摘要
目的回顾性分析髋、膝关节置换术围手术期尿路感染的病原菌构成及药物敏感性(药敏)结果,以协助制定有效的抗菌药物治疗方案。方法收集骨科2013年1月1日—2015年10月1日诊治的髋、膝关节置换术围手术期尿路感染患者的病原菌种类及药敏结果,分析各类病原菌的构成比及对各类抗菌药物的耐药情况。结果尿培养共检出117株病原菌,包含11类菌种,革兰阴性菌占86.3%,其中大肠埃希菌所占比例最高(70.9%),其次为肺炎克雷伯菌(7.7%)及变形杆菌(3.4%);而检出的革兰阳性菌中,粪肠球菌与屎肠球菌占检出菌株总数的比例分别为6.8%及3.4%。病原菌对头孢菌素类、喹诺酮类及磺胺类抗菌药物的耐药率较高,但对呋喃妥因、部分氨基糖苷类、碳青霉烯类、酶抑制剂复合制剂抗菌药物仍具有较高的敏感性。结论尿路感染的病原菌谱广,主要致病菌为大肠埃希菌、肠球菌及肺炎克雷伯菌,药敏结果提示病原菌对常用抗菌药物的耐药率较高,初始经验治疗可选择呋喃妥因、丁胺卡那霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦,但应根据药敏结果及时调整抗菌药物。
Objective To explore the microbiological etiology and antibiotic susceptibility ofperiopertive urinary tract infection （UTI） in patients undergoing hip or knee arthroplasty, so as to provide recommendations for antibiotic treatment. Methods A retrospective review was conducted for patients with perioperative UTI who underwent hip or knee arthroplasty between January 1st, 2013 and October 1st, 2015. Microbiological data and antibiotic susceptibility of bacteria were analyzed. Results A total of 117 strains of bacteria were identified, including 11 types of species. Among the organisms cultured, 86.3% （101 strains） were gram-negative bacteria, in which Escherichia coli was the most common causative organism （70.9%, 83 strains）, followed by Klebsiella species （7.7%, 9 strains） and Proteus rnirabilis （3.4%, 4 strains）. And among the gram-positive bacteria detected, the proportion of Enterococcusfaecalis and Feces Enterococcus was 6.8% （8 strains） and 3.4% （4 strains）, respectively. The bacteria showed highly resistance to cephalosporins, quinolones and sulfonamides, but showed high sensitive to nitrofurantoin, carbopenems, the enzyme inhibitor complex and aminoglycoside antibiotics. Conclusions There is a diversity of bacteria involved in UTI, and the top 3 pathogens are Escherichia coli, Enterococcusfaecalis and Klebsiella species. The resistance rate is high, and nitrofurantoin, amilacin, piperacillin-tazobactam, cefoperazone-sulbactam are the recommended antibiotics to treat the UTI, but the antibiotic should be adjusted according to susceptibility results.
出处
《华西医学》
CAS
2017年第9期1387-1390,共4页
West China Medical Journal
基金
卫生部卫生行业科研专项(201302007)
关键词
关节置换
髋
膝
尿路感染
药物敏感性
Arthroplasty, hip, knee
Urinary tract infection
Bacterial sensitivity
