CAJ | 학술논문

目的：分析尿液细菌培养中病原菌分布与耐药情况，为临床合理选择抗生素提供依据。方法回顾性调查南京医科大学附属淮安第一医院2011年1月至2013年12月门诊及住院患者送检的3271例尿液标本培养鉴定及药敏试验结果，并进行统计分析。结果3271例尿液标本共检出病原菌1188株，总检出率为36.3%，其中革兰阴性菌799株，占67.3%，以大肠埃希菌为主，革兰阳性菌257株，占21.6%，以屎肠球菌为主，两者比较差异具有统计学意义（P＜0.05）；真菌132株，占11.1%，以白色念珠菌为主。大肠埃希菌对亚胺培南、呋喃妥因及哌拉西林/他唑巴坦有较高的敏感性，耐药率分别为0.4%、6.5%、13.9%，对喹诺酮类耐药率为75.3%～77.3%，对青霉素类和β-内酰胺类抗菌药物耐药率为45.9%～93.4%，超广谱β-内酰胺酶阳性的大肠埃希菌223株，占48.3%；屎肠球菌对万古霉素及氯霉素显示有较好的敏感性，耐药率分别为0.0%、11.4%，对其他抗菌药物耐药率均在57.1%～94.3%；白色念珠菌对常用抗真菌药物敏感性较高，耐药率最高为12.9%。结论泌尿道感染病原菌以大肠埃希菌、屎肠球菌及白色念珠菌为主，肠杆菌科细菌及肠球菌属对常用抗菌药物喹诺酮类及第三代头孢菌素耐药率较高，应重视泌尿道细菌感染的病原菌培养，加强抗菌药物的合理使用。
목적：분석뇨액세균배양중병원균분포여내약정황，위림상합리선택항생소제공의거。방법회고성조사남경의과대학부속회안제일의원2011년1월지2013년12월문진급주원환자송검적3271례뇨액표본배양감정급약민시험결과，병진행통계분석。결과3271례뇨액표본공검출병원균1188주，총검출솔위36.3%，기중혁란음성균799주，점67.3%，이대장애희균위주，혁란양성균257주，점21.6%，이시장구균위주，량자비교차이구유통계학의의（P＜0.05）；진균132주，점11.1%，이백색념주균위주。대장애희균대아알배남、부남타인급고랍서림/타서파탄유교고적민감성，내약솔분별위0.4%、6.5%、13.9%，대규낙동류내약솔위75.3%～77.3%，대청매소류화β-내선알류항균약물내약솔위45.9%～93.4%，초엄보β-내선알매양성적대장애희균223주，점48.3%；시장구균대만고매소급록매소현시유교호적민감성，내약솔분별위0.0%、11.4%，대기타항균약물내약솔균재57.1%～94.3%；백색념주균대상용항진균약물민감성교고，내약솔최고위12.9%。결론비뇨도감염병원균이대장애희균、시장구균급백색념주균위주，장간균과세균급장구균속대상용항균약물규낙동류급제삼대두포균소내약솔교고，응중시비뇨도세균감염적병원균배양，가강항균약물적합리사용。
Objective To investigate the distribution of pathogens and antibiotic resistant state in urinary tract infection, to provide reference for clinical rational use of antibiotics. Methods Review analysis was performed for 3 271 urine culture samples from Nanjing Medical University affiliated Huai’an No.1 hospital during 2011 to 2013. Statistical analysis was applied for the types and antibiotic resistance of 1 188 strains of pathogenic bacteria in urine culture positive. Results The total isolation rate of urine culture samples was 36.3%. In these positive cases, 799 strains of Gram negative bacteria were detected 67.3%and the most common was Escherichia coli. There were 257 strains of Gram positive bacteria 21.6%and the majority was Enterococcus. Significant difference was obtained in the strains of Gram negative bacteria and positive bacteria (P<0.05). Fungi occupied 11.1%among the strains of pathogenic bacteria in urine culture positive (132/1 188) and the majority was Candida albicans. Antimicrobial susceptibility tests showed the strains of Escherichia coli were susceptible to Imipenem, Nitrofurantoin, and Piperacillin/Tazobactam. The drug resistance rates of Escherichia coli to these antibiotics were 0.4%, 6.5%, and 13.9% separately. And the rates of drug resistance to other antibiotics were as follows: Quinolones 75.3%-77.3%, Penicillin andβ-lactams 45.9%-93.4%. Among all the strains of Escherichia coli, 223 cases were Extended-Spectrum Beta-Lactamase-Producing and the percentage was 48.3%. The strains of Enterococcus were susceptible to Vancomycin and Chloramphenicol, and the antibiotic resistance rates were 0.0%and 11.4%. The rates of drug resistance to other antibiotics were among 57.1%-94.3%. A high sensitivity of the strains of Fungi to the common antifungal antibiotics was shown and the highest rate of drug resistance was only 12.9%. Conclusion Escherichia coli, Enterococcus and Fungi are the major pathogens in urinary tract infection. There are high rates of antibiotic resistance of Escherichia coli and Enterococcus to Quinolones and third generation Cephalosporin. It is of importance to perform urine culture and antimicrobial susceptibility test as well as clinical rational use of antibiotics.