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目的监测江苏省苏北人民医院2013-2015年泌尿道医院感染病原菌菌种分布及耐药性的变迁,指导临床合理使用抗菌药物。方法回顾性调查2013-2015年该院泌尿道医院感染的病原菌菌种及耐药性。结果 3年共检出病原菌710株,其中革兰阴性菌占58.2%(413株),革兰阳性菌占20.4%(145株),真菌占21.4%(152株);检出菌前3位分别是大肠埃希菌(154株,21.7%)、白色念珠菌(80株,11.2%)和肺炎克雷伯菌(65株,9.2%),真菌感染呈减少趋势;3年间大肠埃希菌对氨苄西林耐药达90%,对复方新诺明耐药率最高达71.4%,对亚胺培南、呋南妥因耐药率较低;肺炎克雷伯菌对氨苄西林耐药率100%,对亚胺培南、哌拉西林/他唑巴坦、头孢吡肟耐药率稍低,对亚胺培南、厄他培南耐药性有逐年增加趋势(P<0.05),对呋南妥因耐药性有逐年减少趋势(P<0.05);白色念珠菌对两性霉素B、伊曲康唑、伏立康唑、制霉菌素、氟康唑、酮康唑均敏感。结论随着病原菌耐药性不断上升,不同病原菌对药物耐药性变异较大,根据泌尿道医院感染病原菌分布及耐药性变迁,及时调整抗菌药物使用并加强医院感染等管理,有利于减少耐药菌株,提高治疗效果。
Objective To monitor the distribution of pathogenic bacteria in Jiangsu Provincial Hospital of Jiangsu Province from 2013 to 2015 and the change of drug resistance, and to guide the rational use of antibacterial drugs. Methods Retrospective investigation of pathogenic bacteria strains and drug resistance of hospital urinary tract infection in 2013-2015. Results A total of 710 pathogens were detected in 3 years, of which, Gram-negative bacteria accounted for 58.2% (413 strains), Gram-positive bacteria accounted for 20.4% (145 strains) and fungi accounted for 21.4% (152 strains) Escherichia coli (154 strains, 21.7%), Candida albicans (80 strains, 11.2%) and Klebsiella pneumoniae (65 strains, 9.2% Resistant to ampicillin up to 90%, up to 71.4% resistance to cotrimoxazole, low resistance rate to imipenem and fenantoin; Klebsiella pneumoniae to ampicillin resistance rate of 100 %, To imipenem, piperacillin / tazobactam, cefepime slightly lower rate of resistance to imipenem, ertapenem increased year by year (P <0.05), the There was a decreasing trend of the drug resistance of fenantoin due to year by year (P <0.05). Candida albicans was sensitive to amphotericin B, itraconazole, voriconazole, nystatin, fluconazole and ketoconazole. Conclusion With the increasing of drug resistance of pathogenic bacteria, the variation of drug resistance of different pathogenic bacteria is quite large. According to the distribution of pathogenic bacteria in urinary tract infection of hospitals and the change of drug resistance, the timely adjustment of antimicrobial use and the management of nosocomial infections are beneficial to reduce the resistance Drug strains, improve the therapeutic effect.