三种非发热性下尿路感染患者病原菌分布及耐药性分析
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摘要
目的研究分析3种非发热性下尿路感染的病原菌分布及耐药性特征,为临床治疗提供实验依据。方法选取2016年2月至2017年6月临海市第二人民医院收治的166例非发热性下尿路感染患者作为研究对象,其中,急性非复杂性膀胱炎患者93例,反复发作下尿路感染患者39例,复杂性下尿路感染34例,取所有患者中段尿液进行细菌培养检查,药敏试验计算菌株对抗菌药物的敏感性、耐药性及中介性。结果 166例下尿路感染患者中,108例进行尿培养检查呈阳性结果,阳性率为65.06%,最终共有173株病原菌纳入本次研究,其中革兰阴性菌102株(58.96%),革兰阳性菌71株(41.04%)。急性非复发性膀胱炎患者93例,共分离出病原菌72株,其中革兰阴性菌49株(68.06%)。反复发作性下尿路感染患者39例,共分离出病原菌59株,其中革兰阴性菌30株(50.85%),复杂性下尿路感染患者共分离出病原菌42株,其中革兰阴性菌23株(54.76%);不同类型非发热性下尿路感染的病原菌均对磷霉素氨丁三醇敏感性较高,证明了此药物对下尿路感染患者的治疗效果。结论急性非复杂性膀胱炎、反复发作性下尿路感染、复杂性下尿路感染患者产ESBLs大肠埃希菌均具有较高的检出率,3种类型下尿路感染对磷霉素氨丁三醇均具有较低的耐药性,适合临床选择应用。
Objective To analyze the distribution and drug resistance of three non-fever lower urinary tract infections, and to provide laboratory evidence for clinical treatment. Methods A total of 166 patients with non-fever lower urinary tract infections admitted to our hospital from February 2016 to June 2017 were enrolled as study subjects, including 93 patients with acute non-complex cystitis, 39 patients with recurrent lower urinary tract infections and 34 patients with complex lower urinary tract infections.Urine samples were collected for urine culture and drug susceptibility test. Results Out of 166 patients with lower urinary tract infection, 108 were positive for urine culture with the positive rate of 65.06%.A total of 173 stains of pathogenic bacteria were isolated, including 102 strains of gram-negative bacteria(58.96%) and 71 strains of gram-positive bacteria(41.04%).Among the 93 patients with acute non-recurrent cystitis, 72 strains of pathogenic bacteria were isolated, including 49 strains of gram-negative bacteria(68.06%).A total of 59 strains of pathogenic bacteria were isolated from 39 patients with recurrent lower urinary tract infection, including 30 gram-negative bacteria(50.85%), and 42 strains of pathogenic bacteria were isolated from patients with complex lower urinary tract infection, including 23 gram-negative bacteria(54.76%).The pathogens isolated from different types of non-fever lower urinary tract infections were highly sensitive to fosfomycin tromethamine. Conclusions The detection rate of ESBLs escherichia coli is high among patients with acute non-complicated cystitis,recurrent lower urinary tract infection,and complex lower urinary tract infection.However,pathogenic bacteria isolated from these three types of lower urinary tract infection are sensitive to Fosfomycin tromethamine,which can be used in the treatment.
Objective To analyze the distribution and drug resistance of three non-fever lower urinary tract infections, and to provide laboratory evidence for clinical treatment. Methods A total of 166 patients with non-fever lower urinary tract infections admitted to our hospital from February 2016 to June 2017 were enrolled as study subjects, including 93 patients with acute non-complex cystitis, 39 patients with recurrent lower urinary tract infections and 34 patients with complex lower urinary tract infections.Urine samples were collected for urine culture and drug susceptibility test. Results Out of 166 patients with lower urinary tract infection, 108 were positive for urine culture with the positive rate of 65.06%.A total of 173 stains of pathogenic bacteria were isolated, including 102 strains of gram-negative bacteria(58.96%) and 71 strains of gram-positive bacteria(41.04%).Among the 93 patients with acute non-recurrent cystitis, 72 strains of pathogenic bacteria were isolated, including 49 strains of gram-negative bacteria(68.06%).A total of 59 strains of pathogenic bacteria were isolated from 39 patients with recurrent lower urinary tract infection, including 30 gram-negative bacteria(50.85%), and 42 strains of pathogenic bacteria were isolated from patients with complex lower urinary tract infection, including 23 gram-negative bacteria(54.76%).The pathogens isolated from different types of non-fever lower urinary tract infections were highly sensitive to fosfomycin tromethamine. Conclusions The detection rate of ESBLs escherichia coli is high among patients with acute non-complicated cystitis,recurrent lower urinary tract infection,and complex lower urinary tract infection.However,pathogenic bacteria isolated from these three types of lower urinary tract infection are sensitive to Fosfomycin tromethamine,which can be used in the treatment.
引文
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[10] Flannigan R,Choy WH,Chew B,et al.Renal struvite stones-pathogenesis,microbiology,and management strategies[J].Nat Rev Uml,2014,11:333-341.
[11] Nozarian Z.Abdollahi A.Microbial etiology and antimicrobial susceptibility of bactria implicated in urinary tract infection in Tehran,Iran[J].Iran J Pathol,2015,10:54-60.
[12] 李朋,张伟丽,尤升杰,等.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].中华医院感染学杂志,2015,25(7):1626-1628.
[13] 赵东明.复发性尿路感染患者的细菌检验与药敏情况分析[J].中外医学研究,2014,12:157-158.
[14] Wang Y,Wu j,Cao Y.The extended spectrum beta-lactamases (ESBL)and virulence genes of intestinal enteroaggregative Escherichia coli(EAEC)in healthy elderly individuals[J].Int J Clin Exp Med,2015,8:20953-20958.
[2] Datta P,Rani H,Chauhan R,et al.Health-care-associated infections:risk factors and epidemiology from an intensive care unit in Northern India[J].Induan J Anaesth,2014,58(1):30-35.
[3] 杜震,乔庐东,闫伟,等.导管相关尿路感染患者尿路上皮细胞内检出细菌群落的临床意义[J].中华泌尿外科杂志,2017,38(1):51-54.
[4] Martis N,Leroy S,Blanc V.Colistin in multi-drug resistant Pseudomonas aemginosa blood-stream infections:a narrative review for the clinician[J].J lnfec,2014,69:l-12.
[5] Lai B,Zheng B,Li Y,et al.In vitro susceptibility of Eseherichia coli strains isolated from urine samples obtained in mainland China to fosfomycin trometamol and other antibiotics:a 9-year surveillance study(2004-2012)[J/OL].BMC Infect Dis,2014,14:66.
[6] 赵彩萍,周茂亮,胡晓燕,等.尿路感染患者病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(14):3170-3172.
[7] Nicolle LE.Urinary tract infections in special populations:diabetes,renal transplant,HIV infection,and spinal cord injury[J].Infect Dis Clin North Am,2014,28(1):91-104.
[8] 汪海源,洪涛,臧彬.危重症患者尿路感染的病原菌谱和时间分布特点[J].中华泌尿外科杂志,2015,36(5):380-383.
[9] 林泉,张旭,彭经宙.成人尿路感染的病原菌调查与耐药性分析[J].中华医院感染学杂志,2014,24(5):1107-1109.
[10] Flannigan R,Choy WH,Chew B,et al.Renal struvite stones-pathogenesis,microbiology,and management strategies[J].Nat Rev Uml,2014,11:333-341.
[11] Nozarian Z.Abdollahi A.Microbial etiology and antimicrobial susceptibility of bactria implicated in urinary tract infection in Tehran,Iran[J].Iran J Pathol,2015,10:54-60.
[12] 李朋,张伟丽,尤升杰,等.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].中华医院感染学杂志,2015,25(7):1626-1628.
[13] 赵东明.复发性尿路感染患者的细菌检验与药敏情况分析[J].中外医学研究,2014,12:157-158.
[14] Wang Y,Wu j,Cao Y.The extended spectrum beta-lactamases (ESBL)and virulence genes of intestinal enteroaggregative Escherichia coli(EAEC)in healthy elderly individuals[J].Int J Clin Exp Med,2015,8:20953-20958.