摘要
目的分析经尿道膀胱肿瘤切除(TURBT)术后尿路感染患者的病原菌分布及耐药性,探讨诊治的有效方法。方法选择2010年3月-2013年3月62例膀胱肿瘤患者资料进行回顾性分析,所有患者治疗方法均为经尿道膀胱肿瘤切除术,取尿液进行培养及药敏试验,并对诊治方法及效果进行评价。结果 62例TURBT术后尿路感染患者中段尿培养出病原菌71株,其中革兰阴性杆菌50株占70.4%,革兰阳性球菌17株占24.0%,真菌4株占5.6%;前3位的病原菌分别为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌,分别占33.8%、15.5%、9.9%;大肠埃希菌、肺炎克雷伯菌对临床常用的广谱抗菌药物高度耐药,对头孢哌酮/舒巴坦、美罗培南、亚安培南耐药率较低,均<10.0%,革兰阳性菌对临床常用抗菌药物耐药率均>60.0%,未发现耐万古霉素菌株;所有患者在经验用药基础上调整,感染均得到控制,无1例患者死亡。结论经尿道膀胱肿瘤切除术后尿路感染的主要病原菌是革兰阴性杆菌,病原菌耐药现象日趋严重,加强基础疾病的治疗,合理选择抗菌药物,是治疗术后尿路感染的主要策略。
OBJECTIVE To analyze the distribution of pathogens and drug resistance of urinary tract mlectlons atter urethral resection of bladder tumor （TURBT） to discuss the effective way of diagnosis and treatment. METHODS The data from 62 patients with bladder tumor in our hospital from Mar. 2010 to Mar. 2013 were retrospectively analyzed, and all patients were received transurethral bladder tumor resection. Urine was cultured and sensitivity test was taken. Diagnosis and treatment was evaluated. RESULTS Midstream urine was cultured for 62 patients with the TURBT postoperative urinary tract infection, and a total of 71 strains of pathogens were cultured, among which there were 50 strains of gram negative bacilli, accounting for 70.4%, while gram positive coccus 17 strains, accounting for 24.0%, fungi 4 strains, aceounting for 5.6%. The top three pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae, accounting for 33.8 %, 15.5 % and 9.9 % ; Escherichia coli and Klebsiella pneumoniae had highly resistance to antimicrobial agents commonly used in clinical, and had low resistance to cefoperazone/sulbactam sodium, meropenem, imipenem, and the resistant rates were all lower than 10.0%. Drug resistance rates of gram-positive bacteria to antimicrobial commonly used in clinical were higher than 60% and found no vancomycin-resistant strains. All patients had the adjustment of drugs on the basis of the experience of drug use, and infection were under control with no deaths. CONCLUSION Main pathogenic bacteria caused urinary tract infections after transurethral bladder tumor resection are gram-negative bacilli, the resistance of pathogenic bacteria is growing serious. In this condition, the treatment of the underlying disease should be strengthened, and antibiotics should be selected racially, which are the key measures to treat postoperative urinary tract infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第11期2642-2644,共3页
Chinese Journal of Nosocomiology
基金
浙江省自然科学基金资助项目(2012R10034)
关键词
经尿道膀胱肿瘤切除术
尿路感染
病原菌
诊治
Transurethral bladder tumor resection
Urinary tract infection
Pathogenic bacteria
Diagnosis and treatment
