Drug Resistance Of Pathogens Causing Urinary Tract Infection And Whole Genome Sequencing Analysis Of G~+ Representative Flora

Objective:To explore the distribution and drug resistance of pathogens in patients with local urinary tract infection,so as to provide theoretical basis for clinical rational drug use and delaying the emergence of drug resistance of pathogens.Reveal the drug resistance genes and virulence factors of G~+representative bacteria(Enterococcus faecalis and enterococcus faecium),and analyze the generation of drug resistance and pathogenicity.Methods:The age,sex,pathogen distribution and drug resistance of 889 patients with urinary tract infection admitted in the Third Affiliated Hospital of Zunyi Medical University from July 2019 to June 2021 were analyzed retrospectively.The drug resistance genes and virulence factors of Enterococcus faecalis and Enterococcus faecium were detected by whole genome sequencing.Results:1.Among 889 patients with upper urinary tract infection,34.42%were male and 65.58%were female.Female patients were significantly more than men,about 1.9 times that of male patients.Grouped by age:young people accounted for 9.11%,middle-aged people accounted for 35.32%and old people accounted for 55.57%.Male patients were lower than female patients in all age groups.2.Among the pathogens,G~-bacteria accounted for 68.57%,G~+bacteria 26.02%and fungi5.41%.8.10%of patients detected two pathogens at the same time.The top five pathogens were Escherichia coli(50.36%),Enterococcus faecalis(9.37%),Enterococcus faecium(7.49%),Klebsiella pneumoniae(4.79%)and Pseudomonas aeruginosa(2.71%).Escherichia coli accounted for 62.12%in women,which was significantly higher than28.70%in men.3.Among the top three G~-bacteria,the resistance rates of Escherichia coli and Klebsiella pneumoniae to amikacin,cefotiam,piperacillin/tazobactam and meropenem are very low;Furantoin and ceftazidime were relatively sensitive to Escherichia coli and Klebsiella pneumoniae;The resistance rate of Escherichia coli to cefuroxime is close to 70%,and the resistance rate to ceftiomer,ampicillin and levofloxacin is more than 80%,of which the resistance rate to ampicillin is as high as 92.77%;The drug resistance rates of Pseudomonas aeruginosa to the tested drugs were very low.Enterococcus faecalis and Enterococcus faecium are the most common G~+bacterias.They are highly sensitive to vancomycin,teicoplanin,tegacyclin and linezolid.The resistance rate of Enterococcus faecium to ampicillin,high concentration gentamicin,erythromycin,furantoin and levofloxacin was higher than that of Enterococcus faecalis.Candida albicans is the most common fungus,and the resistance rate of fungi to common antifungal drugs is generally low.4.Each enterococcal strain generally carries dozens of drug resistance genes and virulence factors.The detection rates of common drug resistance genes:AAC(6’)93.75%,ant(6)-I 37.50%,APH(2’)31.25%,APH(3’)-III 25.00%,TEM 75.00%,tetM 62.50%,gyrA 56.25%,ermA 56.25%,ermB 43.75%.optrA,cfr,vanA and vanB were not detected.The carrying amount of drug resistance gene of Enterococcus faecalis was lower than that of Enterococcus faecium;The detection rates of common virulence factors were asal93.75%,gelE 68.75%,efaA 62.5%.There was no significant difference between Enterococcus faecalis and Enterococcus faecium.Conclusions:1.G~-bacteria were the main pathogens of urinary tract infection,among which Escherichia coli accounted for more than half.Escherichia coli should be used empirically before urine culture and drug sensitivity results are available,especially for female patients.Nitrofurantoin,ceftazidime,cefotiam,amikacin,piperacillin/tazobactam and meropenem can be selected as the first choice for empirical medication.When the treatment is ineffective,G~+bacterial infection or combined G~+bacterial infection should be considered,and vancomycin and linezolid can be used together when necessary.2.Enterococcus faecalis and Enterococcus faecium are the representative flora of G~+bacteria in urinary tract infection.They carry a variety of drug-resistant genes and virulence factors at the same time,resulting in enhanced drug resistance and pathogenicity.