琼海地区尿路感染病原菌分布及耐药性分析
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摘要
目的了解琼海地区尿路感染病原菌的分布特点,分析其对常见抗菌药物的耐药性,为临床合理用药提供依据。方法收集琼海地区2家三级医院的17 364例尿液标本,对病原菌培养阳性标本进行菌种鉴定及药物敏感度试验,分析病原菌的分布特点及对常见抗菌药物的耐药性。结果共检出尿路感染病原菌2 292株,剔除同一患者的重复菌株后为1 945株。病原菌主要来源于泌尿外科、神经外科、肾内科、骨科等,患者多为50～90岁的中老年人(76.1%),其中71～80岁的老年人比例最高。其中革兰阴性菌1 153株(59.3%)、革兰阳性菌531株(27.3%)、真菌261株(13.4%)。排名前5位的病原菌分别是大肠埃希菌(33.8%)、粪肠球菌(13.2%)、肺炎克雷伯菌(6.1%)、白色假丝酵母菌(5.0%)、铜绿假单胞菌(4.9%)。肠杆菌科细菌中,大肠埃希菌对氨苄西林的耐药率最高,达84.1%,其对常用抗菌药物复方磺胺甲口恶唑、环丙沙星、头孢曲松钠、头孢唑啉钠、左氧氟沙星的耐药率均超过50%。肺炎克雷伯菌对复方磺胺甲口恶唑和头孢唑啉钠的耐药率最高,均为47.9%。奇异变形杆菌对呋喃妥因的耐药率最高,达95.7%。铜绿假单胞菌、鲍曼不动杆菌的耐药率较低,对常见抗菌药物均较敏感。粪肠球菌和屎肠球菌对利奈唑胺的非敏感率分别为5.2%和3.6%。溶血葡萄球菌、表皮葡萄球菌、金黄色葡萄球菌对苯唑西林的耐药率分别为89.1%、74.4%和26.5%。白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌对伊曲康唑的非敏感率分别为13.4%、36.7%、38.1%。结论引起感染的主要革兰阴性菌为大肠埃希菌,革兰阳性菌为粪肠球菌,真菌为白色假丝酵母菌。尿路感染病原菌对常见抗菌药物耐药严重,临床医师应重视尿液的细菌培养结果,避免滥用抗菌药物。
Objective To investigate the pathogen distribution of urinary tract infection in Qionghai and analyze the drug resistance towards common antibacterial drugs, aiming to provide evidence for rational use of drugs in clinical practice. Methods A total of 17 364 urine specimens were collected from two tertiary hospitals in Qionghai. The specimens with positive pathogens were subject to bacterial identi?cation and drug susceptibility test. The distribution characteristics of pathogenic bacteria and the drug resistance to common antibacterial drugs were analyzed. Results A total of 2 292 strains of pathogenic bacteria were detected and1 945 strains were ?nally obtained after eliminating the repeated strains from the same patient. The pathogenic bacteria mainly originated from Department of Urology, Neurosurgery, Nephrology and Orthopeadics, etc. A majority of the patients were aged 50-90 years(76.1%) with the highest percentage in those aged 71-80 years.Among the isolated strains, 1 153(59.3%) strains were gram-negative bacteria, 531(27.3%) gram-positive bacteria and 261(13.4%) fungi. The top ?ve pathogens were Escherichia coli(33.8%), Enterococcus faecalis(13.2%), Klebsiella pneumoniae(6.1%), Candida albicans(5.0%) and Pseudomonas aeruginosa(4.9%).Among Enterobacteriaceae bacteria, Escherichia coli yielded the highest drug resistance rate to ampicillin up to 84.1%, and the drug resistance rate to common antibacterial drugs, such as compound sulfamethoxazole, ciprofloxacin, ceftriaxone sodium, cefazolin sodium and levofloxacin exceeded 50%. Klebsiella pneumoniae showedthehighestdrugresistancerateto compound The drug resistance rate of Proteus mirabilis to nitrofurantoin was the highest, reaching 95.7%. Pseudomonas aeruginosa and Acinetobacter baumannii had relatively low drug resistance rates and were sensitive to common antibacterial drugs. The insensitive rates of Enterococcus faecalis and Enterococcus faecium to linezolid were5.2%and3.6%.Thedrugresistancerates Staphylococcus aureus towards oxacillin were 89.1%, 74.4% and 26.5%, respectively. The non-sensitive rates of Candida albicans, Candida glabrata and Candida tropicalis to itraconazole were 13.4%, 36.7% and 38.1%, respectively. Conclusions Among the pathogens inducing urinary tract infection, the main gram-negative bacteriumis Escherichia coli, theprimarygram-positive bacterium fungus is Candida albicans. The pathogens related to urinary tract infection are highly resistant to common antimicrobial drugs. Clinicians should attach importance to the bacterial culture of urine samples to avoid the abuse of antibiotics.
Objective To investigate the pathogen distribution of urinary tract infection in Qionghai and analyze the drug resistance towards common antibacterial drugs, aiming to provide evidence for rational use of drugs in clinical practice. Methods A total of 17 364 urine specimens were collected from two tertiary hospitals in Qionghai. The specimens with positive pathogens were subject to bacterial identi?cation and drug susceptibility test. The distribution characteristics of pathogenic bacteria and the drug resistance to common antibacterial drugs were analyzed. Results A total of 2 292 strains of pathogenic bacteria were detected and1 945 strains were ?nally obtained after eliminating the repeated strains from the same patient. The pathogenic bacteria mainly originated from Department of Urology, Neurosurgery, Nephrology and Orthopeadics, etc. A majority of the patients were aged 50-90 years(76.1%) with the highest percentage in those aged 71-80 years.Among the isolated strains, 1 153(59.3%) strains were gram-negative bacteria, 531(27.3%) gram-positive bacteria and 261(13.4%) fungi. The top ?ve pathogens were Escherichia coli(33.8%), Enterococcus faecalis(13.2%), Klebsiella pneumoniae(6.1%), Candida albicans(5.0%) and Pseudomonas aeruginosa(4.9%).Among Enterobacteriaceae bacteria, Escherichia coli yielded the highest drug resistance rate to ampicillin up to 84.1%, and the drug resistance rate to common antibacterial drugs, such as compound sulfamethoxazole, ciprofloxacin, ceftriaxone sodium, cefazolin sodium and levofloxacin exceeded 50%. Klebsiella pneumoniae showedthehighestdrugresistancerateto compound The drug resistance rate of Proteus mirabilis to nitrofurantoin was the highest, reaching 95.7%. Pseudomonas aeruginosa and Acinetobacter baumannii had relatively low drug resistance rates and were sensitive to common antibacterial drugs. The insensitive rates of Enterococcus faecalis and Enterococcus faecium to linezolid were5.2%and3.6%.Thedrugresistancerates Staphylococcus aureus towards oxacillin were 89.1%, 74.4% and 26.5%, respectively. The non-sensitive rates of Candida albicans, Candida glabrata and Candida tropicalis to itraconazole were 13.4%, 36.7% and 38.1%, respectively. Conclusions Among the pathogens inducing urinary tract infection, the main gram-negative bacteriumis Escherichia coli, theprimarygram-positive bacterium fungus is Candida albicans. The pathogens related to urinary tract infection are highly resistant to common antimicrobial drugs. Clinicians should attach importance to the bacterial culture of urine samples to avoid the abuse of antibiotics.
引文
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[2]张伟,金炎,黄敏,郝莹莹,柳欣琦,李静,田季平,邵春红.2014~2016年尿路感染的病原菌及耐药分析.新医学,2018,49(6):416-420.
[3]解泽强,陈亮,张曼.2009-2015年泌尿系统感染病原菌种类构成及耐药性变迁.中华医院感染学杂志,2017,27(13):2991-2994.
[4]王姣平.女性泌尿系统感染的病原菌分布及耐药性分析.中国医院药学杂志,2014,34(12):1024-1027.
[5]黄丽萍,王芬,郑玲.泌尿系统感染患者病原菌分布与耐药性分析.中国消毒学杂志,2016,33(8):739-741,745.
[6]江丹英,林雪峰,王兵勇,陈静.泌尿系感染3062株分离菌的分布及耐药性.中国微生态学杂志,2016,28(5):550-554.
[7]陈玉玉,张秋桂,吴移谋,刘双全,黄再平.2010年~2011年衡阳地区泌尿系感染病原菌调查和药敏谱分析.中南医学科学杂志,2013,41(1):43-45.
[8]廖一群,江丽霞.导尿管相关性尿路感染病原菌分布及耐药性分析.实验与检验医学,2016,34(5):621-623.
[9]罗珊,刘文恩,晏群,刘清霞,简子娟,李艳明.172株奇异变形杆菌和68株普通变形杆菌临床分布及其耐药性.中国感染控制杂志,2014,13(12):710-713.
[10]王毅,刘洪韬,唐甜甜,孔垂泽.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.微生物学杂志,2014,34(2):99-102.
[11]Lee SM,Huh HJ,Song DJ,Shim HJ,Park KS,Kang CI,Ki CS,Lee NY.Resistance mechanisms of linezolid-nonsusceptible enterococci in Korea:low rate of 23S r RNA mutations in Enterococcus faecium.J Med Microbiol,2017,66(12):1730-1735.
[12]姜森,王占伟,刘井波,张正.2622株泌尿系感染病原菌的分布及耐药性分析.中国实验诊断学,2012,16(11):2077-2080.
[13]胡明,韩福郎,徐勋,张湛英,关礼贤,冯权花.尿脓毒血症与复杂性尿路感染病原学特点及耐药性对比研究,新医学,2018,49(4):265-269.
[14]魏绪霞,陆平兰,黎利娟,安玉玲,吕海金,易小猛,刘剑戎,熊亮,周密,易慧敏.外科ICU院内感染的病原菌及其耐药性分析,新医学,2016,45(11):718-723.
[2]张伟,金炎,黄敏,郝莹莹,柳欣琦,李静,田季平,邵春红.2014~2016年尿路感染的病原菌及耐药分析.新医学,2018,49(6):416-420.
[3]解泽强,陈亮,张曼.2009-2015年泌尿系统感染病原菌种类构成及耐药性变迁.中华医院感染学杂志,2017,27(13):2991-2994.
[4]王姣平.女性泌尿系统感染的病原菌分布及耐药性分析.中国医院药学杂志,2014,34(12):1024-1027.
[5]黄丽萍,王芬,郑玲.泌尿系统感染患者病原菌分布与耐药性分析.中国消毒学杂志,2016,33(8):739-741,745.
[6]江丹英,林雪峰,王兵勇,陈静.泌尿系感染3062株分离菌的分布及耐药性.中国微生态学杂志,2016,28(5):550-554.
[7]陈玉玉,张秋桂,吴移谋,刘双全,黄再平.2010年~2011年衡阳地区泌尿系感染病原菌调查和药敏谱分析.中南医学科学杂志,2013,41(1):43-45.
[8]廖一群,江丽霞.导尿管相关性尿路感染病原菌分布及耐药性分析.实验与检验医学,2016,34(5):621-623.
[9]罗珊,刘文恩,晏群,刘清霞,简子娟,李艳明.172株奇异变形杆菌和68株普通变形杆菌临床分布及其耐药性.中国感染控制杂志,2014,13(12):710-713.
[10]王毅,刘洪韬,唐甜甜,孔垂泽.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.微生物学杂志,2014,34(2):99-102.
[11]Lee SM,Huh HJ,Song DJ,Shim HJ,Park KS,Kang CI,Ki CS,Lee NY.Resistance mechanisms of linezolid-nonsusceptible enterococci in Korea:low rate of 23S r RNA mutations in Enterococcus faecium.J Med Microbiol,2017,66(12):1730-1735.
[12]姜森,王占伟,刘井波,张正.2622株泌尿系感染病原菌的分布及耐药性分析.中国实验诊断学,2012,16(11):2077-2080.
[13]胡明,韩福郎,徐勋,张湛英,关礼贤,冯权花.尿脓毒血症与复杂性尿路感染病原学特点及耐药性对比研究,新医学,2018,49(4):265-269.
[14]魏绪霞,陆平兰,黎利娟,安玉玲,吕海金,易小猛,刘剑戎,熊亮,周密,易慧敏.外科ICU院内感染的病原菌及其耐药性分析,新医学,2016,45(11):718-723.