2013—2015年云南省三级医院尿培养病原菌分布及耐药性分析

发布时间：2018-11-04 10:44

【摘要】：目的分析云南地区尿路感染患者病原菌分布和对常见抗菌药物的耐药状况,为合理选用抗菌药物提供客观依据。方法按统一方案,采用纸片扩散法或自动化仪器法进行细菌鉴定及抗菌药物敏感试验,判定标准按CLSI 2016年版,统计分析使用WHONET 5.6软件进行。结果 2013年1月—2015年12月云南省35家三级医院临床尿标本分离出病原菌42232株,女性患者尿标本占55.4%,其中65.0%为大肠埃希菌,男性患者尿标本占44.6%,其中39.6%为大肠埃希菌。42232株菌中革兰阴性菌32786株,占77.6%,革兰阳性菌9446株,占22.4%;以大肠埃希菌最常见(53.8%),其余依次为肠球菌属细菌(13.9%)、克雷伯菌属细菌(8.3%)和变形菌属细菌(3.5%)等。大肠埃希菌和肺炎克雷伯菌ESBLs检出率分别为52.3%和44.4%。大肠埃希菌对抗菌药物的敏感率前9位依次为:厄他培南(99.7%)、美罗培南(99.7%)、亚胺培南(99.6%)、头孢替坦(97.6%)、阿米卡星(96.7%)、磷霉素(94.3%)、哌拉西林/三唑巴坦(87.4%)、呋喃妥因(83.3%)和头孢哌酮/舒巴坦(64.9%);耐药率最高的抗菌药物为氨苄西林(89.9%)。肺炎克雷伯菌对厄他培南(6.5%)和美罗培南(9.9%)耐药率低于10.0%。除阿米卡星和呋喃妥因外,住院患者分离出的大肠埃希菌和肺炎克雷伯菌对各种抗菌药物的耐药率均高于门诊患者。除利奈唑胺和四环素外,屎肠球菌对其他抗菌药物的耐药率均明显高于粪肠球菌。不同抗菌药物3年耐药率变化趋势有所不同。结论云南地区尿培养病原菌以大肠埃希菌、肠球菌属和肺炎克雷伯菌为主。不同年份、不同地区、不同科室、不同年龄、不同性别及不同标本中病原菌对抗菌药物的耐药率各不相同。临床应依据药敏结果或参照当地细菌耐药性资料合理选择抗菌药物。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria and drug resistance to common antibiotics in urinary tract infection patients in Yunnan, and to provide an objective basis for the rational selection of antimicrobial agents. Methods according to the unified scheme, the bacteria identification and antimicrobial susceptibility test were carried out by using disk diffusion method or automatic instrument method. The criteria were determined by CLSI 2016 edition, and the statistical analysis was carried out by WHONET 5.6 software. Results from January 2013 to December 2015, 42232 strains of pathogenic bacteria were isolated from clinical urine samples from 35 hospitals in Yunnan Province. The urine samples of female patients accounted for 55.45.0% of them were Escherichia coli and 44.6% were male patients. Among them, 39.6% were Escherichia coli. Among the 42232 strains, 32786 were Gram-negative bacteria (77.6%), 9446 were Gram-positive bacteria (22.4%). Escherichia coli was the most common (53.8%), followed by Enterococcus (13.9%), Klebsiella (8.3%) and Proteus (3.5%). The ESBLs positive rates of Escherichia coli and Klebsiella pneumoniae were 52.3% and 44.4%, respectively. The susceptibility rates of Escherichia coli to antibiotics were as follows: ertapenem (99.7%), meropenem (99.7%), imipenem (99.6%), ceftitan (97.6%), amikacin (96.7%). Fosfomycin (94.3%), piperacillin / triazobactam (87.4%), furantoin (83.3%) and cefoperazone / sulbactam (64.9%). Ampicillin (89.9%) was the most resistant antibiotic. The resistance rates of Klebsiella pneumoniae to ertapenem (6.5%) and meropenem (9.9%) were lower than 10.0%. With the exception of amikacin and furantoin, the antibiotic resistance rates of Escherichia coli and Klebsiella pneumoniae isolated from inpatients were higher than those of outpatients. The resistance rate of Enterococcus faecium to other antimicrobial agents was significantly higher than that of Enterococcus faecalis except linazolamine and tetracycline. The change trend of resistance rate of different antimicrobial agents in 3 years was different. Conclusion Escherichia coli, Enterococcus and Klebsiella pneumoniae are the main pathogens in urine culture in Yunnan. In different years, different regions, different departments, different ages, different genders and different specimens, the resistance rate of pathogens to antimicrobial agents is different. Antimicrobial agents should be selected according to the results of drug sensitivity or according to the data of drug resistance of local bacteria.
【作者单位】：昆明医科大学第一附属医院医学检验科;
【基金】：2014年国家自然科学基金(No.81460322) 2014年云南省应用基础研究联合专项(No.2014FB043)
【分类号】：R446.5

【相似文献】