Resistant Analysis And Distribution Of Common Pathogens In Patients With Urinary Tract Infection Of A Classified 3A Hospital In Qiqihaer City Between 2014 And 2017

Objective:A retrospective study was conducted on the urine specimen test data of patients with urinary tract infection in a classified 3A hospital in Qiqihar in order to analyze the detection of pathogenic bacteria and drug resistance and to provide a reference basis for the development of targeted antimicrobial treatment plans and the rational selection of antimicrobial drugs in clinic.Methods:A total of 1168 inpatients diagnosed with urinary tract infection and identified by general bacterial culture were selected as subjects in a classified 3A hospital in Qiqihar from 2014 to 2017.As well as,the total number of 1168 urine specimens of patients with urinary tract infection were collected from each department.The clinical indicators of patients with urinary tract infection and the identification data of general bacterial culture were collected from the case management system and LIS system and they are analyzed by using retrospective analysis.Epidata 3.0 software was used for data entry,and IBM SPSS 24.0 statistical software for data statistical analysis.Results:1.Among the 1,168 patients with urinary tract infection included in this study,346were males,accounting for 29.6%.and 822 were cases of women,accounting for 70.4%.2.The amount of 1,040 strains of major pathogenic bacteria were collected from1168 positive urine infection samples,851 strains of gram-negative bacillus?81.8%?,187 strains of gram-positive coccus?18.0%?,and 2 strains of fungi?0.2%?.Gram-negative bacillus was dominated by escherichia coli?64.6%?,followed by klebsiella pneumoniae?9.0%?.Gram positive cocci were mainly fecal enterococci?7.8%?.3.The first three major pathogenic bacteria were 208 strains in nephrology department?20.0%?,131 strains in endocrinology department?12.6%?and 112 strains in urology department?10.8%?.And,the top three strains in renal medicine were 137strains?58.1%?of escherichia coli,21 strains?8.9%?of enterococcus faecalis,and 16strains?6.8%?of klebsiella pneumoniae.What's more,the top three in the department of endocrinology were 100 strains of escherichia coli?66.2%?,12 strains of Streptococcus agalactiae?7.9%?,and 8 strains of klebsiella pneumoniae?5.3%?.The first three in urinary surgery were 63 strains of escherichia coli?48.1%?and 15 strains of klebsiella pneumoniae?11.5%?.14 strains of enterococcus faecalis?10.7%?.The distribution of pathogenic bacteria in different genders,ages and susceptibility factors was statistically significant?P<0.05?.The proportion of enterococcus faecium in gram-negative bacilli increased from 2014 to 2017?P<0.05?.4.Among gram-negative bacilli,escherichia coli had the highest resistance rate to ampicillin?84.5%?,followed by ciprofloxacin?72.2%?and levofloxacin?67.6%?.Resistance rates to furantoin?8.9%?,amikacin?4.0%?,cefotetan?2.4%?,ertapenem?1.9%?,piperacillin/tazobactam?1.8%?and imipenem?1.0%?were relatively low.The drug resistance rate of klebsiella pneumoniae to cefazolin?56.4%?,ampicillin/sulbactam?52.1%?,compound xinomine?48.9%?and ceftriaxone?48.9%?was higher,while the drug resistance rate to ceftetan?9.6%?,amikacin?5.3%?and imipenem?2.1%?were lower.The resistance rate of gram-positive coccus to tetracycline?86.4%?and erythromycin?71.6%?was higher.The drug resistance rates of tigacycline,ampicillin?2.5%?,penicillin,furantoin and vancomycin?1.2%?were low.No strain resistant to linazolamide was found.5.The detection rate of ESBLs is 40.8%in Multi-resistant bacteria,the detection rates of methicillin-resistant staphylococcus aureus and carbapenem antibiotics were4.16%and 17.7%,respectively.The top three of the major multi-drug resistant bacteria were 76 strains in nephrology department?21.8%?,46 strains in urology department?13.2%?,and 37strains in rheumatology department?10.6%?.Ultra broad spectrum beta lactamase?ESBLs?order of enterobacteriaceae and top three department distribution is renal medicine 70 strains?22.4%?,urology 39 strains?12.5%?,rheumatology 34 strains?10.9%?;The proportion of ESBLs in total bacterial strains was 30.0%,in addition to bone surgery,the multi-drug resistant bacteria detected in each department were mainly enterobacter coliform with?-hypoplaxin-lactamase?ESBLs?.From 2014 to2017,the detection rate of ESBLs was 31.7%,37.8%,42.0%and 47.6%,respectively,showing an increasing trend year by year(?²_trend=9.338,P=0.002).The differences of detection rates in gender,age and susceptibility factors were statistically significant?P<0.05?.Conclusions:1.The main pathogenic bacteria in the samples of urine infection patients were gram-negative bacillus,escherichia coli was the main pathogenic bacteria,followed by klebsiella pneumoniae.Gram-positive cocci were mostly enterococcus,the main pathogenic bacteria were enterococcus faecalis.2.The first three major pathogenic bacteria of pathogenic bacteria were nephrology department,endocrinology department and urology department.The bacterial spectrum changed from 2014 to 2017,and the proportion of gram-positive cocci,especially enterococcus,was significantly increased.3.Escherichia coli bacillus had higher drug resistance rate to ampicillin,ciprofloxacin and levofloxacin,and higher sensitivity to furantoin,amikacin,cefotetan,ertapenem,piperacillin/tazobactin and imipenem.Klebsiella pneumoniae is also highly sensitive to cefotetan,amikacin and imipenem.Tigecycline,vancomycin and linazolamide are highly sensitive to gram-positive cocci.4.In the specimens submitted to patients with urinary tract infection,the multi-drug resistant bacteria were mainly ESBLs,and the detection rate was higher?40.8%?.5.The first three departments of multi-drug resistant bacteria were nephrology,urology and rheumatology.From 2014 to 2017,the detection rate of enterobacter coli with ultra-broad spectrum betabeta-lactamase?ESBLs?increased year by year.The multiple drug-resistant bacteria detected in all departments were mainly enterobacter betabeta-lactase?ESBLs?,with a higher proportion in vascular surgery,hematology and radiotherapy departments,while the proportion of enterobacter betabeta-lactase?ESBLs?in osteosurgery was the same as that of enterobacter carbapenems antibiotic resistance.