泌尿系结石患者尿路大肠埃希菌感染的临床特点及药物敏感性分析

Antibiotic susceptibility and clinical characteristics of Escherichia coli in patients with urinary tract stones

摘要:

目的 分析泌尿系结石患者尿路大肠埃希菌感染的临床特点及药物敏感性情况，为临床合理用药 提供参考。方法 回顾性分析广州医科大学附属第一医院泌尿外科2010 年1 月-2015 年12 月泌尿系结石患 者中段尿培养分离的大肠埃希菌对常见抗菌药物敏感性的结果。结果 泌尿系结石合并尿路大肠埃希菌感染 的患者共1 894 例。其中，男性患者555 例（29.30%），平均年龄54.05 岁，女性患者1 339 例（70.70%），平均 年龄53.24 岁。41 ～ 60 岁年龄段的男、女性患者比例最大，分别占41.34% 和55.82%。大肠埃希菌对头孢美唑、 头孢替坦、丁胺卡那霉素、替加环素、哌拉西林/ 他唑巴坦以及碳青霉烯类（厄他培南、美罗培南、亚胺培南） 等抗菌药物的敏感性高于90% 以上；对氨苄西林、头孢唑啉、头孢噻肟、头孢曲松、左氧氟沙星、环丙沙星 等抗菌药物的敏感性低于40%。结论 泌尿系结石患者尿路大肠埃希菌对喹诺酮类及部分第3 代头孢菌素类 抗菌药物的敏感性较低，不适合用于经验性治疗；而对头孢美唑、头孢替坦、哌拉西林/ 他唑巴坦以及碳青 霉烯类等抗菌药物则较为敏感，临床治疗中需根据药敏结果进行规范用药。

Abstract:

Objective To investigate the antibiotic susceptibility and clinical characteristics of Escherichia coli isolated from urine specimens in patients with urinary calculi. Methods The results of antibiotic susceptibility of Escherichia coli isolated from mid-stream urine of the patients with urinary calculi in the First Affiliated Hospital of Guangzhou Medical University between January 2010 and December 2015 were analyzed retrospectively. Results A total of 1,894 strains of Escherichia coli were detected from urine specimens in the patients with urinary calculi, including 555 (29.30%) from male and 1,339 (70.70%) from female. Among them, the most common age group was 41-60 years both in male (41.34%) and female (55.82%). Escherichia coli was sensitive to Cefmetazole, Cefotetan, Amikacin, Tigecycline, Piperacillin/Tazobactam and Carbapenems (including Ertapenem, Meropenem and Imipenem), and the sensitive rates were all more than 90%. In contrast, it was less sensitive to antibiotics such as Ampicillin, Cefazolin, Cefotaxime, Ceftriaxone, Levofloxacin and Ciprofloxacin, with the sensitive rate less than 40%. Conclusions Escherichia coli from the urine of the patients with urinary calculi showed low sensitive rate to Fluoroquinolones and some of the third-generation Cephalosporins, which may not be suitable for empirical therapy in the patients with urinary calculi. In contrast, the bacteria is sensitive to Cefmetazole, Cefotetan, Piperacillin/Tazobactam and Carbapenems. In the treatment of urinary tract infection in the patients with urinary calculi, standardized medication should be taken according the antibiotic sensitivity.