摘要
目的了解青岛地区儿童泌尿系统感染的病原谱及其对常用抗生素的耐药性,为临床及时有效的治疗提供科学实验依据。方法收集2013年1月~2014年12月青岛市妇女儿童医院门诊及住院疑似泌尿系统感染患儿的中段清洁尿标本进行细菌培养,分离到的菌株经VITEK 2 COMPACT全自动微生物分析仪进行细菌鉴定及药敏试验分析。结果分离到433株病原菌,其中革兰阴性菌263株（60.7%）,革兰阳性菌153株（35.3%）,真菌17株（4.0%）。位居首位的是大肠埃希菌110株,占总分离菌的25.4%,其次是屎肠球菌94株（21.7%）,铜绿假单胞菌57株（13.2%）,粪肠球菌30株（6.9%）,肺炎克雷伯菌29株（6.7%）。大肠埃希菌和肺炎克雷伯菌的ESBL检出率分别为62.7%和72.4%。ESBL（＋）菌株对青霉素类、头孢菌素类和氨曲南均高度耐药,而对碳青酶烯类抗生素、β内酰胺类/酶抑制剂、氨基糖苷类抗生素普遍敏感。铜绿假单胞菌对妥布霉素、环丙沙星、左氧氟沙星、哌拉西林/他唑巴坦、阿米卡星、庆大霉素等100%敏感;肠球菌对克林霉素、四环素、红霉素普遍耐药,而对替加环素、利奈唑胺、万古霉素均高度敏感。结论青岛地区儿童泌尿系统感染病原谱很广,耐药性严重,临床应合理选用抗生素,减缓耐药株的产生,并积极采取措施控制耐药株的播散,减少医源性感染发生。
Objective To investigate the distribution and drug resistance of pathogens in children with urinary tract infection（UTI） from Qingdao district, so as to guide clinical treatment. Methods Clean midstream urine samples from outpatient and inpatient children suspected with UTI in Qingdao women children hospital from Jan 2013 to Dec 2014 were collected for bacterial culture. Identification of isolated pathogens and drug sensitivity analysis were performed using VITEK 2 COMPACT microbiology analysis system. Results 433 strains of pathogens were isolated, including 263 strains of gram-negative bacteria（60.7%）, 153 strains of gram-positive bacteria（35.3%） and 17 strains of fungi（4.0%）. Escherichia coli（110 strains, 25.4%） was ranked first, followed by enterococcus faecium（94 strains, 21.7%）,pseudomonas aeruginosa（57 strains, 13.2%）, enterococcus faecalis（30 strains, 6.9%） and Klebsiella pneumonia（29strains, 6.7%）. Among Escherichia coli and Klebsiella pneumonia, strains which could secrete extended spectrum beta-lactamases（ESBLs） accounted for 62.7% and 72.4%, respectively. ESBLs positive strains were highly resistant to picilline, cephalosporins and aztreonam, while sensitve to carbapenem antibiotics（imipenem and ertapenem）, β lactams and enzyme inhibitors（piperacillin-tazobactam） and aminoglycoside antibiotics（amikacin）. All pseudomonas aeruginosa strains were 100% sensitive to tobramycin, ciprofloxacin, levofloxacin, piperacillin-tazobactam, amikacin and gentamicin, etc. Enterococci were resistant to clindamycin, tetracycline and erythromycin, while highly sensitive to tigecycline, linezolid and vancomycin. Conclusion There is a broad spectrum of pathogens associated with UTI of children in Qingdao district, the condition of drug resistance is very severe, so clinical therapists should choose optional antibiotics carefully to avoid the emergence of resistant strains. And strict measures should be taken to control transmission and diffusion of resistant strains so as to decrease hospital-acquired infection.
出处
《中国现代医生》
2016年第5期116-119,125,共5页
China Modern Doctor
关键词
泌尿系统感染
病原谱
抗生素
耐药性
Urinary tract infection
Spectrum of pathogens
Antibiotics
Drug resistance
