导尿管相关菌尿的病例特点及病原学耐药分析

发布时间：2018-07-17 00:17

【摘要】：目的结合临床资料及病原菌的药敏检测结果,分析导尿管相关菌尿的病例特点和病原菌耐药情况。方法收集我院2010年至2014年所有住院病人的尿标本分离的非重复细菌1831株进行耐药率分析,通过电子病历系统收集患者资料。结果留置导尿和非留置导尿组中,无症状菌尿分别占55.9%和57.2%,留置导尿管组所有病人均接受了抗菌素治疗。有症状感染的病人合并菌血症的比例明显升高。大肠埃希菌在非尿管来源病原体中占60.1%,在导尿管来源病原体中占35.2%,肠球菌属在导尿管来源病原体中比例为34.9%。尿管来源和非尿管来源的大肠埃希菌对头孢菌素(第2,3,4代)、哌拉西林/他唑巴坦、喹诺酮类和呋喃妥因的耐药率分别为65%~80%和29.4%~68.8%,4.9%~9.8%和2.9%~4.2%,85%~90%和62.7%~77.3%,0~16.7%和7.4%~8.3%。没有发现对利奈唑胺耐药的肠球菌。导尿管来源和非导尿管来源的铜绿假单胞菌对头孢他啶、哌拉西林/他唑巴坦和碳青霉烯类的耐药率分别为11.9%~16.1%和5.7%~7.5%,4.8%~12.5%和2.9%~10.0%,11.9%~21.8%和2.5%~8.6%。而有症状组铜绿假单胞菌的耐药率均低于无症状组,两组耐药率差异5%~15%。结论导尿管相关的无症状菌尿病人仍在临床中接受抗菌素治疗。导尿管来源细菌对抗菌素耐药率高于非尿管来源细菌。
[Abstract]:Objective to analyze the case characteristics and drug resistance of urine associated with urethral catheter combined with clinical data and drug sensitivity test results of pathogenic bacteria. Methods from 2010 to 2014, 1831 strains of non-repetitive bacteria were collected from urine samples of all inpatients in our hospital for drug resistance analysis, and the data of patients were collected by electronic medical record system. Results in the indwelling catheterization and non-indwelling catheterization groups, the asymptomatic bacteriuria accounted for 55.9% and 57.2% respectively. All the patients in the indwelling urethral catheter group were treated with antibiotics. The proportion of patients with symptomatic infection associated with bacteremia increased significantly. Escherichia coli accounted for 60.1% of non-urethral pathogens and 35.2% of urethral pathogens, while Enterococcus accounted for 34.9% of urethral pathogens. The resistance rates of piperacillin / tazobactam, quinolones and furantoin to cephalosporins, piperacillin / tazobactam, quinolones and furantoin were 65, 80% and 29. 448%, 68. 8% and 2. 9%, 4. 22 8590% and 62. 7%, 7. 3% and 8. 3% respectively for Escherichia coli from urethral and non-catheterized Escherichia coli, and piperacillin / tazobactam, quinolone and furantoin, respectively. No enterococci resistant to linazolamine were found. The resistance rates of Pseudomonas aeruginosa from urethral and non-urethral sources to ceftazidime, piperacillin / tazobactam and carbapenem were 11.991% and 5.77.5%, 12.5% and 10.0%, respectively, and 2.5% and 8.6% to ceftazidime, piperacillin / tazobactam and carbapenem, respectively. The resistance rate of Pseudomonas aeruginosa in symptomatic group was lower than that in asymptomatic group. Conclusion the patients with asymptomatic bacteriuria associated with urethral catheter are still receiving antibiotic therapy. The rate of antibiotic resistance of urethral-derived bacteria was higher than that of non-urethral catheter-derived bacteria.
【作者单位】：北京大学第一医院临床药理研究所;
【分类号】：R446.5

【参考文献】