产超广谱β-内酰胺酶大肠埃希菌在尿路感染中的相关分析  

Analysis urinary tract infections caused by extended spectrumβ-lactamase producing Escherichia coli

作　　者：韩明明 袁月 Han Mingming;Yuan Yue(Department of Blood Transfusion,the Second Central Hospital of Baoding,Baoding 071000,China;Department of Laboratory Medicine,Shanghai Jiaotong University Hospital,Shanghai 200240,China)

机构地区：[1]保定市第二中心医院输血科,保定071000 [2]上海交通大学校医院检验科,上海200240

出　　处：《国际泌尿系统杂志》2024年第2期260-264,共5页International Journal of Urology and Nephrology

摘　　要：目的分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌在尿路感染中的临床特点和耐药情况以及快速诊断的方法,为临床合理使用抗菌药物提供参考。方法收集2020年1月至2022年6月保定市第二中心医院6620例疑似尿路感染患者的中段尿进行细菌培养,采用全自动微生物鉴定仪及配套卡进行细菌鉴定及药敏试验。结果6620份尿培养标本检出病原菌845株,检出率为12.8%;其中革兰阴性菌529株,占62.6%,革兰阳性菌135株,占16.0%,真菌181株,占21.4%,检出率最高的前3位细菌依次为大肠埃希菌411株、肺炎克雷伯菌58株、粪肠球菌50株。科室分布中泌尿外科和肾内科占比最高分别为28.4%和13.0%。检出产ESBLs大肠埃希菌共255株,产ESBLs大肠埃希菌对氨苄西林、哌拉西林、头孢唑啉、头孢噻肟、头孢曲松的耐药率均在90%以上,显著高于非产ESBLs大肠埃希菌(P<0.05)。产ESBLs大肠埃希菌对于碳青霉烯类抗生素(亚胺培南、美洛培南)和氨基糖苷类抗生素(阿米卡星)较为敏感。在尿常规两项指标联合分析中,无论在ESBLs阳性还是阴性的大肠埃希菌中,白细胞和亚硝酸盐的联合检测较单项指标检测有更高的灵敏度、特异度,阳性预测值和阴性预测值均在80%以上;在单项指标分析中,亚硝酸盐在ESBLs阳性的大肠埃希菌中有更高的灵敏度。当尿常规pH<6.0时,产ESBLs大肠埃希菌的占比为34.9%;而非产ESBLs大肠埃希菌的占比为52.87%。结论尿常规中白细胞和亚硝酸盐的联合检测快速、简便,具有良好的敏感性和特异性,适用于尿路感染,特别是产ESBLs大肠埃希菌的早期诊断和快速筛检。经验选择能覆盖ESBLs菌感染的药物,可避免多种耐药菌的产生。Objective To analyze clinical characteristics and drug resistances with urinary tract infections caused by extended spectrumβ-lactamase producing Escherichia coli and provides suggestions for rational use of antibiotics.Methods The midstream urine of 6620 patients with suspected urinary tract infection from the Second Central Hospital of Baoding City from January 2020 to June 2022 was collected for bacterial culture,and bacterial identification and drug sensitivity test were conducted by automatic microbial identification instrument and matching card.Results Eight hundred and forty-five strains of pathogens were detected in 6620 urine culture samples,the detection rate was 12.8%.Among them,there were 529 strains of gram-negative bacteria(62.6%),135 strains of gram-positive bacteria(16.0%)and 181 fungi(21.4%).The top 3 bacteria with the highest detection rate were Escherichia coli(411),Klebsiella pneumoniae(58)and Enterococcus faecalis(50).Urology and nephrology accounted for 28.4%and 13.0%of the departments,respectively.A total of 255 ESBLs-producing Escherichia coli strains were detected.The drug resistance rate of ESBLs-producing Escherichia coli to ampicillin,piperacillin,cefazolin,cefotaxime and ceftriaxone was above 80%,which was significantly higher than that of non-ESBLs-producing Escherichia coli(P<0.05).It is sensitive to carbapenem antibiotics(imipenem,meropenem)and aminoglycoside antibiotics(amikacin).In the combined analysis of the two indexes of urine routine,no matter in ESBLs positive or negative Escherichia coli,the combined detection of leukocyte and nitrite had higher sensitivity and specificity than the single index,and the positive predictive value and negative predictive value were more than 80%.In the single index analysis,nitrite has higher sensitivity in ESBLs-positive Escherichia coli.When urine pH was less than 6.0,the proportion of ESBLs-producing Escherichia coli was 34.9%.Non-ESBLs-producing Escherichia coli accounted for 52.87%.Conclusions The comprehensive analysis of white blood c

关 键 词：白细胞 亚硝酸盐类 超广谱Β-内酰胺酶 大肠埃希菌 尿路感染 

分 类 号：R691.3[医药卫生—泌尿科学]