中段尿培养病原菌分布及药敏分析  

Analysis of the distribution characteristics of pathogenic bacteria and the change of antimicrobial susceptibility in midstream urine

作　　者：陈武[1] 陈立坚[1] 薛勇达 何芳婷 CHEN Wu;CHEN Lijian;XUE Yongda(Fuqing City Hospital of Fujian Province,Fuqing City Hospital Affiliated to Fujian Medical University,Fujian Fuqing 350300)

机构地区：[1]福建省福清市医院/福建医科大学附属福清市医院检验科,福建福清350300

出　　处：《医学检验与临床》2023年第3期29-35,共7页Medical Laboratory Science and Clinics

摘　　要：目的:探讨医院中段尿标本采集质量和泌尿系统感染(USI)病原菌分布特征及抗菌药物敏感性变化情况,为临床规范化标本采集和合理选用抗菌药物治疗USI提供科学依据。方法:采用VITEK2 Compact全自动微生物鉴定和药敏分析系统及纸片扩散法(K-B法),对2020年1月-2021年12月间临床科室送检的中段尿标本中分离出来的细菌进行鉴定和药敏分析。结果:6808份中段尿标本中被认定为污染的标本1345份,污染率19.76%。分离出病原菌1943株,分离率35.57%,革兰氏阴性菌居多,主要是大肠埃希菌、肺炎克雷伯菌;革兰氏阳性菌次之,主要是屎肠球菌、粪肠球菌、溶血葡萄球菌;其次是真菌,主要是白假丝酵母;病原菌多从泌尿外科和普内三区(主要收治肾病、糖尿病及肿瘤患者)患者中检出;60岁及以上老年人检出率高。大肠埃希菌、肺炎克雷伯菌对阿莫西林、头孢克罗、头孢地尼、多西环素(强力霉素)的敏感率小于40%,治疗首选喹诺酮类抗菌药物;屎肠球菌对喹诺酮类、大环内酯类、四环素类等多种抗菌药物耐药率高;粪肠球菌对抗菌药物的敏感性明显高于屎肠球菌,但对四环素、多西环素、诺氟沙星有很高的耐药率。溶血葡萄球菌对氨苄西林/舒巴坦、万古霉素、替加环素、呋喃妥因高度敏感,无耐万古霉素菌株。产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为49.40%和21.77%;多重耐药菌检出率为32.32%。结论:了解USI的病原菌分布特征及抗菌药物敏感性变化情况,指导临床医生合理使用抗菌药物,避免或减少耐药菌株的产生,提高治愈率。Objective:To investigate the quality of midstream urine sample collection,the distribution characteristics of pathogens in urinary system infection(USI)and the changes of antibacterial drug sensitivity,and to provide scientific basis for standardized clinical sample collection and rational use of antibacterial drugs in the treatment of USI.Methods:VITEK2 Compact automatic microorganism identification and drug sensitivity analysis system and disk diffusion method(K-B method)were used to identify and analyze the drug sensitivity of bacteria isolated from midstream urine samples submitted to clinical departments from January 2020 to December 2021.Results:6808 midstream urine samples were cultured,1345 samples were identified as contaminated,the contaminated rate was 19.76%.1943 strains of pathogenic bacteria were isolated,isolated rate was 35.57%.And the majority bacteria were gram-negative bacteria,especially Escherichia coli and Klebsiella pneumoniae;Gram-positive bacteria were the second,mainly Enterococcus faecium,Enterococcus faecalis,Staphylococcus haemolyticus;Followed by fungi,mainly Candida albicans;Pathogens were mostly detected from urology and the third general internal medicine(mainly admitted to patients with nephropathy,diabetes and tumors);The detection rate was high in the elderlies(aged 60 years and above).The sensitivity rates of E.Coli and K.Pneumoniae to amoxicillin,cefaclor,cefdinir and doxycycline were less than 40%.In addition to norfloxacin and moxifloxacin,the sensitivity rates of other quinolones preferred for treatment are low;Enterococcus faecium has high resistance to quinolones,macrolides,tetracyclines and other antibacterial drugs;The sensitivity of Enterococcus faecalis to antibacterial drugs is significantly higher than that of Enterococcus faecium,but it has a high resistance rate to tetracycline,prostacyclin and norfloxacin.Hemolytic staphylococci were highly susceptible to ampicillin/sulbactam,vancomycin,tetracycline,and nitrofurantoin,and there were no vancomycin-resistant strai

关 键 词：中段尿培养 病原菌分布 抗菌药物敏感性 污染率 合理使用抗菌药物 

分 类 号：R446[医药卫生—诊断学]