阳性菌为主,各病原菌对抗菌药物敏感率不同,产ESBLs菌检出率高,且敏感药物少,临床应依据病原菌培养与药敏试验结果安全合理应用抗菌药物,提高治疗效果。Objective To analyze the influence of pathogenic bacteria culture and drug sensitivity test in clean-voided midstream urine on the rational use of antibiotics in patients with acute pyelonephritis(APN).Methods There were 185 patients with APN,and their clean-voided midstream urine was collected for pathogenic bacteria culture and drug sensitivity test.The distribution of pathogenic bacteria and the sensitivity rate of pathogenic bacteria to antibiotics were analyzed.Results A total of 116 strains of pathogenic bacteria were detected in 185 patients,including 83 strains of gram-negative bacteria,accounting for 71.55%,24 strains of gram-positive bacteria,accounting for 20.69%,and 9 strains of fungi,accounting for 7.76%.The results of drug susceptibility test showed that extended-spectrumβ-lactamases(ESBLs)producing Escherichia coli among gram-negative bacteria was only sensitive to imipenem and meropenem,and was basically resistant to cephalosporin antibiotics,ESBLs-producing Klebsiella pneumoniae was only fully sensitive to imipenem;among the gram-positive bacteria,Enterococcus faecium and Enterococcus faecalis were more sensitive to tigecycline,vancomycin,and linezolid,both of which were>90%.Conclusion The distribution of pathogenic bacteria in patients with APN is mainly gram-negative and gram-positive.The sensitivity of each pathogenic bacteria to antibacterial drugs is different.The detection rate of ESBLs-producing bacteria is high,and there are few sensitive drugs.Clinically,antibiotics should be used safely and reasonably based on the results of pathogenic bacteria culture and drug sensitivity test to improve the therapeutic effect.

关 键 词：急性肾盂肾炎 病原菌培养 药敏试验 超广谱Β-内酰胺酶 大肠埃希菌 

分 类 号：R446.5[医药卫生—诊断学] R692.7[医药卫生—临床医学]