复杂上尿路结石患者尿和结石标本的细菌学研究

摘要

目的 分析接受经皮肾镜碎石术的复杂上尿路结石患者的膀胱尿、肾盂尿和结石的细菌学分布和差异.方法 回顾性选取2010年12月至2013年12月北京大学人民医院收治的复杂上尿路结石患者1 197例,对患者的膀胱尿、肾盂尿以及结石标本的细菌培养和药敏结果进行描述性统计分析.结果 膀胱尿标本1 197份,标本阳性率39.3％ (470/1 197),分离出病原菌484株,其中革兰阳性菌143株(29.5％),革兰阴性菌314株(64.9％),真菌27株(5.6％).肾盂尿标本759份,标本阳性率41.8％(317/759),分离出病原菌330株,其中革兰阳性菌118株(35.8％),革兰阴性菌195株(59.1％),真菌17株(5.2％).结石标本136份,标本阳性率52.9％ (72/136),分离出病原菌81株,革兰阳性菌10株(12.3％),革兰阴性菌70(86.4％)株,真菌1株(1.2％).肾盂尿和膀胱尿标本的细菌培养结果符合率为67.1％(509/759),结石和膀胱尿标本细菌培养结果符合率为47.8％ (65/136).膀胱尿和肾盂尿培养前3位的菌株为大肠埃希菌、粪肠球菌和肺炎克雷伯菌.结石培养前3位的菌株为大肠埃希菌、铜绿假单胞菌和阴沟杆菌.最常见致病菌大肠埃希菌对推荐预防使用的抗菌药物复方磺胺甲(口恶)唑、氨苄西林/舒巴坦、头孢曲松、庆大霉素和左氧氟沙星的耐药率分别为47.6％ (40/84)、52.4％ (44/84)、65.5％ (55/84)、70.2％ (59/84)和77.4％(65/84).结论 大肠埃希菌、粪肠球菌等是结石合并感染最常见致病菌;膀胱尿和肾盂尿培养结果符合率较好,但与结石细菌培养结果符合率低;主要致病菌对于常用抗菌药物耐药率较高.%Objective To describe the bacteriology of bladder urine,pelvis urine and stone of patients with complex upper urinary calculus who underwent percutaneous nephrolithotomy (PCNL).Methods Totally 1 197 patients with complex upper urinary calculus who underwent PCL from December 2010 to December 2013 were enrolled,the results of bacterial culture and drug sensitivity of bladder urine,pelvis urine and stone samples were reviewed.Results There were 1 197 bladder urine samples,the positive rate of bacterial culture was 39.3％ (470/1 197),484 strains were separated,including 143 gram positive strains (29.5％),314 gram negative strains (64.9％) and 27 fungus (5.6％).There were 759 pelvis urine samples,the positive rate of bacterial culture was 41.8％ (317/759),330 strains were separated,including 118 gram positive strains (35.8％),195 gram negative strains (59.1％) and 17 fungus (5.2％).There were 136 stone samples,the positive rate of bacterial culture was 52.9％ (72/136),81 strains were separated,including 10 gram positive strains (12.3 ％),70 gram negative strains (86.4％) and 1 fungus (1.2％).The coincidence rate of bacterial culture was 67.1％(509/759) between bladder urine and pelvis urine culture,and was 47.8％ (65/136) between bladder urine and stone.The top three common bacteria of bladder and pelvis urine were both escherichia coli,enterococcusfaecal and klebsiella pneumoniae;the top three common bacteria of stone were escherichia coli,pseudomonas aeruginosa and enterobacter cloacae.The resistance rate of escherichia coli to co-trimoxazole,ampicillin ± sulbactam,ceftriaxone,gentamicin and levofloxacin was 47.6％ (40/84),52.4％ (44/84),65.5％ (55/84),70.2％ (59/84) and 77.4％ (65/84),respectively.Conclusions The most common bacteria of upper urinary tract calculi are escherichia coli,enterococcus faecal and klebsiella pneumoniae;the coincidence rate of bacterial culture is high between bladder and pelvis urine,while is low between bladder urine and stone;the most common pathogens are highly resistant to the first line antibiotics.