标题：泌尿外科患者尿路感染病原菌分布及耐药性分析

      作者：严友纪 1，廖星富 2，陈忠军 1，周家杰 1    (荆州市中心医院长江大学第二临床医学院泌尿外科 1、检验科 2，湖北 荆州 434020)

      卷次： 2018年29卷20期

      【摘要】 目的 了解我院泌尿外科住院患者泌尿道感染常见的病原菌分布及耐药性特点，为临床医师合理选用抗菌素及控制院内感染、降低细菌耐药性提供帮助。方法 收集2014年1月至2016年12月荆州市中心医院泌尿外科门诊及住院部4 938例尿液标本，分离出690株尿液病原菌，采用VITEK-2全自动药敏鉴定分析仪对分离的菌株进行鉴定及药敏分析。结果 4 938例尿液标本中分离出690株病原菌，病原菌分离率为14.00%。其中，革兰阴性菌504株，占70.0%；革兰阳性菌130株，占18.9%；真菌56株，占8.1%。分离株位于前五位者分别为大肠埃希菌 367株(53.2%)、铜绿假单胞菌 43株(6.2%)、粪肠球菌 40株(5.8%)、肺炎克雷伯菌 39株(5.6%)、屎肠球菌 26株(3.8%)。碳青霉烯类、含酶的复合抗菌素、氨基糖苷类的阿米卡星及头孢菌素类的头孢西丁对革兰阴性菌显示了较好的抗菌活性。呋喃妥因、万古霉素、利奈唑胺及替加环素对革兰阳性菌显示了较好的抗菌活性。前三位的泌尿道真菌为光滑假丝酵母菌、热带假丝酵母菌和近平滑假丝酵母菌，其对5-氟胞嘧啶、两性霉素B及伏立康唑均有较高的敏感率。结论 在治疗泌尿道感染时，要了解病原菌分布及耐药性特点，应加强病原菌的检测，合理规范使用抗菌药物，提高治疗效果，缩短感染进程。
      【关键词】 尿路感染；尿脓毒血症；病原菌；耐药性
      【中图分类号】 R69 【文献标识码】 A 【文章编号】 1003—6350（2018）20—2869—04

Analysis of distribution and drug resistance of pathogens causing urinary tract infections in patients fromDepartment of Urology.
YAN You-ji 1, LIAO Xing-fu 2, CHEN Zhong-jun 1, ZHOU Jia-jie 1. Department of Urology 1,Department of Clinical Laboratory 2, Jingzhou Central Hospital, the Second Clinical Medical College, Yangtze University,Jingzhou 434020, Hubei, CHINA
【Abstract】 Objective To investigate the distribution and drug resistance characteristics of common species ofpathogens in hospitalized patients of Department of Urology, and provide help for clinicians to select antibiotics reason-ably, control nosocomial infection and reduce bacterial resistance. Methods A total of 690 urine pathogens isolatedfrom 4 938 urine samples of Inpatient and Outpatient Department of Urology, Jingzhou Central Hospital from January2014 to December 2016 were collected. The identification of isolated strains and drug susceptibility tests were carriedout by using Vitek-2 automatic analyzer. Results A total of 690 strains of pathogenic bacteria were isolated in 4 938urine samples, and the isolation rate of pathogenic bacteria was 14.00%. Among them, 504 strains were Gram-negativebacteria, accounting for 70.0%. There were 130 strains of Gram-positive bacteria, accounting for 18.9%. A total of 56strains were fungi, accounting for 8.1%. The top five species of isolated pathogens were: 367 strains (53.2%) of Esche-richia coli, 43 strains (6.2%) of Pseudomonas aeruginosa, 40 strains (5.8%) of Enterococcus faecalis, 39 strains (5.6%) ofKlebsiella pneumonia, 26 strains (3.8%) of Enterococcus faecium. Carbapenem, enzyme based compound antibiotics, ami-noglycosides Amikacin and cephalosporin cefoxitin showed excellent antibacterial activity against Gram-negative bacte-ria. Furantoin, vancomycin, linezolid, and tegicycline showed good antibacterial activity to Gram-positive bacteria. 5-flu-cytosine, amphotericin B and voriconazole showed high sensitive rate to the top three urinary tract fungi: Candida gla-brata, Candida tropicalis and Candida parapsilosis. Conclusion In the process of treating urinary tract infection, weshould understand the distribution and drug resistance characteristics of pathogens, strengthen the detection of patho-gens, rationally regulate the use of antibiotics, improve the therapeutic effect, and shorten the infection process.
      【Key words】 Urinary tract infection; Urinary sepsis; Pathogen; Drug resistance·论 著·doi:10.3969/j.issn.1003-6350.2018.20.018