绍兴地区2型糖尿病尿路感染病原菌及其耐药性分析

摘要：目的 回顾分析本院2型糖尿病伴尿路感染患者的病原菌分布特点及其耐药性，为指导临床用药提供参考。方法 收集2013年1月至2014年1月2型糖尿病合并尿路感染患者186例，留取中段尿分离培养病原菌，用VITEK-2细菌鉴定仪鉴定，纸片扩散法（K-B）测定药物敏感性。结果 186例患者中段尿共培养出病原菌137株，其中革兰阴性菌102株（74.45%），革兰阳性菌21株（15.33%），真菌14株（10.22%）。革兰阴性菌以大肠埃希菌为主，检出79株占57.66%，对青霉素类，头孢菌素类，喹诺酮类抗菌药耐药率较高均＞50.00%，对头霉素类药物如头孢替坦、含酶抑制剂复合物如哌拉西林/他唑巴坦以及碳青霉烯类药物敏感率均达100.00%；革兰阳性球菌以无乳链球菌为主，检出10株占7.30%，对克林霉素及红霉素耐药率较高，耐药率＞50.00%，而对氯霉素、呋喃妥因、利奈唑烷、替加环素、万古霉素敏感率均达100.00%。除1株光滑假丝酵母菌对氟康唑和伊曲康唑中介，其余13株真菌对两性霉素B、5-氟胞嘧啶、伏立康唑、氟康唑、伊曲康唑这5种抗真菌药物均敏感。结论 2型糖尿病患者发生尿路感染的病原菌以大肠埃希菌为主，且有较高的耐药率。

The distribution of pathogens and drug resistance of urinary tract infections among patients with type 2 diabetes in Shaoxing

Abstract: Objective To analyze the distribution of pathogenic bacteria and drug resistance of urinary tract infections in patients with type 2 diabetes in our hospital, to guide the clinical medication. Methods 186 cases of type 2 diabetes patients with urinary tract infection from January 2013 to January 2014 were collected; their midstream specimens of urine were cultured for identification of pathogenic bacteria by using VITEK-2 bacterial identification instrument and for test of drug sensitivity by usig disk diffusion (K-B) method. Results A total of 137 strains of bacteria were detected, including 102 Gram negative bacteria (74.45%), 21 Gram positive bacteria (15.33%), and 14 fungi (10.22%). Most of the Gram negative bacteria were Escherichia coli, accounting for 57.66% (79 strains); the resistance rates to penicillins, cephalosporins and quinolones were higher than 50%, and the sensitivity rate to cefotetan, piperacillin/tazobactam and carbapenems were 100%. The main Gram positive cocci was Streptococcus agalactiae, accounting for 7.30% (10 strains); the resistance rates to clindamycin and erythromycin were higher than 50%, while the sensitivity rates to chloramphenicol, nitrofurantoin, linezolid, tigecycline and vancomycin were 100%. The fungi were sensitive to amphotericin B, 5-flucytosine, voriconazole, fluconazole and itraconazole, except 1 strain of Candida which showed intermediary resistance to fluconazole and itraconazole. Conclusion In patients with type 2 diabetes, urinary tract infections were mainly caused by highly resistant Escherichia coli.