尿路感染中常见病原菌及其特殊类型对抗菌药物的耐药情况  

Antimicrobial resistance of common pathogens and their special types in urinary tract infection

作　　者：郑思强 刘琳 范神栋 孙文博 陈彬 何强 ZHENG Siqiang;LIU Lin;FAN Shendong;SUN Wenbo;CHEN Bin;HE Qiang(Second Clinical Medical College,the Second Clinical Medical College of Zhejiang Chinese Medicine University,Hangzhou,Zhejiang 310053,China;不详)

机构地区：[1]浙江中医药大学第二临床医学院,浙江杭州310053 [2]杭州医学院附属人民医院肾脏病科,浙江杭州310014 [3]宁波市镇海区人民医院肾内科,浙江宁波315200 [4]浙江中医药大学附属第一医院肾内科,浙江杭州310003

出　　处：《中华全科医学》2023年第11期1852-1855,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2022KY1172)。

摘　　要：目的了解尿路感染患者尿培养中的常见病原菌及其特殊类型对抗菌药物的耐药情况,为临床医生经验性治疗尿路感染提供参考依据。方法从浙江省人民医院信息系统数据库中收集2020年1月-2021年12月的尿液培养结果及其耐药情况,最终纳入3770例尿路感染患者,并对分离出的病原菌与其药敏结果进行统计分析。结果本研究共计分离非重复菌株4284株,其中革兰阴性菌2746株(64.10%),革兰阳性菌875株(20.42%),真菌385株(8.99%),支原体278株(6.49%)。分离菌株前4位分别为:大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌。其中产超广谱β-内酰胺酶类菌以及耐碳青霉烯类菌的耐药率明显高于普通病原菌,前者对β-内酰胺类、喹诺酮类抗菌药物耐药率较普通病原菌明显升高,对加酶抑制剂抗生素及碳青霉烯类抗菌药物保持良好的抗菌活性,后者仅对替加环素、阿米卡星少量抗菌药物表现良好的敏感性。结论尿路感染中最常见的病原菌仍为革兰阴性菌,产超广谱β-内酰胺酶类菌、耐碳青霉烯类肠杆菌等耐药菌较前增多,临床上初次使用抗菌药物可参考本研究结果进行经验性治疗,获取尿培养结果后再根据病原菌耐药情况酌情更换抗菌药物。Objective To investigate the antimicrobial resistance of common pathogenic bacteria and their special types in urine culture of urinary tract infection(UTI)patients,and to provide reference for clinical workers in the empirical treatment of urinary tract infection.Methods The urine culture results and drug resistance were collected from the information system database of Zhejiang Provincial People's Hospital from January 2020 to December 2021,and 3770 UTI patients were eventually included.The isolated pathogens and their drug susceptibility results were statistically analyzed.Results A total of 4284 non-duplicate strains were isolated in this study.There were 2746 strains(64.10%)of Gram-negative bacteria,875 strains(20.42%)of Gram-positive bacteria,385 strains(8.99%)of fungi and 278 strains(6.49%)of mycoplasma.The top four isolates were Escherichia coli,Klebsiella pneumoniae,Enterococcus faecium and Enterococcus faecalis.Among them,the drug resistance rate of the bacteria producing extended-spectrumβ-lactamases and carbapenem resistant bacteria was significantly higher than that of common pathogens.The resistance rate of the former toβ-lactam and quinolone antibacterial drugs was significantly higher than that of common pathogens,and it maintained good antibacterial activity against antibiotics and carbapenems with enzyme inhibitors.The latter only showed good sensitivity to tigecycline and amikacin.Conclusion The most common pathogen in urinary tract infection is still gram-negative bacteria.Drug-resistant bacteria such as producing extended-spectrumβ-lactamases and carbapenem resistant bacteria are more than before.Clinical initial use of antibacterial drugs can refer to the results of this study for empirical treatment,and antibacterial drugs can be changed according to the drug resistance of pathogenic bacteria after the results of urine culture are available.

关 键 词：尿路感染 尿液培养 药敏分析 耐药率 

分 类 号：R691.3[医药卫生—泌尿科学] R372[医药卫生—外科学]