2017-2019年湖北某三甲医院尿培养病原菌构成及耐药性分析

Distribution and drug resistance of pathogenic bacteria in urinary tract infection in a tertiary hospital of Hubei Province in 2017-2019

摘要:

目的 对2017-2019年襄阳市中心医院尿培养病原菌构成及耐药性进行回顾性分析，为临床尿路感染治疗及合理使用抗生素提供依据。方法 收集我院2017年1月-2019年12月临床分离的尿培养病原菌细菌鉴定和药敏结果数据，应用WHONET 5.6和GraphPad Prism 5.0软件对数据进行回顾性分析。结果 15672例尿培养中阳性检出率为19.50%(3056/15672)，革兰阴性菌占77.95%，其中大肠埃希菌最常见(52.45%)；革兰阳性菌占12.63%，以粪肠球菌(4.80%)和屎肠球菌(4.80%)为主，真菌占9.50%。尿培养送检率和阳性率最高临床科室分别为泌尿外科(26.20%)和内分泌科(41.90%)。分离培养出的大肠埃希菌和肺炎克雷伯菌对哌拉西林、复方新诺明、头孢呋辛、头孢曲松和头孢唑啉耐药率较高，均超过50.00%，铜绿假单胞菌对各类抗生素的敏感率均较高，这3种革兰阴性菌对碳青酶烯类抗生素的耐药率呈逐年上升趋势。分离的革兰阳性球菌主要以屎肠球菌和粪肠球菌为主，其对万古霉素、利奈唑胺及替考拉宁均高度敏感，但二者对其它类型抗生素耐药率差异较大。产ESBLs的大肠埃希菌和肺炎克雷伯菌的平均检出率分别为52.90%和59.00%。 结论 本院尿培养病原菌以革兰阴性菌为主，且对碳青酶烯类药物的耐药率呈逐年上升趋势，临床医师要重视病原菌鉴定与药敏试验结果，以其指导抗菌药物合理使用，同时应加强重点科室监测，避免医院感染暴发。

Abstract:

Objective To retrospectively analyze the distribution and drug resistance of pathogenic bacteria in urinary tract infection in Xiangyang Central Hospital from 2017-2019, so as to provide a basis for clinical treatment of urinary tract infection and rational use of antibiotics. Methods The pathogenic bacteria isolated from clinical urine culture in Xiangyang Central Hospital from January 2017 to December 2019 were collected, and BD Phoenix TM 100 was used for the identification of pathogens and antimicrobial sensitivity test. The WHONET 5.6 and GraphPad Prism 5.0 software were used for data analysis. Results A total of 3 056 strains of pathogens were isolated from 15 672 urine specimens (19.50%). Gram-negative bacteria accounted for 77.95%, of which E. coli was the most common (52.45%). Gram-positive bacteria accounted for 12.63%, including E. faecalis (4.80%) and E. faecium (4.80%). Fungi accounted for 9.50%. The clinical departments with the highest rates of urinary culture submission and positive detection were Urology (26.20%) and Endocrinology (41.90%), respectively. E. coli and K. pneumoniae had high resistance rates to piperacillin, compound trimethoprim, cefuroxime, ceftriaxone and cefazolin, all exceeding 50.00%, while P. aeruginosa was relatively sensitive to various antibiotics. The resistance rates of these three gram-negative bacteria to carbapenem antibiotics increased year by year. The isolated gram-positive cocci were mainly enterococcus faecalis and enterococcus faecalis. They were highly sensitive to linazolamide, vancomycin and teicoplanin, but the resistance rates to other types of antibiotics were quite different. The average detection rates of ESBLs-producing E. coli and K. pneumoniae were 52.90% and 59.00%, respectively. Conclusion The pathogens of urinary tract infections in Xiangyang Central Hospital from 2017 to 2019 are mainly gram-negative bacteria, and the resistance rate to carbapenem drugs is increasing year by year. The ESBLs-producing strains of E. coli and K. pneumoniae are high.