【摘要】 目的 了解2015—2021年CHINET细菌耐药监测网中尿液分离菌的分布和耐药性。方法 收集CHINET细菌耐药监测网51家医疗机构2015—2021年所有尿液标本临床分离菌的耐药监测数据资料，采用WHONET 5.6软件进行统计分析。结果 2012—2021年尿液标本共分离细菌261 893株，其中革兰阳性菌62 219株，占23.8%，革兰阴性菌199 674株，占76.2%。常见的分离菌依次为大肠埃希菌(46.7%)、屎肠球菌(10.4%)、肺炎克雷伯菌(9.8%)、粪肠球菌(8.7%)、奇异变形杆菌(3.5%)、铜绿假单胞菌(3.4%)、无乳链球菌(2.6%)和阴沟肠杆菌(2.1%)。上述细菌主要分离自住院患者，女性多见于男性，成人多见于儿童。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中产超广谱β内酰胺酶(ESBL)菌株分别占53.2%、52.8%和37.0%。耐碳青霉烯类的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌中检出率分别为1.7%、18.5%、16.4%和40.3%。粪肠球菌对氨苄西林、呋喃妥因、利奈唑胺、万古霉素、替考拉宁和磷霉素的耐药率<10%，屎肠球菌对氨苄西林、左氧氟沙星、红霉素的耐药率>90%，对万古霉素、利奈唑胺和替考拉宁的耐药率<2%。ICU住院患者分离的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌对大部分抗菌药物的耐药率明显高于门诊患者和非ICU住院患者。结论 尿液标本临床分离菌主要以大肠埃希菌、肠球菌和肺炎克雷伯菌为主，不同人群尿液标本中分离的细菌种类和耐药性不尽相同，应重视细菌耐药监测，减少抗菌药物的不合理使用。更多还原

【Abstract】 Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8% (62 219/261 893),and gram-negative bacteria 76.2% (199 674/261 893).The most common species were E.coli (46.7%),E.faecium (10.4%),K.pneumoniae (9.8%),E.faecalis (8.7%),P.mirabilis (3.5%),P.aeruginosa (3.4%),S.agalactiae (2.6%),and E.cloacae (2.1%).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2%,52.8% and 37.0%,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7%,18.5%,16.4%,and 40.3%,respectively.Lower than 10% of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90% of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was <2%.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.更多还原