目的: 研究糖尿病住院患者泌尿系统感染的致病菌分布以及耐药性,为湖南地区临床筛选抗菌药物、指导合理用药提供科学依据。方法: 选取2021年1月―2023年5月湖南某医院526例糖尿病并发泌尿系统感染住院患者送检的中段尿标本,分别进行分离培养和药物敏感试验,观察并比较不同性别、年龄患者之间的致病菌分布及耐药率情况。结果: 526例标本中共分离培养出细菌609株;其中,革兰阴性菌（G-）432株,以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌（G+）177株,以屎肠球菌和粪肠球菌为主。大肠埃希菌对左氧氟沙星、环丙沙星耐药率较高,分别为77.83%、66.02%,对替加环素和粘菌素高度敏感;肺炎克雷伯菌对左氧氟沙星耐药率最高,为60.27%。屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、红霉素耐药率高,分别为98.17%、92.66%、88.07%、93.58%、93.58%,对喹努普汀/达福普汀、利奈唑胺、万古霉素、四环素、替加环素敏感;粪肠球菌对红霉素、四环素、喹努普汀/达福普汀耐药率高,分别为96.67%、96.67%、76.67%,对青霉素、氨苄西林、环丙沙星、左氧氟沙星、万古霉素和替加环素高度敏感。在不同性别组中,大肠埃希菌均占最高比例,且女性患者大肠埃希菌分离率显著增高;在不同年龄组中,随着宿主年龄的增加,大肠埃希菌对不同抗菌药物的敏感性呈现不同趋势。结论: 糖尿病并发泌尿系统感染患者的致病菌以革兰阴性菌为主,这些致病菌对常用抗菌药物的耐药率存在明显差异,且随着性别、年龄等的不同而变化;本研究为湖南地区的临床合理用药以及遏制耐药菌的播散、积极探索新的治疗方法以应对日益严峻的细菌耐药形势等提供了依据。
Abstract
Objective To study the pathogenic bacteria distribution and drug resistance of urinary system infection in inpatients with diabetes, and to provide scientific basis for clinical screening of antibiotics to guide rational drug use. Methods 526 midcourse urine samples from inpatients with diabetes complicated with urinary system infection in a hospital of Hunan Province from January 2021 to May 2023 were selected, and then isolation culture and drug sensitivity experiments were carried out to observe and compare the distribution of pathogenic bacteria and drug resistance rates among patients of different genders and ages. Results A total of 609 strains of bacteria were isolated and cultured. The main strains of Gram-negative bacteria (G-) were Escherichia coli and Klebsiella pneumoniae, and the main strains of Gram-positive bacteria (G+) were Enterococcus faecium and Enterococcus faecalis. The resistance rate of Escherichia coli to levloxacin and ciprofloxacin was 77.83% and 66.02%, respectively, and it was highly sensitive to tigacycline and colistin. The resistance rate of Klebsiella pneumoniae to levofloxacin was the highest (60.27%). Among the main G+ bacteria, Enterococcus faecium had high resistance rates to penicillin, ampicillin, ciprofloxacin, levofloxacin and erythromycin (98.17%, 92.66%, 88.07%, 93.58%, 93.58%), and was sensitive to quinuptidine/dafoptidine, linezolid, vancomycin, tetracycline and tigacycline, respectively. Enterococcus faecalis had high resistance rates to erythromycin, tetracycline, quinuptine/Dafoptene (96.67%, 96.67%, 76.67%, respectively), and was highly sensitive to penicillin, ampicillin, ciprofloxacin, levofloxacin, vancomycin and tigacycline. Escherichia coli accounted for the highest proportion in different gender groups, and the isolation rate of Escherichia coli in female patients was significantly increased. In different age groups, with the increase of host age, the sensitivity of Escherichia coli to different antibiotics showed different trends. Conclusion The main pathogenic bacteria in patients with diabetes complicated with urinary system infection are gram-negative bacteria, and the resistance rate of these pathogenic bacteria to commonly used antibiotics is significantly different, and it changes with the difference of gender and age. This study provides a basis for the rational clinical use of drugs in Hunan Province, the prevention of the spread of drug-resistant bacteria, and the active exploration and research of new treatments to deal with the increasingly severe situation of bacterial resistance.
关键词
糖尿病 /
泌尿系统感染 /
细菌分布 /
耐药性
Key words
diabetes /
urinary system infection /
bacterial distribution /
drug resistance
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基金
湖南省卫生健康委员会重点项目“肠道微生物群与帕金森病的相关性研究”（202201065690）; 长沙市卫生健康委员会科研项目“益生菌对青少年抑郁障碍的干预及相关研究”（KJ-B2023101); 湖南省大学生创新创业训练计划项目“利培酮联合益生菌对精神分裂症患者肠道微生物群的干预及分析”（S202310542121）
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