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目的通过对尿路感染病原微生物的调查,了解社区尿路感染的病原构成及其对抗生素的耐药性,为抗菌药物的合理应用提供依据。方法回顾性调查2004年1月1日—2007年12月31日复旦大学附属中山医院微生物检验室所有来自门诊和急诊的清洁中段尿培养的真性菌尿的记录和药敏试验结果。结果4年来,来自清洁中段尿和导尿管尿培养的真性菌尿菌株共2049株,革兰阴性杆菌在社区尿路感染病原菌中最常见,检出率为82.5%,其中大肠埃希菌仍是最主要的革兰阴性杆菌,占总菌株的68.0%;革兰阳性球菌的检出率为14.7%,真菌的检出率为2.8%。4年来,革兰阴性杆菌、革兰阳性球菌和真菌的构成比的差异无统计学意义(P>0.05)。大肠埃希菌、肺炎克雷伯菌对环丙沙星和大多数β内酰胺类抗生素都有较高的耐药性,但当这些抗生素与β内酰胺酶抑制剂联合应用后,细菌对它们的耐药率可有不同程度的下降。4年来大肠埃希菌和肺炎克雷伯菌对常用抗生素的耐药率的差异无统计学意义(P值均>0.05)。未发现对万古霉素耐药的肠球菌,除万古霉素以外,屎肠球菌对几乎所有抗生素都有很高的耐药率,且均显著高于粪肠球菌(P值均<0.01)。未发现对常用的两种三唑类抗真菌药氟康唑和伏立康唑耐药的白念珠菌,非白念珠菌对以上两种抗真菌药物也比较敏感,耐药率均仅为3.6%。结论社区尿路感染仍以大肠埃希菌最为常见,肠球菌次之,但常见病原菌的耐药现象较为严重,应及时检测病原菌及其耐药情况,制定相应的治疗方案,指导抗生素的合理应用。
Objective To investigate the pathogenic constitution of urinary tract infection and its resistance to antibiotics through the investigation of pathogenic microorganisms in urinary tract infection and provide basis for the rational application of antibacterial drugs. Methods A retrospective survey was conducted on the records and susceptibility testing results of all the urinary tract bacteriuria in urine collected from the out-patient clinic and the emergency department from January 1, 2004 to December 31, 2007 in the Microbiology Laboratory of Zhongshan Hospital Affiliated to Fudan University. Results In the past 4 years, there were 2049 strains of true bacteriuria from urine and catheter urine culture in clean center. Gram-negative bacilli were the most common pathogens in urinary tract infection in community, the detection rate was 82.5%, of which Escherichia coli still Is the most important gram-negative bacilli, accounting for 68.0% of the total strains; Gram-positive cocci detection rate was 14.7%, fungal detection rate was 2.8%. In the past 4 years, there was no significant difference in the constituent ratios of gram-negative bacilli, gram-positive cocci and fungi (P> 0.05). Escherichia coli and Klebsiella pneumoniae have high resistance to ciprofloxacin and most β-lactam antibiotics, but when these antibiotics are used in combination with β-lactamase inhibitors, the bacteria treat them The resistance rate may have different degrees of decline. There was no significant difference in the rate of resistance to commonly used antibiotics between Escherichia coli and Klebsiella pneumonia in the past four years (P> 0.05). Enterococci resistant to vancomycin were not found. Enterococcus faecium had a high resistance rate to almost all antibiotics, except vancomycin, which were significantly higher than those of Enterococcus faecalis (P <0.01). No common Candida albicans were found to be susceptible to fluconazole and voriconazole, two commonly used triazole antifungal agents. Non-Candida albicans was also sensitive to the above two antifungal agents with resistance rates of only 3.6%. Conclusions Community-based urinary tract infection is still the most common Escherichia coli, followed by enterococci, but the common pathogen resistance is more serious, should be timely detection of pathogens and their resistance, the development of appropriate treatment programs to guide the rational use of antibiotics .