门诊就诊女性尿路感染患者的尿液病原菌种类及其耐药率分析  

Analysis of pathogenic bacteria and drug resistance of urinary tract infection in outpatient women

作　　者：钟小晴 廖康[2] 王欣[1] 郑勋华[1] 邱亚桂 许元文[1] 李广然[1] 张涤华[1] 黄锋先[1] 阳晓[1] Zhong Xiaoqing;Liao Kang;Wang Xin;Zheng Xunhua;Qiu Yagui;Xu Yuanwen;Li Guangran;Zhang Dihua;Huang Fengxian;Yang Xiao(Department of Nephrology,First Affiliated Hospital of Sun Yat-Sen University,NHC Key Laboratory of Clinical Nephrology(Sun Yat-Sen University)and Guangdong Provincial Key Laboratory of Nephrology,Guangzhou 510080,Guangdong Province,China;Department of Clinical Laboratory,First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,Guangdong Province,China)

机构地区：[1]中山大学附属第一医院肾内科,国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州510080 [2]中山大学附属第一医院检验科,广州510080

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第2期185-191,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：广东省自然科学基金项目(2019A1515011956);广东省肾脏病重点实验项目(2020B1212060028);国家卫生健康委员会肾脏病临床研究重点实验室(中山大学)。

摘　　要：目的探讨门诊就诊女性尿路感染(UTI)患者尿液病原菌谱分布及药物敏感性,为该类患者抗菌药物的选择和治疗提供依据。方法选择1998年1月至2018年12月,于中山大学附属第一医院门诊就诊并确诊为UTI的643例女性患者为研究对象,年龄为14~95岁。根据是否绝经,将其分为绝经组(n=362)与非绝经组(n=281)。本研究遵循的程序经中山大学附属第一医院伦理委员会批准(审批文号:伦审〔2021〕372号)。结果①自纳入研究的643例UTI患者的尿液标本中,分离获得643株病原菌中,革兰阴性(G-)杆菌为567株(88.2%),革兰阳性(G+)球菌为76株(11.8%);G-杆菌主要为大肠埃希菌(70.3%,452/643),其次为肺炎克雷伯菌(6.2%,40/643);G+球菌主要为粪肠球菌(2.6%,17/643)、无乳链球菌(1.9%,12/643)和屎肠球菌(1.7%,11/643)。②药物敏感性试验:大肠埃希菌和肺炎克雷伯菌对头孢哌酮舒巴坦、阿米卡星、哌拉西林/他唑巴坦、亚胺培南等药物维持较高敏感度;大肠埃希菌对呋喃妥因同样具有较高的敏感度,而对环丙沙星、头孢曲松及磺胺甲唑/甲氧苄啶高度耐药。肺炎克雷伯菌对头孢曲松、呋喃妥因高度耐药。③42.0%(190/452)大肠埃希菌与40.0%(16/40)肺炎克雷伯菌,为产超广谱β内酰胺酶(ESBLs)菌株。④2组患者的主要病原菌均为大肠埃希菌(68.0%,72.1%),肺炎克雷伯菌(6.4%,6.1%)。2组患者的主要病原菌分布所占比例比较,差异无统计学意义(P>0.05)。⑤绝经组UTI患者大肠埃希菌对环丙沙星耐药率为69.7%(166/238),明显高于非绝经组的54.0%(95/176),并且差异具有统计学意义(P<0.05)。⑥绝经组UTI患者肺炎克雷伯菌对头孢曲松、头孢吡肟的耐药率分别为66.7%(14/21)和45.0%(9/20),明显高于非绝经组的33.3%(6/18)和5.6%(1/18),并且差异亦有统计学意义(P<0.05)。结论门诊就诊UTI女性患者最常见的病原菌为大肠埃希菌。绝经期UTI患者对氟喹诺酮类药物的耐药率高。�Objective To explore spectrum distribution and drug sensitivity of main pathogenic bacteria in outpatients with urinary tract infection(UTI),so as to provide the basis for the selection and treatment of antibacterial drugs.Methods From January 1998 to December 2018,a total of 643 women,aged from 14 to 95 years old,who were diagnosed as UTI in the outpatient department of First Affiliated Hospital of Sun Yat-Sen University were selected into this study old.According to whether menopause or not,they were divided into menopausal group(n=362)and non-menopausal group(n=281).The procedures in this study were approved by Ethics Committee of First Affiliated Hospital of Sun Yat-Sen University(Approval No.〔2021〕372).Results①A total of 643 pathogenic bacteria were isolated,including 567(88.2%)Gram-negative(G-)and 76(11.8%)Gram-positive(G+)bacteria strains.The most common G-uropathogens were Escherichia coli(70.3%),followed by Klebsiella pneumonia(6.2%).Enterococcus faecalis(2.6%,17/643),Streptococcus agalactiae(1.9%,12/643)and Enterococcus faecium(1.7%,11/643)were found to be the predominant G+strains.②Escherichia coli and Klebsiella pneumoniae sustained high susceptibility to cefoperazone-sulbactam,amikacin,piperacillin-tazobactam and imipenem,Escherichia coli remained high susceptibility to nitrofurantoin as well.However,Escherichia coli were highly resistant to ciprofloxacin,ceftriaxone and trimethoprim-sulfamethoxazole.Klebsiella pneumoniae were highly resistant to ceftriaxone and nitrofurantoin.③42.0%(190/452)Escherichia coli strains and 40.0%(16/40)Klebsiella pneumoniae strains were extended-spectrum-lactamase-producing(ESBLs)strains.④The main pathogenic bacteria in both groups were Escherichia coli(68.0%,72.1%)and Klebsiella pneumoniae(6.4%,6.1%).There was no significant difference in the distribution proportion of main pathogenic bacteria between two groups(P>0.05).⑤The resistance rate of Escherichia coli to ciprofloxacin was higher in menopausal group(69.7%,166/238)than that of non-menopausal group(5

关 键 词：绝经期 泌尿道感染 微生物敏感性试验 大肠杆菌 肺炎克雷伯菌 抗药性 女(雌)性 

分 类 号：R44[医药卫生—诊断学]