【摘要】 目的分析围手术期泌尿系统多重耐药菌感染的尿细菌谱及其药物敏感实验结果,指导临床治疗。方法回顾性分析我院自2013年1月至2016年12月154例患者围手术期清洁中段尿培养的多重耐药感染细菌谱和药物敏感实验结果报告。结果 154例多重耐药菌感染患者中革兰氏阴性菌有148例,占96.1%(148/154),阴性菌中β-内酰胺酶(ESBLs)阳性145例,占97.97%(145/148),阴性中大肠埃希菌127例,占第一位为82.47%(127/154),其中ESBLs阳性125例,占98.43%(125/127);革兰氏阳性菌有6例,其中屎肠球菌4例,溶血葡萄球菌2例。多重耐药菌在疾病分布中泌尿系结石占69.48%(107/154),其次为泌尿系梗阻占21.43%(33/154);人群分布中以中老年组最多,占80.52%(124/154),青年组占15.58%(24/154)。对革兰氏阴性菌耐药率高的抗菌药分别是:羧苄西林、环丙沙星、头孢噻肟、复方新诺明,而敏感率较高的药物为:亚胺培南、阿米卡星、哌拉西林/他唑巴坦、呋喃妥因;革兰氏阳性菌敏感率高抗菌药为:亚胺培南、万古霉素,耐药率较高的药物为:羧苄西林、环丙沙星、头孢噻肟、复方新诺明、头孢他啶。结论围手术期尿路多重耐药菌感染患者中以革兰氏阴性菌感染为主,其中又以大肠埃希菌最多,产生耐药性的主要原因为产生ESBLs。在进行经验性治疗时可选择对大肠埃希菌产ESBLs菌株敏感的抗菌药物进行治疗,并加强对抗菌药物使用的监测。更多还原

【Abstract】 Objective To analyze the urinary bacterial spectrum and drug sensitivity test results of multidrug resistant bacterial infection in the urinary system during the perioperative period, aiming to guide clinical treatment. Methods The multidrug resistant bacterial spectrum and drug sensitivity test results of 154 patients with multidrug-resistant infection in the urine culture during the perioperative period in our hospital from January, 2013 to December, 2016 were retrospectively analyzed. ResultsAmong 154 cases, 148 patients were infected with Gram-negative bacteria(96.1%, 148/154) including positive ESBLs in 145 cases(97.97%, 145/148) and Escherichia coli in 127 patients(82.47%, 127/154), which included positive ESBLs in 125 cases(98.43%, 125/127). Six cases were infected with Grampositive bacteria, including 4 cases of Enterococcus faecium and 2 cases of Staphylococcus haemolyticus. Multidrug-resistant bacteria were dominantly detected in urinary stones, accounting for 69.48%(107/154), followed by urinary obstruction(21.43%, 33/154). Regarding the population distribution, the middle-aged and elderly patients accounted for 80.52%(124/154) and 15.58%(24/154) for their young counterparts. Antibiotics with high resistance to Gram-negative bacteria included carboxybenzillin, ciprofloxacin, cefotaxime and compound sulfamethoxazole, whereas those with high sensitivity consisted of imipenem, amikacin, piperacillin/tazobactam and nitrofurantoin. Antibiotics with high sensitivity to Gram-positive bacteria were imipenem and vancomycin, and those with high resistance included carboxybenzillin, ciprofloxacin, cefotaxime, compound sulfamethoxazole and ceftazidime. Conclusions Gram-negative bacteria are the main cause of infection in patients with multidrug-resistant bacterial infection in the urinary tract during perioperative period, dominated by the Escherichia coli. The main cause of drug resistance is the generation of ESBLs. During empirical treatment, antibiotics sensitive to the ESBLs of Escherichia coli can be selected. The monitoring of antibiotic use should be strengthened.更多还原