医院获得性与社区获得性尿路感染患者致病菌谱的构成及其耐药性比较  

Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Patients with Hospital-acquired and Community-acquired Urinary Tract Infection

作　　者：文锐玲 林桂鸿 李欣影[1] WEN Rui-ling;LIN Gui-hong;LI Xin-ying(Huizhou Fifth Hospital,Huizhou Guangdong 516000,China)

机构地区：[1]惠州市第一人民医院,广东惠州516000

出　　处：《抗感染药学》2021年第10期1425-1431,共7页Anti-infection Pharmacy

摘　　要：目的:分析医院获得性尿路感染(hospital-acquired urinary tract infection,HAUTI)的危险因素,并比较医院获得性和社区获得性尿路感染(community-acquired urinary tract infection,CAUTI)患者间病原菌的分布和耐药性。方法:选取2018年1月—2019年12月惠州市第一人民医院收治的408例尿路感染患者和2 506例社区获得性尿路感染患者的病历资料;分析与HAUTI相关的危险因素,比较和分析HAUTI和CAUTI患者感染病原菌的分布及其主要病原菌的耐药特点。结果:HAUTI与患者性别、年龄和住院天数、慢性基础病症、抗菌药物使用、昏迷、侵入性操作相关;408例HAUTI患者中段尿中分离出病原菌299株,而CAUTI患者中段尿中分离出病原菌1 393株;药敏结果发现,HAUTI患者中大肠埃希菌对头孢吡肟、头孢唑林、头孢噻肟、莫西沙星的耐药率高于CAUTI(P<0.05),对其他抗菌药物的耐药率经比较其差异均无统计学意义(均P>0.05);肺炎克雷伯菌、粪肠球菌和屎肠球菌对常用抗菌药物的耐药率相对较高经比较其差异无统计学意义(均P>0.05)。结论:HAUTI患者感染病原菌的耐药率高于CAUTI,临床应加强对HAUTI患者的目标性监测和感染危险因素的分析,采取适当防控措施有效控制HAUTI;无论是HAUTI或是CAUTI均应结合病原体的构成特点与药敏结果,合理选用抗菌药物治疗,避免经验性用药,以减少耐药菌株产生,确保其疗效。Objective: To analyze the risk factors of hospital-acquired urinary tract infection(HAUTI), and compare the distribution and drug resistance of pathogenic bacteria between patients with HAUTI and patients with community-acquired urinary tract infection(CAUTI). Methods: The medical records of 408 patients with HAUTI and2506 patients with CAUTI admitted to the Huizhou Fifth Hospital from January 2018 to December 2019 were selected.Risk factors associated with HAUTI were analyzed,and the distribution of pathogenic bacteria and drug resistance characteristics of main pathogenic bacteria were compared and analyzed between HAUTI and CAUTI patients. Results:HAUTI was associated with gender,age,length of hospital stay,chronic underlying conditions,antibacterial usage,coma,and invasive procedures. 299 strains of pathogenic bacteria were isolated from the midstream urine of 408 HAUTI patients,while 1 393 strains were isolated from the midstream urine of CAUTI patients. Drug sensitivity results showed that the drug resistance rate of Escherichia coli in HAUTI patients to cefepime,cefazolin,cefotaxime and moxifloxacin was higher than that of CAUTI(P< 0.05),and there was no statistical significance in the comparison of drug resistance rate to other antibacterial drugs(P>0.05). The drug resistance rates of Klebsiella pneumoniae,Enterococcus faecalis and Enterococcus faecium to commonly used antibacterials were relatively high,but there was no statistical significance between two groups(ALL P>0.05). Conclusion: The drug resistance rates of HAUTI patients are higher than those of CAUTI,so it is necessary to strengthen the targeted surveillance and analysis of infection risk factors for HAUTI patients,and take appropriate prevention and control measures to effectively control HAUTI. Both HAUTI and CAUTI should be rationally treated with antibacterial agents based on the component characteristics of pathogens and drug sensitivity results,and empirical drug use should be avoided to reduce the generation of resistant strains and ens

关 键 词：尿路感染 医院获得性 社区获得性 社区感染 病原菌 耐药性 

分 类 号：R915[医药卫生—微生物与生化药学] R969.3[医药卫生—药学]