姚佳欣 蒋雪梅

摘要：目的  分析社区获得性泌尿系统感染病原菌分布及耐药性，为临床合理使用抗菌药物提供依据， 减少耐药菌株的产生。方法  收集2015年1月～2019年1月绵阳科学城医院门诊疑似泌尿系统感染患者中段尿标本分离培养的病原菌及其体外药敏试验结果，并对结果进行统计分析。结果  共分离187株泌尿系统感染细菌，以大肠埃希菌、肺炎克雷伯菌、肠球菌、葡萄球菌为主，其中革兰阴性杆菌148株，占79.14%，检出产ESBLs大肠埃希菌82株，产ESBLs肺炎克雷伯菌13株;革兰阳性球菌37株，占19.78%。药敏结果分析显示大肠埃希菌、肺炎克雷伯菌对碳青霉烯类和头霉素类抗菌药物高度敏感，其次为哌拉西林+他唑巴坦、呋喃妥因（平均耐药率<10.00%）;粪肠球菌、葡萄球菌对万古霉素、利奈唑胺、呋喃妥因完全敏感。结论  社区泌尿系统感染病原菌以革蘭阴性杆菌为主，大肠埃希菌产酶率高，耐药现象较严重;临床应根据当地病原菌构成特点及药敏试验结果合理使用抗菌药物，避免经验性用药，控制耐药性菌株的播散，提高治疗效果。

关键词：社区获得性感染;泌尿道感染;病原菌;抗药性

Abstract：Objective  To analyze the distribution and drug resistance of pathogenic bacteria in community-acquired urinary tract infections， and provide evidence for clinical rational use of antibiotics and reduce the emergence of drug-resistant strains.Methods  The pathogens isolated from the mid-stage urine specimens of patients with suspected urinary tract infection in Mianyang Science City Hospital from January 2015 to January 2019 were collected and their in vitro susceptibility test results were collected. The results were statistically analyzed.Results A total of 187 urinary tract infection bacteria were isolated， including Escherichia coli， Klebsiella pneumoniae， Enterococcus， and Staphylococcus， among which 148 were Gram-negative bacilli， accounting for 79.14%， and ESBLs-producing Escherichia coli were detected. There were 82 strains， 13 strains of Klebsiella pneumoniae producing ESBLs， and 37 strains of Gram-positive cocci， accounting for 19.78%. Analysis of drug susceptibility results showed that Escherichia coli and Klebsiella pneumoniae were highly sensitive to carbapenems and cephalosporin antibiotics， followed by piperacillin + tazobactam and nitrofurantoin （mean resistance rate <10.00%）; Enterococcus faecalis and Staphylococcus are completely sensitive to vancomycin， linezolid and nitrofurantoin.Conclusion  The pathogens of urinary tract infection in the community are mainly Gram-negative bacilli. Escherichia coli has high enzyme production rate and serious drug resistance. The clinical use of antibiotics should be based on the characteristics of local pathogens and drug susceptibility test results to avoid empiric drugs. Control the spread of drug-resistant strains and improve the therapeutic effect.

Key words：Community acquired infection;Urinary tract infection;Pathogen;Drug resistance

社区获得性泌尿系统感染（community-acquired urinary tract infection，CA-UTI）是常见的社区感染性疾病，其发生率仅次于上呼吸道感染，位居社区感染的第2位。由于地区及性别构成的不同，泌尿系统感染的病原菌构成存在一定的差异，社区获得性泌尿系感染的致病因素具有一定的区域性与时间性，细菌的耐药性也有一定的差异性[1]。因此，有必要对泌尿系统感染病原菌及耐药性进行动态监测，临床在治疗泌尿系统感染时，应根据抗菌药物的使用原则规范用药，避免经验性用药，慎用广谱抗菌药物，不滥用及频繁更换药物，以减少细菌耐药、菌群失调的发生[2]。现将2015年1月～2019年1月绵阳科学城医院CA-UTI病原菌分布及耐药性报道如下。

1材料和方法