Analysis and clinical implication of upper urinary tract stone's bacterial spectrum

目的 研究上尿路结石的细菌谱及其药敏结果,为相关结石患者合理选择抗生素提供依据.方法 2007年4月至2008年10月,共采集146例经皮肾镜手术结石标本,术中采用标准化Stamey法留取结石标本进行细菌培养及药敏试验,对结果进行总结分析.结果 146份结石标本中,72份细菌培养结果呈阳性,阳性率为49.3%.共培养出14种81株细菌.革兰阴性菌70株(86.4%),主要菌种分别为大肠杆菌25株(30.9%)、铜绿假单胞菌19株(23.5%)及阴沟肠杆菌10株(12.4%);革兰阳性菌10株(12.4%),主要为表皮葡萄球菌6株(7.4%);另有真菌1株(1.2%).药敏结果显示氨苄西林钠舒巴坦钠、头孢曲松、环丙沙星总体耐药率较高,分别为88.8%、81.2%、67.5%.硫酸阿米替星、亚胺培南西司他丁钠及哌拉西林钠他唑巴坦钠对于革兰阴性菌耐药率均≤10%,分别为8.6%、10.0%、10.0%.红霉素、替考拉宁、复方磺胺甲噁唑、呋喃妥因等药物对于革兰阳性菌也有较好的药敏结果.结论 上尿路结石细菌分布以革兰阴性菌为主,菌种多样,且对不同抗生素的耐药率差异较大.经皮肾镜术后早期抗感染治疗,应根据不同菌种合理选择抗生素.Objectives To analyze the pathogenic bacterial's distribution and the drug resistance in the upper urinary tract stones, and to provide the information for choosing suitable antibiotics. Methods Stone samples were taken for culture and for drug sensitivity test in 146 patients undergoing percutaneous nephrolithotomy between April 2007 and October 2008, and the results were analyzed. Results Pathogens presented in 72(49.3%) patients. There were 70 (86.4%) Gram-negative bacteria strains. Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae were the predominant bacteria, accounted for 30.9% (25 strains), 23.5% (19 strains) and 12.3% (10 strains), respectively. There were 10(12.3%) Gram-positive bacteria strains, the predominant bacteria was Staphylococcus epidermidis(6 strains), accounting for 7.4%. And there was 1 fungi strain (1.2%). Resistance to ampicillin/sulbactam (88.7%), ceftriaxone (81.3%) and ciprofloxacin(67.5%) was most commonly found in pathogen, and the rate of resistance to amikacin, imipenem and piperacillin/tazobactam were 8.6%, 10.0%, 10.0%, respectively.Erythromycylamine, teicoplanin, SMZ-TMP, nitrofurantoin were sensitive to Gram-positive bacteria.Conclusions Bacterial's distribution of upper urinary tract stones are multiple, and the majority pathogen is Gram-negative bacteria. A big variant resistance is found among different bacterium. The suitable antibiotics should be chosen according to the different bacterium in the patients who underwent percutaneous nephrolithotomy.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)04293-2954