社区获得性尿路感染患者尿路病原菌分布及其对奈诺沙星和左氧氟沙星的敏感性  

Distribution of urinary tract pathogens and susceptibility to nenofloxacin and levofolxacin in patients with community-acquired urinary tractinfection

作　　者：杜震[1] 陈山[1] 崔亮 吴慧玲[3] 高瞻[4] 杨进[5] 崔刚[6] 王家菁[7] 舒铁环[8] 冯宁翰[9] 乔庐东[1] Du Zhen;Chen Shan;Cui Liang;Wu Huiling;Gao Zhan;Yang Jin;Cui Gang;Wang Jiajing;Shu Tiehuan;Feng Ninghan;Qiao Ludong(Department of Urology,Beijing Tongren Hospital,Capial Medical University,Beijing 100176,China;Department of Urology,Civil Aviation General Hospital,Beijing 100123,China;Department of Urology,Jinhua People's Hospital,Jinhua 321099,China;Department of Urology,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Department of Urology,Affiliated Hospital of Chengdu University,Chengdu 610081,China;Department of Urology,Daxing District People's Hospital,Beijing 102600,China;Department of Urology,Beijing Chuiyangliu Hospital,Beijing 100021,China;Department of Urology,The First People's Hospital of Huaihua,Huaihua 418000,China;Department of Urology,The Second People's Hospital of Wuxi,Wuxi 214001,China)

机构地区：[1]首都医科大学附属北京同仁医院泌尿外科,北京100176 [2]民航总医院泌尿外科,北京100123 [3]金华市人民医院泌尿外科,金华华321099 [4]中国中医科学院西苑医院泌尿外科,北京100091 [5]成都大学附属医院泌尿外科,成都610081 [6]北京市大兴区人民医院泌尿外科,北京102600 [7]北京市垂杨柳医院泌尿外科,北京100021 [8]怀化市第一人民医院泌尿外科,怀化418000 [9]无锡市第二人民医院泌尿外科,无锡214001

出　　处：《中华泌尿外科杂志》2024年第1期24-28,共5页Chinese Journal of Urology

摘　　要：目的探讨社区获得性尿路感染患者的尿路病原菌分布特点,及其对奈诺沙星和左氧氟沙星的敏感情况。方法本研究为前瞻性、多中心临床试验。纳入2021年11月至2022年8月于国内9家临床研究中心泌尿外科门诊就诊的患者。纳入标准:年龄18~70岁的社区获得性急性非复杂性膀胱炎(AUC)、反复发作尿路感染(rUTI)急性发作和非发热性复杂性尿路感染(cUTI)患者;具有尿路刺激征且尿常规白细胞异常升高。排除标准:人组前72h内接受有效的抗菌药物治疗,持续时间超过24h者;发热(>37.3℃)或存在上尿路感染症状如腰痛、肾区叩痛等;留置尿路导管者。初次就诊时留取清洁中段尿标本做细菌培养,分析不同类型尿路感染的尿路病原菌分布特点,并对革兰阴性菌进行超广谱β-内酰胺酶(ESBLs)测定。使用纸片扩散法测定尿路病原菌对奈诺沙星和左氧氟沙星的敏感性。比较不同病种病原菌对抗菌药物的敏感率和耐药率的差异。结果本研究共纳人9家医院的404例患者,男40例(9.9%),女364例(90.1%);6例细菌学结果缺失,最终398例纳入分析。398例中AUC243例,cUTI46例,rUTI109例。398例中,170例尿细菌培养阳性(共分离出177株病原菌),总体阳性率为42.7%(170/398)。177株病原菌中,大肠埃希菌比例最高为66.1%(117/177),其次为肺炎克雷伯杆菌6.8%(12/177)、无乳链球菌5.1%(9/177)。AUC和rUTI患者中大肠埃希菌比例分别为70.6%(85/119)和65.9%(29/44);cUTI患者中大肠埃希菌比例为28.6%(4/14),粪肠球菌比例为7.1%(1/14)。行ESBLs检测的革兰阴性菌中ESBLs总体检出率为30.9%(43/139)。药敏试验结果显示,总体对奈诺沙星的敏感率为74.6%(91/122),耐药率为25.4%(31/122);总体对左氧氟沙星敏感率为44.9%(70/156),耐药率为36.5%(57/156)。既往有尿路感染病史和无尿路感染病史患者中,尿路病原菌对左氧氟沙星耐药率分别为48.2%(27/56)和30.0%(30/100),二者差异有统计�Objective To investigate the distribution characteristics of urinary tract pathogens in patients with community-acquired urinary tract infection and their sensitivity to nenoxacin and levofloxacin.Methods This prospective,multicenter clinical trial included patients with community-acquired urinary tract infection who were admitted to urological clinics at 9 clinical research centers from November 2021 to August 2022.Inclusion criteria:Patients aged 18-70 years with community-acquired acute uncomplicated cystitis(AUC),recurrent acute episodes of urinary tract infection(rUTI),and non-febrile complicated urinary tract infection(cUTI)with signs of urinary tract irritation and abnormal elevation of routine white blood cells in urine.Exclusion criteria:①Patients who received effective antimicrobial therapy within 72 h before enrollment and lasted for more than 24 h.②Fever(>37.3℃)or symptoms of upper urinary tract infection such as low back pain,tapping pain in the kidney area,etc.③Indwelling urinary catheter.At the first visit,clean midstream urine samples were taken for bacterial culture,and the distribution characteristics of urinary pathogens of different types of urinary tract infections were analyzed.Extended spectrum β-lactamases(ESBLs)were measured for Gram-negative bacteria.The susceptibility of nenoxacin and levofloxacin to urinary tract pathogens was determined by disk diffusion method.Drug resistance rate,sensitivity rate were analyzed between different disease groups.Results There were 404 enrolled patients from 9 hospitals,including 364(90.1%)females and 40(9.9%)males.A total of 177 strains of pathogenic bacteria were isolated,among which the highest proportion of Escherichia coli was 66.1%(117/177).Klebsiella pneumoniae was followed by 6.8%(12/177)and Streptococcus agalactis 5.1%(9/177).The bacterial spectrum distribution of AUC and rUTI were similar,and the proportions of Escherichia coli were 70.6%(85/119)and 65.9%(29/44),respectively.However,the proportions of Escherichia coli isolated from cU

关 键 词：尿路感染 体外活性分析 药物敏感性 奈诺沙星 左氧氟沙星 

分 类 号：R446.5[医药卫生—诊断学]