复杂性尿路感染243例病原菌构成及药敏分析

摘要

Objective To analyze pathogen distributions and drug resistances in patients with complicated urinary tract infections and provide evidences for rational use of antibiotics.Methods The relevant clinical and laboratory data of patients with complicated urinary tract infections in Sichuan Provincial People's Hospital from January 2014 to December 2016 were analyzed retrospectively.Results A total of 289 strains of pathogens were isolated from 243 cases with complicated urinary tract infections,which included 211 (73％) Gram-negative bacilli,55 (19.1％) Gram-positive cocci and 23 (7.9％) fungal isolates.The main pathogens were Escherichia coli,Klebsiella pneumoniae,Enterococcus faecium,Enterococcus faecalis,Candida glabrata and Candida albicans.The isolation rates of Klebsiella pneumoniae,Enterococcus and Candida glabrata in patients with hospital-acquired complicated urinary tract infections,were higher than those with community-acquired complicated urinary tract infections.The main Gram-negative bacteria were highly sensitive to carbapenem,piperacillin/tazobactam,amikacin(≥80％).The main Gram-negative bacteria of Escherichia coli and Klebsiella pneumoniae from hospital-acquired complicated urinary tract infections were highly sensitive to carbapenem(≥92.9％),which were less sensitive to other common antibiotics.The detection rates of ESBLs in Escherichia coli and Klebsiella pneumoniae were 59％ and 44％.The strains of Enterococcus were 100％ sensitive to linezolid,but were 13.8％ resistant to vancomycin.All 8 strains of Candida albicans were sensitive to commonly used antifungal agents.However,only two out of nine strains of Candida glabrata were sensitive to fluconazole.Conclusions The main pathogenic bacteria of complicated urinary tract infections were Gram-negative bacteria with high rates of producing ESBLs and high resistances.The rational use of antibiotics should be based on pathogens and drug susceptibility results.%目的 分析复杂性尿路感染的病原菌构成及耐药性,为临床合理使用抗菌药物提供依据.方法 收集四川省人民医院2014年1月-2016年12月的复杂性尿路感染243例,对临床资料及实验室检查进行回顾分析.结果 243例复杂性尿路感染共分离出289株病原菌,其中革兰阴性菌211株(73％)、革兰阳性菌55株(19.1％)、真菌23株(7.9％),主要病原菌为大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌、光滑念珠菌及白念珠菌;医院获得复杂性尿路感染分离的肺炎克雷伯菌、肠球菌、光滑念珠菌,较社区获得复杂性尿路感染分离高.主要革兰阴性菌仅对碳青霉烯、哌拉西林/三唑巴坦、阿米卡星的敏感性较好,敏感率在80％以上,其中医院获得复杂性尿路感染分离的大肠埃希菌和肺炎克雷伯菌,除对碳青霉烯类保持高度敏感外,敏感率在92.9％以上,其余常用抗菌药物的敏感性均有不同程度下降,大肠埃希菌和肺炎克雷伯菌中ESBLs检出率分别为59％和44％;肠球菌对利奈唑胺100％敏感,屎肠球菌对万古霉素耐药率达13.8％;8株白念珠菌对常用抗真菌药物均敏感,9株光滑念珠菌中仅2株对氟康唑敏感.结论 复杂性尿路感染病原菌以革兰阴性菌为主,ESBLs检出率高,耐药率较高,临床应根据复杂因素及病原菌和药敏结果合理选择抗菌药物.