【摘要】 目的 探讨门诊就诊女性尿路感染(UTI)患者尿液病原菌谱分布及药物敏感性，为该类患者抗菌药物的选择和治疗提供依据。方法 选择1998年1月至2018年12月，于中山大学附属第一医院门诊就诊并确诊为UTI的643例女性患者为研究对象，年龄为14～95岁。根据是否绝经，将其分为绝经组(n=362)与非绝经组(n=281)。本研究遵循的程序经中山大学附属第一医院伦理委员会批准(审批文号：伦审[2021]372号)。结果 (1)自纳入研究的643例UTI患者的尿液标本中，分离获得643株病原菌中，革兰阴性(G~-)杆菌为567株(88.2%),革兰阳性(G~+)球菌为76株(11.8%);G~-杆菌主要为大肠埃希菌(70.3%,452/643),其次为肺炎克雷伯菌(6.2%,40/643);G~+球菌主要为粪肠球菌(2.6%,17/643)、无乳链球菌(1.9%,12/643)和屎肠球菌(1.7%,11/643)。(2)药物敏感性试验：大肠埃希菌和肺炎克雷伯菌对头孢哌酮舒巴坦、阿米卡星、哌拉西林/他唑巴坦、亚胺培南等药物维持较高敏感度；大肠埃希菌对呋喃妥因同样具有较高的敏感度，而对环丙沙星、头孢曲松及磺胺甲■唑/甲氧苄啶高度耐药。肺炎克雷伯菌对头孢曲松、呋喃妥因高度耐药。(3)42.0%(190/452)大肠埃希菌与40.0%(16/40)肺炎克雷伯菌，为产超广谱β内酰胺酶(ESBLs)菌株。(4)2组患者的主要病原菌均为大肠埃希菌(68.0%,72.1%),肺炎克雷伯菌(6.4%,6.1%)。2组患者的主要病原菌分布所占比例比较，差异无统计学意义(P>0.05)。(5)绝经组UTI患者大肠埃希菌对环丙沙星耐药率为69.7%(166/238),明显高于非绝经组的54.0%(95/176),并且差异具有统计学意义(P<0.05)。(6)绝经组UTI患者肺炎克雷伯菌对头孢曲松、头孢吡肟的耐药率分别为66.7%(14/21)和45.0%(9/20),明显高于非绝经组的33.3%(6/18)和5.6%(1/18),并且差异亦有统计学意义(P<0.05)。结论 门诊就诊UTI女性患者最常见的病原菌为大肠埃希菌。绝经期UTI患者对氟喹诺酮类药物的耐药率高。大肠埃希菌对呋喃妥因持续高度敏感，可推荐作为门诊UTI女性患者治疗的经验性治疗用药。更多还原

【Abstract】 Objective To explore spectrum distribution and drug sensitivity of main pathogenic bacteria in outpatients with urinary tract infection(UTI), so as to provide the basis for the selection and treatment of antibacterial drugs. Methods From January 1998 to December 2018, a total of 643 women, aged from 14 to 95 years old, who were diagnosed as UTI in the outpatient department of First Affiliated Hospital of Sun Yat-Sen University were selected into this study old. According to whether menopause or not, they were divided into menopausal group(n=362) and non-menopausal group(n=281). The procedures in this study were approved by Ethics Committee of First Affiliated Hospital of Sun Yat-Sen University(Approval No. [2021]372). Results(1) A total of 643 pathogenic bacteria were isolated, including 567(88.2%) Gram-negative(G~-) and 76(11.8%) Gram-positive(G~+) bacteria strains. The most common G~- uropathogens were Escherichia coli(70.3%), followed by Klebsiella pneumonia(6.2%). Enterococcus faecalis(2.6%, 17/643), Streptococcus agalactiae(1.9%, 12/643) and Enterococcus faecium(1.7%, 11/643) were found to be the predominant G~+ strains.(2)Escherichia coli and Klebsiella pneumoniae sustained high susceptibility to cefoperazone-sulbactam, amikacin, piperacillin-tazobactam and imipenem, Escherichia coli remained high susceptibility to nitrofurantoin as well. However, Escherichia coli were highly resistant to ciprofloxacin, ceftriaxone and trimethoprim-sulfamethoxazole. Klebsiella pneumoniae were highly resistant to ceftriaxone and nitrofurantoin.(3)42.0%(190/452) Escherichia coli strains and 40.0%(16/40) Klebsiella pneumoniae strains were extended-spectrum-lactamase-producing(ESBLs) strains.(4)The main pathogenic bacteria in both groups were Escherichia coli(68.0%, 72.1%) and Klebsiella pneumoniae(6.4%, 6.1%). There was no significant difference in the distribution proportion of main pathogenic bacteria between two groups(P>0.05).(5) The resistance rate of Escherichia coli to ciprofloxacin was higher in menopausal group(69.7%, 166/238) than that of non-menopausal group(54.0%, 95/176), and the difference was significant(P<0.05).(6) The drug resistance rates of Klebsiella pneumoniae in menopausal group to ceftriaxone and cefepime were 66.7%(14/21) and 45.0%(9/20), respectively, which were significantly higher than those in non-menopausal group(33.3%, 6/18; 5.6%, 1/18), and the differences were statistically significant(P<0.05). Conclusions Escherichia coli is the most common uropathogens obtained from female with UTI in outpatient clinic. The isolated Escherichia coli remain high resistance rate to fluoroquinolones in postmenopausal patients. Escherichia coli sustain highly sensitive to nitrofurantoin which can be recommended as an empirical treatment for uncomplicated UTI in outpatient clinic.更多还原