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目的探讨本地区泌尿道结石合并感染患者尿液标本中病原菌分布及耐药性。方法选取2015年1月-2016年12月本院泌尿外科收治的泌尿道结石合并尿路感染的患者309例,采集患者中段尿,对未能成功采集者在外科手术过程中收集尿液,常规进行细菌培养鉴定。全自动微生物分析仪进行药敏实验,使用真菌检测培养基及药敏板条鉴定真菌种类和药敏实验。结果本次研究中共分离出284株病原菌,其中革兰阴性菌195株(68.66%),明显高于革兰阳性菌64株(22.54%)和真菌25株(8.80%),差异有统计学意义(P<0.05)。检出的革兰阴性菌中大肠埃希菌比例明显高于其他菌株,革兰阳性菌中粪肠球菌比例明显高于其他菌株,差异有统计学意义(P<0.05)。革兰阴性菌中大肠埃希菌对亚胺培南、阿米卡星、阿莫西林克拉维酸钾耐药率均低于20.00%,对氨苄西林、喹诺酮类、四环素耐药性均高于65.00%;肺炎克雷伯菌耐药情况分布与大肠埃希菌基本一致,鲍曼不动杆菌对亚胺培南的耐药性较低21.80%(29/133),对其他类抗菌药物均较高。革兰阳性菌中粪肠球菌对万古霉素、利奈唑胺、氨苄西林的耐药率均低于20.00%,对红霉素、四环素、利福平耐药率均高于50.00%,屎肠球菌对常用抗菌药物的耐药率均高于粪肠球菌。结论革兰阴性杆菌为泌尿道结石合并尿路感染的主要致病菌,以大肠埃希菌比例最高;阿莫西林克拉维酸钾可作为该类患者的经验用药,严重感染时可给予碳青霉烯类抗菌药。
Objective To investigate the distribution and drug resistance of pathogens in urine samples from patients with urolithiasis. Methods A total of 309 patients with urolithiasis and urinary tract infection admitted to Department of Urology from January 2015 to December 2016 in our hospital were enrolled. Urine was collected in the middle of the patients and urine was collected during the surgical procedure. Bacterial culture identification. Automatic microbiological analyzer susceptibility testing, the use of fungal test medium and sensitivity of the plate identification of fungal species and susceptibility testing. Results A total of 284 strains of pathogens were isolated from the study, of which 195 strains (68.66%) of Gram-negative bacteria were significantly higher than 64 strains (22.54%) of Gram-positive bacteria and 25 strains (8.80%) of fungi. The difference was statistically significant (P <0.05). The proportion of Escherichia coli in Gram-negative bacteria was significantly higher than that in other strains. The proportion of Enterococcus faecalis in Gram-positive bacteria was significantly higher than that in other strains (P <0.05). The resistance rate of Escherichia coli to imipenem, amikacin and amoxicillin-karacid in Gram-negative bacteria was less than 20.00%, and their resistance rates to ampicillin, quinolone and tetracycline were all higher than 65.00%. The distribution of Klebsiella pneumoniae was basically the same as that of Escherichia coli, and the drug resistance of Acinetobacter baumannii to imipenem was 21.80% (29/133) lower than that of other antibiotics Higher. Gram-positive bacteria Enterococcus faecalis vancomycin, linezolid, ampicillin resistance rates were less than 20.00%, erythromycin, tetracycline, rifampin resistance rates were higher than 50.00%, feces intestinal Cocci common antibacterial drug resistance rates were higher than Enterococcus faecalis. Conclusions Gram-negative bacilli are the main pathogenic bacteria in urinary tract stones combined with urinary tract infection, with the highest proportion of Escherichia coli; amoxicillin and potassium clavulanate can be used as experience in this kind of patients, Mycotoxins antibacterials.