唐山市工人医院2018年—2021年泌尿系结石感染患者的细菌谱变迁及药敏特点分析

Bacterial spectrum changes and drug sensitivity characteristics of patients with urinary stone infection in Tangshan Workers Hospital from 2018 to 2021

摘要:

目的 分析唐山市工人医院2018年—2021年泌尿系结石感染患者的细菌谱变迁及药敏特点。方法 收集2018年1月—2021年12月唐山市工人医院600例泌尿系结石患者的尿路感染病原菌600株，采用Interscience Scan1200型全自动菌落计数器、Thermo Scientific型全自动微生物鉴定仪测定病原菌的种类和数量，通过纸片扩散法（K-B法）进行药敏试验，分析耐药率。结果 2018年—2021年600例患者尿液标本中共分离600株病原菌。其中，革兰阴性菌416株（69.33%），革兰阳性菌136株（22.67%），真菌48株（8.00%）；大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌、假丝酵母菌排在前5位，分别占总菌株数的47.67%、9.83%、9.50%、8.00%、8.00%。4年期间病原菌检出率无明显变化趋势（P >0.05）；2018年—2021年大肠埃希菌对哌拉西林、头孢唑林、头孢呋辛、头孢噻肟的耐药率均> 60%，对替加环素的耐药率均为0%；2018年—2021年大肠埃希菌对庆大霉素、妥布霉素、呋喃妥因的耐药率比较，差异有统计学意义（χ²_线性趋势=5.003、4.009和4.430，P =0.025、0.045和0.035），呈逐渐降低趋势；2018年—2021年肺炎克雷伯菌对哌拉西林、头孢唑林、头孢噻肟的耐药率均> 60%；屎肠球菌对青霉素G、氨苄西林、环丙沙星、氧氟沙星、红霉素的耐药率均> 90%，粪肠球菌对青霉素G、庆大霉素、红霉素的耐药率均> 60%，2种革兰阳性菌对利奈唑胺、替考拉宁的耐药率均为0%；2018年—2021年肺炎克雷伯菌、屎肠球菌、粪肠球菌对各抗菌药物的耐药率比较，差异无统计学意义（P >0.05）。结论 唐山市工人医院2018年—2021年泌尿系结石伴尿路感染患者致病菌以大肠埃希菌为主，细菌谱与药敏特点无明显改变，临床应密切监测分离菌的变迁、耐药性，并根据药敏试验选择合理抗菌药物治疗。

Abstract:

Objective To analyze the bacterial spectrum and drug sensitivity of patients with 2021 infection Tangshan Workers Hospital from 2018 to 2021.Methods Totally 600 strains of pathogenic bacteria of urinary tract infection in patients with urinary calculi in Tangshan workers' hospital from January 2018 to December 2021 were collected. The species and quantity of pathogenic bacteria were determined by Interscience scan1200 automatic colony counter and Thermo Scientific automatic microbial identification instrument. The drug sensitivity test was carried out by paper diffusion method (K-B method), and the drug resistance rate was analyzed by software.Results From 2018 to 2021, in 600 pathogens, 416 gram-negative, 139 gram-positive, and 45 fungal strains were isolated, accounting for 69.33%, 22.67% and 8.00%, respectively. Among them, Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis, and Candida were ranked in the top five, accounting for 47.67%, 9.83%, 9.50%, 8.00% and 8.00% of the total number of strains, respectively. There was no significant change in the detection rate of pathogenic bacteria between 2018 and 2021 (P > 0.05); the resistance rates of Escherichia coli to piperacillin, cefazolin, cefotaxime were > 60% from 2018 to 2021, and the rate of resistance to tigecycline was all 0; From 2018 to 2021, the drug resistance rates of Escherichia coli to gentamicin, tobramycin, and nitrofurantoin were compared, and the difference was statistically significant (linear trend χ² = 5.003, 4.009, and 4.430, P =0.025, 0.045, and 0.035); In 2018 to 2021, the resistance rates of K. pneumoniae to piperacillin, cefazolin, and cefotaxime were > 60%; the resistance rates of enterococcus faecium to penicillin G, ampicillin, ciprofloxacin, ofloxacin, and erythromycin were all > 90%; the resistance rate of E. faecalis to penicillin G, gentamicin, and erycomycin were all > 60%; the resistance rate to linezolid and teicyranine in both Gram-positive bacteria was 0; Compared with the resistance rate of Klebsiella pneumoniae, Enterococcus faecium, and E. faecalis in the four years, there was no statistically significant difference (P > 0.05).Conclusion Escherichia coli is the main pathogenic bacteria in patients with urinary tract infection and calculi in Tangshan Workers Hospital from 2018 to 2021. The bacterial spectrum and drug sensitivity of the patients have not changed obviously. Therefore, the change and drug resistance of the isolated bacteria should be closely monitored, according to the drug sensitivity test, to choose the rational antimicrobial therapy.