摘要
目的:收集泌尿系结石患者尿细菌谱及药敏信息，探讨其临床特点及指导临床用药。方法:回顾性分析上海交通大学医学院附属松江医院自2020年1月至2022年1月收治的175例泌尿系结石患者。所有患者入院时清洁中段尿培养结果均为阳性。比较不同性别、结石部位患者的尿液菌谱及药敏特点，并分析其差异性。结果:175例病原菌中，革兰氏阴性菌130株（74.3%），革兰氏阳性菌45株（25.7%）。最常见的5种病原菌分别为：大肠埃希菌60株（34.2%）、铜绿假单胞菌25株（14.2%）、粪肠球菌16株（9.1%）、肺炎克雷伯杆菌16株（9.1%），以及奇异变形杆菌15株（8.6%）。女性患者中大肠埃希菌37株（40.2%）及奇异变形杆菌11株（12.0%）比例显著高于男性患者23株（27.7%）和4株（4.8%），差异有统计学意义（P<0.05）；男性患者中铜绿假单胞菌16株（19.3%）及肺炎克雷伯杆菌14株（16.9%）比例显著高于女性患者9株（10.0%）和2株（2.2%），差异有统计学意义（P<0.05），而上尿路结石与下尿路结石在主要细菌谱上未见明显差异。药敏结果显示：主要的革兰氏阴性菌对氨卞西林/舒巴坦、头孢唑啉、头孢呋辛、环丙沙星耐药性较高，而对亚胺培南、卡那霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦敏感率较高；主要的革兰氏阳性菌对克林霉素、红霉素、左氧氟沙星耐药性较高，而对万古霉素、替考拉宁、利奈唑胺敏感率较高。结论:上海松江地区泌尿系结石患者尿液菌谱以大肠杆菌为主，并在不同的性别患者中存在差异，而上下路结石主要尿液菌谱类似。革兰氏阴性菌和革兰氏阳性菌药敏结果差异较大，临床上应加强病原学检测，合理使用抗生素。
Abstract
Objective:To collect urine bacterial spectrum and drug sensitivity information of patients with urinary calculi, and to investigate their clinical characteristics then guide clinical medication.Methods:175 patients with urinary calculi in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2020 to January 2022 were retrospectively analyzed. The results of clean midstream urine culture were positive in all patients. The urine bacteria profile and drug sensitivity characteristics of patients with different genders and stone sites were compared, and the differences were analyzed.Results:Among 175 cases of pathogenic bacteria, 130 strains (74.3%) were gram-negative and 45 strains (25.7%) were gram-positive. The most common 5 strains were escherichia coli (60 strains, 34.2%), pseudomonas aeruginosa (25 strains, 14.2%), enterococcus faecalis (16 strains, 9.1%), klebsiella pneumoniae (16 strains, 9.1%), and proteus singular (15 strains, 8.6%). The proportions of escherichia coli 37 strains (40.2%) and proteus mirabilis 11 strains (12.0%) in female patients were significantly higher than those in male patients of 23 strains (27.7%) and 4 strains (4.8%), and the difference was statistically significant (P<0.05). The proportion of 16 strains of pseudomonas aeruginosa (19.3%) and 14 strains of klebsiella pneumoniae (16.9%) in male patients was significantly higher than those in female patients of 9 strains (10.0%) and 2 strains (2.2%), and the difference was statistically significant (P<0.05). There was no significant difference in the main bacterial spectrum between upper urinary tract calculi and lower urinary tract calculi. The drug sensitivity results showed that the main gram-negative bacteria had higher resistance to Ambenicillin/Sulbactam, Cefazolin, Cefuroxime and Ciprofloxacin, but higher sensitivity to Imipenem, Kanamycin, Piperacillin/Tazobactam, Cefoperazone/Sulbactam. The main gram-positive bacteria had higher resistance to Clindamycin, Erythromycin and Levofloxacin, but higher sensitivity to Vancomycin, Teicoranin and Linezolid.Conclusions:Escherichia coli is the predominant bacteria in urolithiasis patients in Songjiang area of Shanghai, and there are differences among different genders, while there are no significant differences in the main bacteria in upper and lower urolithiasis. The results of drug sensitivity of gram-negative bacteria and gram-positive bacteria differ greatly, so it is necessary to strengthen pathogenic detection and rational use of antibiotics.
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