尿路感染相关病原菌的分布及耐药性分析

目的调查尿路感染病原菌的分布和耐药特点,为临床的抗感染治疗提供依据。方法收集2013年至2015年荆州市中心医院门诊和住院患者中,尿路感染患者送检的尿培养和血培养标本中检出的病原菌,采用Vitek2 Compact全自动微生物检测仪进行细菌鉴定,采用纸片扩散法和仪器法分别对革兰阴性杆菌和革兰阳性球菌进行药敏试验,药敏结果的判断依照CLSI M100-S24标准。数据分析采用WHONET5.6和SPSS 19.0软件,统计分析采用x~2检验。结果从尿路感染患者送检的标本中共检出各类非重复病原菌2 306株,其中门诊患者中检出19种100株,住院患者检出56种2 206株。导致尿路感染最多的两种病原菌为大肠埃希菌和粪肠球菌,分别检出1 241株和232株。导致尿脓毒血症最多的两种病原菌为大肠埃希菌和肺炎克雷伯菌,分别检出36株和10株。大肠埃希菌产ESBL.s率达67.9%,其对多种抗菌药物的耐药性均高于60.0%。粪肠球菌对大多数抗菌药物的耐药性均高于50.0%,仅对呋喃妥因和高浓度链霉素的耐药性较低,分别为12.0%和38.7%;未检出对万古霉素、利奈唑胺和替加环素耐药的粪肠球菌。结论导致尿路感染的病原菌种类繁多,大肠埃希菌和粪肠球菌是主要病原菌,其耐药情况严重;为保证治疗的有效性,临床医生应注重相关病原学和药敏检查结果。

The distribution and drug resistance of pathogens in urinary tract infections

Abstract: Objective To investigate the distribution and drug resistance of pathogens in urinary tract infections, so as to provide evidence for clinical anti-infection treatment. Methods The clinical strains isolated from patients with urinary tract infection in Jingzhou Central Hospital from 2013 to 2015 were collected and identified by using Vitek 2 Compact. The susceptibility of gram-negative bacilli and gram-positive cocci were tested with disk diffusion method and instrument method respectively. Interpretation of the results was done according to CLSI M100-S24 standard.WHONET 5.6 and SPSS 19.0 were used for data analysis, and chi-square test was used for statistics. Results A total of 2,306 strains were isolated, among which 100 strains of 19 genera were from outpatients, while 2,206 strains of 56 genera were from inpatients. The top two pathogens causing urinary tract infection wereE.coli (1,241strains)and E. faecalis(232 strains). 36 strains of E.coli and 10 strains of Klebsiella pneumoniae were the main pathogens of urinary sepsis cases. The drug resistance rate of E.colito many antibiotics were higher than 60.0%. ESBLs was detected in 67.9 percent of E.coli. The drug resistance rate of E. faecalis to many antibiotics were higher than 60.0%, but as low as 12.0% to nitrofurantoin and high-unit streptomycin.No E. faecalis strains were found resistant to vancomycin, linezolid and tigecycline. Conclusion E.coli and E. faecalis were the main pathogens among many pathogenic bacteria that cause urinary tract infection, the drug resistance rates of which were high. Doctors should pay attention to the results of etiology and susceptibility tests in order to ensure the effectiveness of treatment.