摘要
目的分析泌尿系感染病原菌分布情况及耐药性。方法收集我院2017—2021年门诊及住院泌尿系感染患者送检清洁中段尿分离的非重复菌株,利用布鲁克基质辅助激光解吸电离飞行时间质谱仪(MALDI-TOF MS)鉴定,Vitek2-Compact系统和纸片扩散法(KB)法进行药敏实验,结果判读参照CLSI M1002020。结果2017—2021年尿培养标本中共分离出病原菌2404株,不同性别患者病原菌的分离率呈现明显的女多男少,女1580株(65.72%)、男824株(34.28%)。革兰阴性杆菌1695株(70.51%),革兰阳性球菌490株(20.38%),真菌105株(4.37%)。其中检出率前3位的病原菌分别是大肠埃希菌1327株(55.20%)、屎肠球菌201株(8.36%)、肺炎克雷伯菌156株(6.49%)。病原菌检出率前3位的病区分别是泌尿外科(923株,38.39%)、肾病内科(360株,14.98%)、重症监护病房(ICU)(219株,9.11%)。革兰阴性杆菌中大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌对头孢菌素类抗生素耐药率较高,对碳青霉烯类及氨基糖苷类抗生素的耐药率较低;超广谱β-内酰胺酶(ESBLs)检出率分别为56.22%、44.23%、42.47%。革兰阳性球菌中肠球菌属对红霉素和利福平的耐药率较高,均已超过50%;没有发现利奈唑胺、万古霉素、替考拉宁的耐药株。结论泌尿系感染尿培养致病菌以大肠埃希菌为主,细菌产生的耐药机制复杂多样,临床医生在治疗泌尿系感染时,应及时送检尿液细菌培养及开展药敏试验,参照药敏试验结果来合理使用抗生素,同时应加强对细菌耐药的监测,防止耐药菌株产生,避免抗生素滥用导致耐药菌增加及多重耐药出现。
Objective To analyze the distribution and drug resistance of pathogenic bacteria in urinary tract infection.Methods Non-duplicate strains isolated from dean midstream urine of urinary tract infection outpatients and inpatients of our hospital from 2017 to 2021 were collected.The Bruk matrix-assisted laser desorption ionisation time-of-flight mass spectrometry(MALDI-TOF MS)identification,Vitek2-Compact system and Kindy-Bauer(KB)method were used for drug sensitivity test and the results were interpreted according to CLSI M1002020.Results A total of 2404 strains of pathogenic bacteria were isolated from urine culture samples from 2017 to 2021,the isolation rates of pathogenic bacteria in different gender patients were more female than male,with 1580 strains(65.72%)from females and 824 strains(34.28%)from males.There were 1695 strains Gram-negative bacteria(70.51%),490 strains Gram-positive bacteria(20.38%),and 105 strains fungi(4.37%).The top three isolates were 1327 strains of Escherichia coli(55.20%),201 strains of Enterococcus faecium(8.36%)and 156 strains of Klebsiella pneumoniae(6.49%).The top three isolate wards were urinary surgery(923 strains,38.39%),nephrology department(360 strains,14.98%)and intensive care unit(ICU)(219 strains,9.11%).Among Gram-negative bacteria,Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis had higher resistance rates to cephalosporins,but had lower resistance rates to carbapenems and aminoglycosides;the detection rates of extended-spectrumβ-lactamases(ESBLs)were 56.22%,44.23%and 42.47%,respectively.The resistance rates of Enterococcus in Gram-positive bacteria to erythromycin and rifampicin were higher than 50%;no resistant strains for linezolid,vancomycin,teicolanin were found.Conclusion Escherichia coli is the main pathogen in urinary culture of urinary tract infection,and the drug-resistance mechanism produced by bacteria is complex and diverse.When treating urinary tract infection,clinicians should timely submit urine bacterial culture and carry out drug sensitivity
作者
李耀妮
顾振东
石红
豆淑媛
LI Yaoni;GU Zhendong;SHI Hong;DOU Shuyuan(Baoji Central Hospital,Baoji 721008;Baoji Hospital of Traditional Chinese Medicine,Baoji 721000,China)
出处
《临床医学研究与实践》
2022年第36期26-30,共5页
Clinical Research and Practice
基金
陕西省卫生健康科研基金项目(No.2021D008)。
关键词
泌尿系感染
病原菌
耐药性
革兰阳性菌
革兰阴性菌
头孢菌素类
抗生素
urinary tract infection
pathogenic bacteria
drug-resistance
Gram-positive bacteria
Gram-negative bacteria
cephalosporins
antibiotics
