Pathogen Distribution And Antimicrobial Susceptibility Analysis Of Urosepsis

Objective(s):In order to know the distribution of common bacteria causing urosepsis and the sensitive antibiotics,and to provide valuable clinical evidence for early empirical antibiotic treatment.Methods:By collected blood culture results of hospitalized patients with urosepsis,from 2017 to 2020,of the Second Affiliated Hospital of ××××××.To retrospectively analyze the bacterial species and antimicrobial susceptibility of urosepsis.According to Chinese health bacterial culture regulate requirement,all blood samples were drawn,sorted,and cultured.The Bact/Alert3D automated blood culture system(Bio Merieux,France)and VITEK2-compact mass spectrometer that support aerobic and anaerobic culture bottles were used to perform automated blood culture,bacterial identification,and antimicrobial sensitivity studies.The American Institute of Clinical and Laboratory Standards(CLSI)standards were used to perform the antimicrobial susceptibility analysis,and CLSI standards were used to interpret the results.SPSS 24.0 software was used for statistical analysis.The Chi squared test was used to compare differences in categorical data between two groups.The Ranksum test and analysis of variance were used to compare the count data.P<0.05 was considered to indicate a statistically significant difference.Results: A total 237 blood culture positive strains were collected from 213 urosepsis patients in this investigation,of whom 189 had cultures with just one bacteria and 24 had cultures with two bacteria.Gram-negative bacilli made up the majority of the pathogens that produced urosepsis(178 strains,75.11%),followed by gram-positive bacilli(46 strains,19.41%),while fungi caused relatively little sepsis(13strains,5.48%).Ertapenem,Meropenem,Amikacin,and Imipenem were the antibiotics with sensitivity to Gram-negative bacteria greater than 85%: 92.70%,91.57%,89.89%,and 86.52%.Cefepime had a sensitivity rate of 73.03%,Nitrofurantoin was 67.42%,cefoxitin was 65.73%,Ceftazidime was 62.92%,piperacillin/tazobactam was 58.99%,cefoperazone/sulbactam was 51.69%,and amtriaxam was 51.69%.The sensitivity rates for all other antibiotics were under 50%.The antibiotics ertapenem,meropenem,amikacin,and imipenem are highly sensitive to Escherichia coli.In 4 years,Escherichia coli’s average sensitivity rates were 100.00%,99.21%,99.21%,and 97.64%,respectively.Nitrofurantoin,the second,had a sensitivity rate of 86.61%.Cefepime(75.59%),cefoxitin(75.59%),ceftazidime(67.72%),piperacillin tazobactam(66.14%),cefoperazone sulbactam(56.69%),and aztreonam(54.33%)all had sensitivity rates above 50%,whereas the other antibiotics had sensitivity rates below 50%.Levofloxacin,gentamicin,and ciprofloxacin all had decreasing sensitivity rates year over year(P<0.05).However cefepime’s sensitive rate grew year over year(P<0.05).No ertapenem-resistant Escherichia coli bacteria were discovered.Meropenem 66.67%,ertapenem 61.90%,imipenem 61.90%,cefepime 57.14%,and amikacin 57.14% were all effective antibiotics against Klebsiella pneumoniae.During four years,there was no significant difference in the sensitivity of other antibiotics(P > 0.05).No Klebsiella pneumoniae strains have been discovered in study that are susceptible to ampicillin and cefazolin.Tegacycline,vancomycin,and linezolid all have high levels of sensitivity against Gram-positive bacteria,the sensitivity rates were 100%,100% and 97.8%,respectively.All fungi were sensitive to Fluconazole and Amphotericin B,and resistant strains to Itraconazole had been detected.Conclusion(s): Our study showed that Gram-negative bacilli accounted for the highest proportion of bacteria causing urosepsis(74.79%),followed by Gram-positive cocci(19.41%)and fungi(5.48%).Escherichia coli was the most detected bacteria,accounting for 53.59%(127/237).Carbapenems had the highest sensitivity to Gramnegative bacteria(90.26%),and other antibiotics such as Amikacin(89.89%),Cefepime(73.03%),Cefoxitin(65.73%),piperacillin/tazobactam(58.99%)had good sensitivity to Gram-negative bacteria.Amikacin was the most sensitive antibiotic for carbapenem-resistant Enterobacteriaceae.The susceptibility of Levofloxacin and Ciprofloxacin to Gram-negative bacilli decreased year by year.Vancomycin and Tigecycline were sensitive to all Gram-positive bacteria,and Linezolid was highly sensitive.All fungi were sensitive to Fluconazole and Amphotericin B,and resistant strains to itraconazole had been detected.In order to obtain effective treatment and prevent antibiotic abuse and the propagation of resistant strains,clinicians should utilize adequate and effective antibiotics based on the actual situation on the ground,together with the findings of drug sensitivity tests.