尿培养中病原菌分布及耐药性分析

目的研究大连市中心医院2007年1月至2012年9月尿培养中常见病原菌（真菌除外）的分布及其耐药性，为临床治疗尿路感染提供诊断及用药依据。方法采用MicroScan—Walkaway40全自动微生物鉴定药敏分析仪和ATBExpression自动细菌鉴定仪及K—B纸片法药敏试验，应用WHONET5．4软件对结果进行回顾性统计分析。结果五年间尿培养中共分离出病原菌1012株（真菌除外），其中革兰阴性菌802株（79．2％），主要是大肠埃希菌538株（53．2％）、肺炎克雷伯菌95株（9．5％）、铜绿假单胞菌51株（5．1％）、奇异变形杆菌30株（2．9％）、鲍曼不动杆菌26株（2．6％）。革兰阳性菌210株（20．8％），主要是粪肠球菌86株（8．6％），屎肠球菌83株（8．2％），凝固酶阴性葡萄球菌21株（2．1％），金黄色葡萄球菌13株（1．3％）。抗生素敏感试验中碳青霉烯类（亚胺培南及美洛培南）对肠杆菌科细菌大肠埃希菌、肺炎克雷伯菌及奇异变形杆菌抗菌活性最强，无耐药菌株，对非发酵菌中铜绿假单胞菌和鲍曼不动杆菌耐药率为30％～40％，革兰阳性菌对糖肽类（万古霉素、替考拉宁）和利奈唑胺等抗菌药物高度敏感。结论应当根据主要易感菌种类及其抗生素敏感试验结果指导临床合理使用抗生素。

The distribution of pathogens in urine culture and their antibiotic resistance

Objective To investigate the distribution and antibiotic resistance of the pathogenic bacteria isolates from urine culture in Dalian Municipal Central Hospital from January 2007 to September 2012, and provide new ev- idences for clinicians to choose the antibiotics. Methods Pathogenic bacteria were identified by MicroScan-Walk- away 40 and ATB Expression system. Antibiotic susceptibility tests were performed with K-B method. The results were analyzed with WHONET 5.4 software. Results Totally 1,012 strains were isolated from the urine samples with the exception of fungi. Among them, 802 strains were Gram-negative bacteria （ 79.2% ） , including Escherich- ia coli （538, 53.2% ）, Klebsiella pneumoniae （88, 8.7% ）, Pseudomonas aeruginosa （51,5.1%）, Proteus mir- abilis （30, 2.9% ） and Acinetobacter baumannii （22, 2.2% ）. 210 strains were Gram-positive ones （20.8%）, with Enterococcus faecalis （88, 8.5% ） , Enterococcus faecium （83, 8.2% ） , Coagulase-negative Staphylococcus （21, 2.1% ） and Staphylococcus aureus （13, 1.3% ） being the main pathogenic bacteria. Escherichia coli, Kleb- siella pneumoniae and Proteus mirabilis showed almost 100% susceptibility to carbopenems such as imipenem and meropenem. But the susceptibility of Pseudornonas aeruginosa to carbopenems was nearly 70%. Gram-positive coc- ci were highly sensitive to glycopeptides （vacocin/vancomycin and teicoplanin） and linezolid. Conclusion Anti- biotic treatment should be based on the pathogenic species and their resistance to antibiotics.