2010-2021年上海市某三甲中医医院尿液临床分离菌的分布和耐药性分析  

Distribution and drug resistance of the bacterial strains isolated from urine in a tertiary Traditional Chinese Medicine hospital in Shanghai from 2010 to 2021

作　　者：裴凌燕 谢国艳 王江丽 梁斌 冯琪 刘庆中 PEI Lingyan;XIE Guoyan;WANG Jiangli;LIANG Bin;FEN Qi;LIU Qingzhong(Department of Laboratory Medicine,Shanghai Municipal Hospital of Traditional Chinese Medicine,Shanghai 200071,China)

机构地区：[1]上海中医药大学附属市中医医院检验科,上海200071

出　　处：《中国感染与化疗杂志》2024年第3期318-325,共8页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(82172281)。

摘　　要：目的了解上海市某三甲中医医院12年间尿液标本临床分离菌的分布及其耐药特点,为临床经验性用药提供依据。方法回顾性分析2010年1月-2021年12月尿路感染患者资料及其尿液标本临床分离菌的种类和耐药性。结果本组资料共收集非重复临床分离菌5231株,其中大肠埃希菌占52.8%,肠球菌属占19.1%,克雷伯菌属占11.1%。各年龄段患者尿液分离菌以60~89岁老年人最多见(76.0%),44岁以下的年轻人最少(3.1%);细菌多数分离自女性患者(75.8%),但铜绿假单胞菌和鲍曼不动杆菌男性多于女性(55.3%对44.7%和67.7%对32.3%)。肾病科分离的菌株数较其他科室多见(占13.7%),其中大肠埃希菌在重症监护病房(ICU)的分布最低,而肠球菌属在ICU分布最高。肠杆菌目细菌对碳青霉烯类、头霉素类、阿米卡星、头孢吡肟、β内酰胺酶抑制剂复方制剂耐药率低,具有较高的敏感率;铜绿假单胞菌对碳青霉烯类、氨基糖苷类、β内酰胺酶抑制剂复方制剂的耐药率低,其敏感率均高于鲍曼不动杆菌(≥54.6%对≤39.8%)。革兰阳性球菌对糖肽类抗菌药物耐药率低,未发现万古霉素耐药的金黄色葡萄球菌和粪肠球菌,屎肠球菌对万古霉素的耐药率为2.7%。主要临床分离耐药菌株在60~89岁的老年患者中分布最高;ICU和急诊科分离出较多的耐药菌株。结论该中医医院相比综合性医院的特点是老年患者占比很高,在治疗尿路感染患者时需更加谨慎。尿液标本临床分离菌以大肠埃希菌、肠球菌属和肺炎克雷伯菌为主;经验性用药治疗应结合患者年龄、性别以及病原菌种类的分布特点进行综合考量,积极送检尿培养及药敏试验,根据药敏试验结果合理选用抗菌药物,并加强耐药性监测。Objective To investigate the distribution and antibiotic resistance profiles of the bacterial strains isolated from urine samples in a tertiary Traditional Chinese Medicine hospital in Shanghai in the 12-year period from 2010 through 2021 for better empirical antibiotic use in clinical practice.Methods The clinical data of patients with urinary tract infection,including the species and antibiotic resistance of the bacterial strains isolated from urine samples from January 2010 to December 2021 were retrospectively analyzed.Results A total of 5231 nondupliate bacterial strains were isolated,among which E.coli was the most common(52.8%),followed by Enterococcus spp(19.1%)and Klebsiella spp(11.1%).Most of the urinary isolates(76.0%)were isolated from the elderly aged 60-89,and only 3.1%of the strains were isolated from the young people aged under 44.Most of the bacterial strains were isolated from female patients(75.8%),however,more P.aeruginosa and A.baumannii were isolated from male patients compared to female patients(55.3%vs 44.7%and 67.7%vs 32.3%).About 13.7%of the strains were collected from the Department of Nephrology,more than the strains from any other clincial department.In intensive care unit(ICU),the proportion of E.coli was the lowest,while the proportion of Enterococcus spp was the highest.Enterobacterales showed lower resistance raets to carbapenems,cephamycin,amikacin,cefepime,andβ-lactam/β-lactamase inhibitor combinations.P.aeruginosa showed higher susceptibility rates to carbapenems,aminoglycosides andβ-lactam/β-lactamase inhibitor combinations compared to A.baumannii(≥54.6%vs≤39.8%).Gram-positive cocci were highly sensitive to glycopeptide antibiotics.No S.aureus or E.faecalis isolates were found resistant to vancomycin.About 2.7%of the E.faecium isolates were resistant to vancomycin.The prevalence of drug-resistant bacteria was the highest in elderly patients,and in the strains isolated from ICU and emergency department.Conclusions Compared with general hospitals,a high proportion of eld

关 键 词：尿液标本 抗菌药物 细菌分布 细菌耐药性 

分 类 号：R378[医药卫生—病原生物学]