1272例尿液标本细菌培养结果及耐药性分析

目的调查临床送检中段尿标本菌群分布及体外抗生素耐药性，为临床合理使用抗生素提供依据。方法回顾性分析2010年1月至2012年6月住院患者送检中段尿标本中，分离的1272株细菌（剔除重复菌株）临床分布及耐药性。采用美国BDphoenix100全自动细菌鉴定药敏分析仪进行菌种鉴定及药敏试验，结合相关临床资料，应用WHONET5．6分析软件进行耐药性分析。结果从分离到的l272株细菌中，检出前5位的细菌是大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌和铜绿假单胞菌，构成比分别为20．3％、14．4％、14．2％、9．4％和7．4％。肠杆菌对氨苄西林的耐药率最高为93．9％，耐药率较低的有亚胺培南、美洛培南、头孢哌酮／舒巴坦和多粘菌素B，它们的耐药率在10．5％～15．9％。非发酵菌对氯霉素、氨苄西林、头孢唑啉和阿莫西林／克拉维酸的耐药率最高在90．1％～100％，对多粘菌素B和头孢哌酮／舒巴坦的耐药率较低，分别为7．7％和16．9％。肠球菌对利奈唑胺、万古霉素、替考拉宁和呋西地酸的耐药率最低，分别为2．6％、7．2％、8．8％和8．8％；葡萄球菌对万古霉素的耐药率为0，对喹奴普汀-达福普汀的耐药率为0．8％，对呋哺妥因、替考拉宁、夫西地酸、利奈唑胺、利福平的耐药率在2．5％～10．7％。结论泌尿系统感染主要病原菌为肠杆菌和肠球菌，由于各病原菌均存在不同程度的耐药性，临床医师应根据尿液细菌培养结果，科学合理使用抗菌药物。

Culture and antibiotic resistance of bacteria from 1 272 urinary specimens

Objective To investigate the distribution and antibiotic resistance of pathogens isolated from urinary specimens and provide evidence for rational selection of antibiotics in clinical practice. Methods The clinical dis- tribution and drug resistance of 1 , 272 strains of bacteria isolated from urinaly specimens of hospitalized patients from January 2010 to June 2012 were retrospectively analyzed. BD phoenix 100 was used to detect bacteria species and drug susceptibility. WHONET 5.6 analysis software was used to analyze the drug resistance on the basis of re- lated clinical data. Results Of all the 1,272 strains of bacteria, the top five bacteria were Escherichia coli （20.3%） , Klebsiella pneumoniae （ 14.4% ） , E. faecium （ 14.2% ） , E. faecalis （9.4%） and Pseudomonasaeruginosa （7.4%）. The resistance of Escherichia coli against ampicillin was the highest （93.9%） , while the re- sistances to imipenem, meropenem, cefoperazone-sulbactam and polymyxin B were lower, ranging from 10.5% to 15.9%. The resistance rates of non-fennentive bacteria were 7.7% and 16.9% to polymyxin B and cefoperazone- sulbactam respectively, and 90.1% - 100% to chloramphenicol, ampicillin, cefazoli and amoxicillin-clavulanicac- id. The Enterococcus had a lowest drug resistance to linezolid （2.6%）, followed by vancomycin （7.2%）, teico- planin （8.8%） and fusidic acid （8.8%）. All Staphylococcus strains were sensitive to vancomycin, and their re- sistance rate was 0.8% to quinupristin-dalfopristin, and 2.5% - 10.7% to nitrofurantoin, teicoplanin, linezolid, rifampicin and fusidic acid. Conclusion The predominant pathogenic bacteria in urinary tract infections are enter- obacteria and enterococcus which have different levels of drug resistance. The clinicians should rationally use anti- biotics according to culture results of urinary specimens in clinical practice.