Analysis of pathogenic bacteria in 120 patients with urinary tract infection
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摘要:目的 探讨泌尿系感染患者的病原菌分布特点及感染状况。方法 选取120例泌尿系感染患者，采集其中段尿液标本进行鉴定分析，应用VITEK全自动微生物分析仪检测病原菌，采用肉汤稀释法确定抗菌药物的最低浓度，然后用K-B纸片扩散法进行药敏试验，确证产超广谱β-内酰胺酶(ESBLs)菌株。结果 120份泌尿系感染患者尿液标本的病原菌检测结果均为阳性，检测出革兰氏阳性菌39株、革兰氏阴性菌70株、真菌11株，泌尿系感染患者的主要病原菌是革兰氏阴性菌(包括大肠埃希菌和肺炎克雷伯菌); 革兰氏阳性菌主要是屎肠球菌和粪肠球菌; 真菌主要是白色假丝酵母菌。药敏试验得到产ESBLs的大肠埃希菌33株(产ESBLs菌株占比68.75%)、产ESBLs的肺炎克雷伯菌7株(产ESBLs菌株占比58.33%), 这两种产ESBLs的病原菌对头孢、青霉素类抗菌药物有较高的耐药性，但对亚胺培南、美罗培南类抗菌药物无耐药性，产ESBLs菌株对抗菌药物的耐药性比非产ESBLs菌株更高。粪肠球菌和屎肠球菌对替考拉宁、万古霉素等强效抗生素无耐药性，对呋喃妥因、利福平的耐药性较低，对青霉素完全耐药。结论 泌尿系感染疾病的病原菌主要是革兰氏阴性菌，其中大多数为大肠埃希菌，且存在较多产ESBLs的菌株，对目前临床常用的抗菌药物均有不同程度的耐药性。泌尿系感染患者在诊治过程中需进行病原菌鉴定和药敏试验，明确病原菌种类及其耐药性，从而选择正确合理的抗菌药物进行治疗，减少抗生素滥用情况，提高抗菌药物的疗效。Abstract:Objective To analyze the distribution characteristics and infection status of pathogenic bacteria in patients with urinary tract infection.Methods A total of 120 patients with urinary tract infection in our hospital were selected. The mid-stream urine samples of the selected patients were collected for identification of pathogens detected by VITEK automatic microbiological analyzer. The minimum concentration of antibacterial agents by broth dilution method, and the drug sensitive test was conducted by K-B disk diffusion method to identify broad spectrum beta-lactamase(ESBLs) strain.Results Pathogenic positive bacteria results were seen in urine samples of 120 patients with urinary tract infection, including 39 strains of Gram-positive bacteria (Enterococcus faecalis and Enterococcus faecalis as major pathogens), 70 strains of Gram-negative bacteria and 11 strains of fungi (Candida albicans as major pathogen), with Gram-negative bacteria accounting for the largest proportion(Escherichia coli and Klebsiella pneumoniae as major pathogen). Thirty-three strains of Escherichia coli producing ESBLs(accounting for 68.75%in obtained strains of Escherichia coli) and seven strains of Klebsiella pneumoniae(accounting for 58.33% in total strains of Klebsiella pneumoniae) producing ESBLs were obtained by drug susceptibility test. The two ESBLs-producing pathogens had high drug resistance to cephalosporins and penicillins, but no resistance to antibiotics such as Penan and meropenem. Drug resistance in ESBLs-producing strains were higher that those of non-ESBLs-producing strains. Enterococcus faecalis and Enterococcus faecalis had no resistance to potent antibiotics such as teicoplanin, vancomycin, less resistance to furantoin and rifampicin and complete resistance to penicillin.Conclusion The main pathogens of urinary tract infections are Gram-negative bacteria, among which Escherichia coli accounts for the most proportion with more strains of ESBLs-producing pathogen and have different degrees of drug resistance to commonly used antibiotics in clinic. Therefore, patients need to carry out pathogenic bacteria identification and drug susceptibility test in the process of diagnosis and treatment of urinary tract infection so as to identify the types of pathogenic bacteria and their drug resistance to select right and reasonable antibiotics for treatment, reduce the abuse of antibiotics, and improve the efficacy of antibiotics.
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Keywords:
- urinary infection /
- distribution of pathogenic bacteria /
- drug resistance /
- antibiotics /
- testing
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表 1 泌尿系感染患者4种主要病原菌的耐药性分析[n(%)]
抗菌药物 大肠埃希菌(n=48) 肺炎克雷伯菌株(n=12) 屎肠球菌(n=14) 粪肠球菌(n=12) 青霉素 48(100.00) 12(100.00) 14(100.00) 12(100.00) 红霉素 - - 14(100.00) 12(100.00) 庆大霉素 30(62.50) 4(33.33) 10(71.43) 5(41.67) 万古霉素 - - 0 0 呋喃妥因 2(4.17) 1(8.33) 2(14.29) 1(8.33) 利福平 - - 3(21.43) 1(8.33) 替考拉宁 - - 0 0 美罗培南 0 0 - - 亚胺培南 0 0 - - 哌拉西林 44(91.67) 11(91.67) 11(78.57) 7(58.33) 头孢呋辛 42(87.50) 10(83.33) - - 头孢曲松 37(77.08) 9(75.00) - - 头孢他啶 30(62.50) 7(58.33) - - 头孢噻肟 36(75.00) 8(66.67) - - 头孢吡肟 33(68.75) 7(58.33) - - 氨曲南 32(66.67) 10(83.33) - - 阿米卡星 5(10.42) 2(16.67) - - 环丙沙星 35(72.92) 8(66.67) 9(64.29) 6(50.00) 左氧氟沙星 4(8.33) 2(16.67) 6(42.86) 5(41.67) 
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