中段尿培养检出B群链球菌的临床意义  

Clinical significance of detecting group B Streptococcus from midstream urine culture

作　　者：蔡兴龙 曹小利[1] 刘静静 高硕[1] 沈瀚[1] 周万青[1] CAI Xing-long;CAO Xiao-li;LIU Jing-jing;GAO Shuo;SHEN Han;ZHOU Wan-qing(Department of Laboratory Medicine,Nanjing Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Southeast University School of Medicine,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院检验科,江苏南京210008 [2]东南大学医学院,江苏南京210009

出　　处：《中国感染控制杂志》2024年第3期277-283,共7页Chinese Journal of Infection Control

基　　金：国家自然科学基金资助项目(81902124);南京市医学科技发展资金项目(QRX17143)。

摘　　要：目的 探讨中段尿培养中分离出B群链球菌(GBS)的临床意义和耐药性,旨在为临床尿路感染诊治提供依据。方法 通过实验室信息系统搜索2020年2月—2022年12月南京某医院住院和门诊患者中段尿培养分离出GBS的菌株信息,筛选资料完整者,查阅病例资料、尿常规及药敏试验结果。结果 中段尿培养标本共检出非重复细菌9 081株,其中GBS 425株,占比4.7%,位列第6。剔除资料不完整者,共纳入365例患者进行研究。其中男性169例(46.3%),女性196例(53.7%),平均年龄(55.4±15.2)岁。365例检出GBS的患者来源于17个科室,泌尿外科(237例,64.9%)占比最高。患者基础疾病主要包括高血压病136例,糖尿病95例,泌尿系统结石120例,泌尿系统肿瘤98例;211例患者接受了泌尿系统手术,术前均使用了抗菌药物,205例在术后留置导尿管;9例在妊娠中晚期尿液中检出GBS。GBS菌落计数≤10^(4)CFU/mL占36.4%(133例),10^(4)~10^(5)CFU/mL占38.9%(142例),≥10^(5)CFU/mL占24.7%(90例)。有尿路感染症状的患者占24.9%(91例),无症状性菌尿患者占75.1%(274例)。男性中有尿路感染症状者低于女性(19.5%VS 29.6%,P<0.05)。随着尿培养GBS菌落计数增加,有尿路感染症状的患者比例呈升高趋势(P<0.05)。尿培养送检当日尿常规白细胞、白细胞酯酶、亚硝酸盐阳性比率分别为53.2%、50.1%、3.8%。有症状尿路感染患者中尿潜血、白细胞酯酶、白细胞、尿蛋白的阳性率均高于无症状性菌尿患者(均P<0.05)。未发现GBS对青霉素、氨苄西林、万古霉素、利奈唑胺、替加环素耐药,对左氧氟沙星、莫西沙星耐药率在40%左右,对四环素、克林霉素耐药率>60%。结论 尿液中分离出GBS在非妊娠成人中比较常见,有尿路感染症状者仅占少数。尿培养、尿常规结果应结合患者临床症状、体征综合判断。尿液中GBS对多种抗菌药物敏感,临床应根据药敏结果合理用药。Objective To explore the clinical significance and antimicrobial resistance of group B Streptococcus(GBS)isolated from midstream urine culture,aiming to provide a basis for the diagnosis and treatment of clinical urinary tract infection(UTI).Methods Information about GBS strains isolated from midstream urine culture of inpatients and outpatient in a hospital in Nanjing from February 2020 to December 2022 were retrieved through laboratory information system,strains with complete data were screened out.Case data,urine routine,and antimicrobial susceptibility testing results were reviewed.Results A total of 9081 non-repetitive bacterial strains were detected from midstream urine culture,including 425 GBS strains,accounting for 4.7%,ranking sixth.Strains with incomplete data were excluded,a total of 365 patients were included in the study.169(46.3%)were males and 196(53.7%)were females,with an average age of(55.4±15.2)years.365 patients who were detected GBS were from 17 departments,with the highest proportion being department of urology(n=237,64.9%).The underlying diseases of patients mainly included hypertension(n=136),diabetes(n=95),urolithiasis(n=120)and urinary tumors(n=98).211 patients underwent urological surgery,all were treated with antimicrobial agents before surgery,and 205 patients underwent indwelling urinary catheters after surgery;9 patients were detected GBS from urine during the middle and advanced stage of pregnancy.36.4%(n=133),38.9%(n=142)and 24.7%(n=90)patients had GBS colony count≤10^(4) CFU/mL,10^(4)-10^(5) CFU/mL,and≥10^(5) CFU/mL,respectively.Patients with symptoms of UTI accounted for 24.9%(n=91),and asymptomatic bacteriuria accounted for 75.1%(n=274).The incidence of UTI symptoms in males was lower than that in females(19.5%vs 29.6%,P<0.05).As the GBS colony count in urine culture increased,the proportion of patients with symptoms of UTI showed an upward trend(P<0.05).On the day of urine culture,the positive rates of urine routine white blood cells,leukocyte esterase,and nitrite were 5

关 键 词：B群链球菌 尿培养 尿常规 尿路感染 无症状性菌尿 

分 类 号：R181.32[医药卫生—流行病学]