输尿管碎石术后泌尿系统感染病原菌及耐药性分析
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摘要
目的探讨输尿管上段结石碎石术后泌尿道系统感染常见病原菌及耐药性。方法分离鉴定341例输尿管上段结石碎石术患者中段尿液病原菌,K-B纸片法进行药敏试验。结果 341例患者输尿管上段结石碎石术后泌尿系统感染40例,占11.73%。尿液标本共离出病原菌126株,主要为革兰阴性菌(97株),其中大肠埃希菌39株(30.95%),肺炎克雷伯菌26株(20.63%),铜绿假单胞菌13株(10.31%);革兰阳性菌29株,其中肠球菌12株(9.52%),金黄葡萄球菌10株(7.94%)。大肠埃希菌和肺炎克雷伯菌产ESBLs率分别为30.77%(12株)和26.92%(7株);MRSA菌株5株。主要革兰阴性菌对哌拉西林和亚胺培南敏感;主要革兰阳性菌对万古霉素、氨苄西林和吗啉恶酮敏感。结论输尿管上段结石碎石术后易发生泌尿系统感染,应加强病原菌药敏监测,合理使用抗生素。
Objective To explore the distribution and drug resistance of bacterial infections in patients with upper ureteral calculi after lithotrity.Methods Pathogenic bacteria isolated from samples from 341 patients with upper ureteral calculi after lithotrity at this hospital were analyzed using an ATB identification system and K-B disc diffusion.Results Of the 341 patients,40(11.73%) had a urinary tract infection.In total,126 strains were separated from the urinary tract.The main Gram-negative pathogenic bacteria were Escherichia coli(30.95%),Klebsiella pneumonia(20.63%),and Pseudomonas aeruginosa(10.31%).The main Gram-positive pathogenic bacteria were Enterococcus(9.52%) and Staphylococcus aureus(7.94%).Of the isolated strains,30.77% were extended-spectrum lactamase-producing E.coli and 26.92% were extended-spectrum lactamase-producing K.pneumonia.There were 5 strains(50.00%) of methicillin-resistant S.aureus.The Gram-positive pathogenic bacilli were sensitive to imipenem and piperacillin.The main Gram-positive bacilli were sensitive to vancomycin,ampicillin,and linezolid.Conclusion Infection is a major complication after lithotrity of upper ureteral calculi.Important steps are to enhance drug resistance surveillance and provide prevention and early treatment.
Objective To explore the distribution and drug resistance of bacterial infections in patients with upper ureteral calculi after lithotrity.Methods Pathogenic bacteria isolated from samples from 341 patients with upper ureteral calculi after lithotrity at this hospital were analyzed using an ATB identification system and K-B disc diffusion.Results Of the 341 patients,40(11.73%) had a urinary tract infection.In total,126 strains were separated from the urinary tract.The main Gram-negative pathogenic bacteria were Escherichia coli(30.95%),Klebsiella pneumonia(20.63%),and Pseudomonas aeruginosa(10.31%).The main Gram-positive pathogenic bacteria were Enterococcus(9.52%) and Staphylococcus aureus(7.94%).Of the isolated strains,30.77% were extended-spectrum lactamase-producing E.coli and 26.92% were extended-spectrum lactamase-producing K.pneumonia.There were 5 strains(50.00%) of methicillin-resistant S.aureus.The Gram-positive pathogenic bacilli were sensitive to imipenem and piperacillin.The main Gram-positive bacilli were sensitive to vancomycin,ampicillin,and linezolid.Conclusion Infection is a major complication after lithotrity of upper ureteral calculi.Important steps are to enhance drug resistance surveillance and provide prevention and early treatment.
引文
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[10]郭玉金,王雪松,杨艳君.ICU下呼吸道感染产ESBLs肠杆菌科细菌的耐药性分析[J].中国病原生物学杂志,2011,6(3):217-9.
[2]Nakamura K,Tobiume M,Narushima M,et al.Treatment of upper urinary tract stones with extracorporeal shock wave litho-tripsy(ESWL)Sonolith vision[J].BMC Urol,2011,11:26.
[3]Hong YK,Park DS.Ureteroscopic lithotripsy using Swiss Litho-clast for treatment of ureteral calculi:12-years experience[J].J Korean Med Sci,2009,24(4):690-4.
[4]Sharifi Aghdas F,Akhavizadegan H,Aryanpoor A,et al.Fever after percutaneous nephrolithotomy:contributing factors[J].Surg Infect(Larchmt),2006,7(4):367-71.
[5]钟一红,龚劭敏,傅辰生,等.社区尿路感染的病原菌调查和耐药性分析[J].上海医学,2009,32(9):764-8.
[6]刘永达,袁坚,李逊,等.微创经皮肾镜取石术的并发症及其防治[J].中华外科杂志,2008,46(3):200-2.
[7]苑广盈,边锋芝,朱健美,等.整合子介导产生超广谱β-内酰胺酶志贺菌的多重耐药研究[J].中国病原生物学杂志,2008,3(4):258-62.
[8]邹桂玲,杜雪飞,孙哲,等.泌尿系统感染病原菌分布及耐药性分析[J].哈尔滨医科大学学报,2011,45(3):275-7.
[9]刘丁,陈萍,王政,等.产超广谱β-内酰胺酶肺炎克雷伯菌耐药性和基因分型研究[J].中国病原生物学杂志,2008,3(11):810-1.
[10]郭玉金,王雪松,杨艳君.ICU下呼吸道感染产ESBLs肠杆菌科细菌的耐药性分析[J].中国病原生物学杂志,2011,6(3):217-9.