Objective To investigate the distribution, drug resistance and rational use of antibiotics in complicated bacterial urinary tract infection. Methods To retrospect the clinical data and results of drug susceptibility from 188 patients in our hospital with complicated urinary tract infection from 2004 to 2009. Results The Gram-negative bacilli ( 40. 4％Escherichia coli and 8. 5％ Klebsiella pneumoniae) accounted for 69. 1％ , Enterococcus faecalis 10. 6％ , Enterococci 7. 4％ ,coagulase-negative staphylococci 3. 7％ ,fungi 4. 3％ among the pathogens caused complicated urinary tract infection. ESBL positive rate in 76 cases of Escherichia coli was 48. 2％. The drug resistance to amoxicillin/clavulanic acid, cefoperazone/sulbactam , piperacillin/tazobactam , cefoxitin , amikacin, carbapenem, nitrofurantoin was low ; while the resistance to ampicillin ,piperacillin, cephalosporins, quinolones was high. Conclusion Escherichia coli is still the main pathogen for current complicated urinary tract infection in hospitals, the drug resistance of which is high and multiple, and is the most common bacterial strain producing ESBLs. The antimicrobial therapy should be adjusted under the guidance of drug sensitivity test.%目的 探讨复杂性细菌性尿路感染致病菌分布、耐药性特点和抗菌药物的合理应用.方法 回顾分析2004年1月～2009年1月华中科技大学同济医学院附属同济医院188例住院复杂性尿路感染患者的临床资料及药敏实验结果.结果 革兰阴性杆菌占69.1%(其中大肠埃希菌占40.4%,肺炎克雷白杆菌占8.5%),球菌占26.6%(其中粪肠球菌占10.6%,屎肠球菌占7.4%,凝固酶阴性葡萄球菌占3.7%),真菌占4.3%.76例大肠埃希菌产ESBL阳性率为48.2%,对阿莫西林/克拉维酸、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢西丁、阿米卡星、碳青霉烯类、呋喃妥因的耐药率较低,而对氨苄西林、哌拉西林、头孢类、喹诺酮类的耐药率较高.结论 大肠埃希菌仍为目前住院的复杂尿路感染的主要致病菌,耐药性高,且常呈多重耐药,而且是最常见的产超广谱β-内酰胺酶菌株的细菌,临床治疗应尽量根据药敏实验调整抗菌药物.
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