2019~2022年成都某三甲医院尿液培养病原菌分布及耐药情况分析  

An Analysis of the Distribution and Drug Resistance of Pathogenic Bacteria in Urine Culture of a Tertiary Hospital in Chengdu Area from 2019 to 2022

作　　者：阳静 全晖 YANG Jing;QUAN Hui(The Second Affiliated Hospital of Chengdu Medical College,China National Nuclear Corporation 416 Hospital,Chengdu 610057,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院,四川成都610057

出　　处：《标记免疫分析与临床》2024年第5期860-866,共7页Labeled Immunoassays and Clinical Medicine

摘　　要：目的收集成都某三甲医院2019~2022年送检的13539例尿液培养感染病原菌的分布与耐药情况,为临床在尿液培养药敏结果未出具前的经验性用药选择提供一定的参考。方法统计2019~2022年门诊和住院患者送检的尿液培养样本,对尿液培养阳性的样本使用全自动细菌分析仪进行细菌鉴定和药敏分析,药敏结果根据美国临床和实验室标准协会(CLSI)标准进行判读,采用WHONET5.5分析致病菌株分布及对抗菌药物的耐药情况。结果送检的13539例尿液培养样本分离出致病菌2586株,培养阳性率19.09%,其中排在前5位的致病菌分别是大肠埃希菌1337株(46.81%)、真菌168株(6.5%)、屎肠球菌136株(5.26%)、粪肠球菌135株(5.22%)、肺炎克雷伯菌133株(5.14%);尿路感染的人群主要集中在40岁以上,且女性感染者多于男性;药敏数据表明革兰阴性菌大肠埃希菌对氨苄西林耐药率在65%以上,而肺炎克雷伯菌对氨苄西林的耐药率在3%以下,大肠埃希菌和肺炎克雷伯菌均对头孢噻肟/克拉维酸钾、头孢他啶/克拉维酸钾100%敏感;革兰阳性菌中的粪肠球菌和屎肠球菌对药物耐药主要集中在氨基糖苷类和青霉素类药物,如庆大霉素、氨苄西林等,但其间耐药有明显差别,如氨苄西林对屎肠球菌几乎100%耐药,而对于粪肠球菌相对较低。结论引起成都某三甲医院临床患者尿路感染的病原菌主要为革兰阴性杆菌,以大肠埃希菌居首位,同时需要注意真菌感染的增加和肠球菌属的耐药菌株比例较高不可忽视。因此在临床诊疗过程中应结合尿培养和药敏试验结果选择合适的抗菌药物,对患者进行有效治疗的同时也应加强对耐药细菌的防控。Objective To collect and analyze the distribution and drug resistance of pathogenic bacteria in 13539 urine culture samples from a tertiary hospital in Chengdu area from 2019 to 2022,and to provide useful references for empirical drug selection in clinical practice before the issuance of urine culture drug sensitivity results.Methods We collected urine culture samples from outpatient and inpatient settings from 2019 to 2022 for the current study.For samples with positive urine culture,a fully automated bacterial analyzer was used for bacterial identification and drug sensitivity analysis.The drug sensitivity results were interpreted according to the Clinical and Laboratory Standards Institute(CLSI)standards in the United States.WHONET5.5 was applied to analyze the distribution of pathogenic strains and data on antibiotic resistance.Results 2586 strains of pathogenic bacteria were isolated from 13539 urine culture samples,with a positive culture rate of 19.09%.Among them,the top five pathogenic bacteria were as follows:1337 strains of Escherichia coli(46.81%),168 strains of fungi(6.5%),136 strains of Enterococcus faecalis(5.26%),135 strains of Enterococcus faecalis(5.22%),and 133 strains of Klebsiella pneumoniae(5.14%);The population with urinary tract infections was mainly concentrated in patients over 40 years old,and the number of infected women was greater than that of men;Drug sensitivity data showed that the resistance rate of Gram-negative Escherichia coli to ampicillin was over 65%,while the resistance rate of Klebsiella pneumoniae to ampicillin was below 3%.Both Escherichiacoli and Klebsiella pneumoniae were 100%sensitive to cefotaxime/potassium clavulanate and cefotaxime/potassium clavulanate;Among Gram-positive bacteria,Enterococcus faecalis and Enterococcus faecalis were mainly resistant to aminoglycosides and penicillin drugs,such as gentamicin and ampicillin,but there were significant differences in resistance between them.For example,ampicillin was almost 100%resistant to Enterococcus faecalis,while

关 键 词：尿路感染 耐药菌 条件致病菌 大肠埃希菌 

分 类 号：R691.3[医药卫生—泌尿科学]