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。
Objective To analyze the distribution of pathogens and the resistance to the antibiotics in patients with urinary tract infections in Yunnan province, and provide reference for clinical rational selections of antimicrobial agents. Methods Bacterial identification and antimicrobial susceptibility testing were carried out according to a unified protocol by using the Kirby-Bauer method or the automated systems, and the data were analyzed by WHONET 5.6 software according to CLSI 2016 breakpoints. Results A total of 42,232 clinical isolates were analyzed from urine specimens from January 2013 to December 2015 of 35 tertiary hospitals in Yunnan province. About 55.4% of the strains were isolated from female patients, of which 65.0% were E. coli; 44.6% of the strains were isolated from male patients, of which 39.6% were E. coli. 32,786 strains of Gram-negative bacteria were isolated, accounting for 77.6%, and 9,446 strains of Gram-positive bacteria were isolated, accounting for 22.4%; E. coli was the most prevalent species, accounting for 53.8%, followed by Enterococcus spp. （13.9%）, Klebsiella spp. （8.3%） and Proteus spp. （3.5%）. The prevalence of ESBLs-producing strains in E. coli and K. pneumoniae were 52.3% and 44.4%, respectively. The top 9 sensitive rates of E. coli to antibiotics were as follows： ertapenem（99.7%）, meropenem （99.7%）, imipenem （99.6%）, cefotetan （97.6%）, amikacin （96.7%）, fosfomycin （94.3%）, piperacillin/tazobactam （87.4%）, nitrofurantoin （83.3%） and cefoperazone/sulbactam （64.9%）. More than 89.9% of the E. coli were resistant to ampicillin. Fewer than 10% of Klebsiella pneumoniae isolates were resistant to ertapenem （6.5%） and meropenem （9.9%）. Excluding amikacin and nitrofurantoin, the resistant rates of E. coli and Klebsiella pneumoniae isolated from hospitalized patients were higher than those of outpatients. Excluding linezolid and tetracycline, E. faecium had higher resistant rates than did E. faeealis. The trend of drug resistance rate was different in 3 years. Conclusion The E. coli, Enterocoecus spp. and Klebsiellapneumoniae were the predominant pathogens of the urine culture in Yunnan province. The resistance profile of pathogens varies in different years, areas, departments, ages, gender and specimens where they were isolated. The treatment of urine tract infections should be based on antimicrobial susceptibility results or local drug resistance data.
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2017年第7期548-560,共13页
Chinese Journal of Antibiotics
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)
关键词
尿路感染
尿标本
病原菌
耐药性
Urinary tract infection
Urine specimen
Pathogen
Drug resistance
