泌尿外科住院患者泌尿系感染病原菌分布及其耐药性分析

了解泌尿外科住院患者泌尿系感染病原菌的分布及其对常用抗菌药物的耐药情况。对泌尿外科泌尿系感染住院患者的消毒中段尿培养结果进行回顾性分析,尿培养菌株的鉴定、药敏分析和统计分析采用VITEK2全自动微生物仪。3 a中泌尿外科泌尿系感染住院患者共分离到细菌1 233株,其中革兰阴性杆菌772株,占62.61%,革兰阳性球菌353株,占28.63%,真菌82株,占6.65%。菌株数居前5位的细菌依次为:大肠埃希菌、肠球菌属、洋葱伯克霍尔德菌、假丝酵母菌属和变形杆菌。分离大肠埃希菌产ESBLs率为66.18%,粪肠球菌中未发现VRE菌株,屎肠球菌VRE为0.8%。未发现对美洛培南耐药的大肠埃希菌,对肠埃希菌耐药率在10%以下的有亚胺培南、阿米卡星、哌拉西林/他唑巴坦和呋喃妥因。洋葱伯克霍尔德菌和铜绿假单胞菌对所监测的抗菌药物均有不同程度的耐药。未发现对万古霉素、替考拉宁及氨苄西林耐药的粪肠球菌。泌尿系感染的病原菌以大肠埃希菌和肠球菌为主,非发酵革兰阴性杆菌及假丝酵母菌所占比例超过20%,不容忽视,病原菌的耐药率较高,临床医生应根据尿培养和药敏试验结果合理使用抗菌药物。

Analysis of Distribution & Drug Resistance of Pathogens Causing Urinary Tract Infections among Inpatients in the Department of Urinary Surgery

In order to understand the distribution of pathogens causing urinary tract infections and their resistance against antibiotics most in use among inpatients in the department of urinary surgery,the results of sterile middle section of urine cultures from inpatients of the department were retrospectively analyzed.Identification,drug resistance and statistic analyses of urine cultured strains were carried out adopting VITEK2 full-automatic microbial ID instrument.A total of 1233 strains of pathogens were isolated from the inpatients with urinary tract infections in the department for 3 years,among them Gram-negative bacilli strains were 772（62.61%）,Gram-positive cocci strains 353（28.63%）,and fungal strains 82（6.65%）.A number of top 5 strains bacteria and fungi successively were：E.coli,Enterococcus,Burkholderia cepacia,Candida and Proteus.The detection rates of extended-spectrum β-lactamases（ESBLs） producing E.coli were 66.18%,among Enterococcus faecalis strains were not found VRE,and VRE of Enterococcus faecium was 0.8%.No E.coli resistant strain to meropenem was found,as for E.coli strains the resistance rate that below 10% were amikacin,imipenem,piperacillin / tazobactam and nitrofurantoin.B.cepacia and Pseudomonas aeruginosa resisted to antibiotics had different extent of resistance against the tested antibiotics.No Enterococcus faecalis was found resistant to vancomycin,teicoplanin and ampicillin.E.coli and Enterococcus sp.were the major pathogens causing urinary tract infections.Nonfermenters Gram-negative bacilli and Candida sp.was over 20%,they should not be ignored.Pathogens had a fairly high resistance rate.Clinicians should choose suitable antibiotics based on the results of urine cultures and drug sensitivity tests.