社区获得性泌尿系感染病原菌分布及耐药性分析

目的分析社区获得性泌尿系感染病原菌的种类及对常用抗生素的耐药性。方法收集2008年5月至2013年3月分离自社区获得性泌尿系感染患者中段尿的菌株，分析病原菌种类并测试主要病原菌对常用抗生素的体外敏感性。结果在215株细菌中，以革兰阴性杆菌155株（72. 1% ）为主。分离前5位的细菌为大肠埃希菌（48.4% ）、肠球菌属（10. 7% ）、肺炎克雷伯菌（7.4% ）、链球菌属（6. 0% ）、假丝酵母属（6. 0% ）。大肠埃希菌和肺炎克雷伯菌中，共63株产ESBL,占52. 5%。产ESBL菌株对头孢替坦、哌拉西林/他唑巴坦、阿米卡星、呋喃妥因、亚胺培南等5种抗生素的耐药率低于10%，对其他抗生素耐药率则超过70%。不产ESBL的菌株除对氨苄西林、氨苄西林/舒巴坦、环丙沙星、左氧氟沙星和复方新诺明的耐药率超过30%外，对其他常用抗生素的耐药率均在10%以下。肠球菌属和链球菌属分别对呋喃妥因和青霉素的耐药率较低（3/23和0/23），未发现对万古霉素耐药株。结论引起社区获得性泌尿系感染的病原菌以大肠埃希菌为代表的革兰阴性杆菌为主，但由于不同菌株对抗生素的敏感性差异较大，用药之前进行尿培养是避免因抗生素使用不合理造成感染慢性化的一项重要措施。

The distribution and antibiotic resistance of bacteria isolated from community-acquired urinary tract infection

Objective To analyze the distribution and antibiotic resistance of bacteria isolated from community-acquired urinarytract infection. Methods The bacteria isolated from community-acquired urinary tract infection, from May 2008 to March 2013,werecalculated the frequency of different bacteria and tested the resistance to the common antibiotics. Results A total of 215 isolates werecollected, among which 155 isolates （72. 1% ） were gram-negative bacillus. The top five bacteria were Escherichia coli （48. 4% ）,Enterococcus spp （ 10. 7% ） , Klebsiella pneumoniae （ 7. 4% ）,Streptococcus spp （ 6. 0% ） and Candida spp （6. 0% ）. There were 63（52. 5% ） Escherichia coli and Klebsiella pneumoniae isolates producing ESBLs, in which more than 70 percent were resistant to the testedantibiotics, except cefotetan, piperacillin/tazobactam, amikacin, macrodantin and imipenem. However, no more than 10 percent of non-producing ESBLs isolates were resistant to the tested antibiotics, except ampicillin,amipicillin/sulbactam,ciprofloxacin,levofloxacin,and SMZ. Enterococcus spp and Streptococcus spp were less resistant to macrodantin and penicillin respectively （3/23 and 0/23 ）. Therewere no isolates resistant to vancomycin. Conclusion Gram-negative bacilli,such as Escherichia coli,are the main causes of communi-ty-acquired urinary tract infection. However, the susceptibility of different isolates to antibiotics is different, so adapting urine culture before using medicine is very important to avoid chronic infection caused by the unreasonable use of antibiotics.