Analysis of pathogenic bacteria and drug resistance of urinary tract infection in outpatient women

doi:10.3877/cma.j.issn.1673-5250.2022.02.009

Objective

To explore spectrum distribution and drug sensitivity of main pathogenic bacteria in outpatients with urinary tract infection (UTI), so as to provide the basis for the selection and treatment of antibacterial drugs.

Methods

From January 1998 to December 2018, a total of 643 women, aged from 14 to 95 years old, who were diagnosed as UTI in the outpatient department of First Affiliated Hospital of Sun Yat-Sen University were selected into this study old. According to whether menopause or not, they were divided into menopausal group (n=362) and non-menopausal group (n=281). The procedures in this study were approved by Ethics Committee of First Affiliated Hospital of Sun Yat-Sen University (Approval No. 〔2021〕372).

Results

① A total of 643 pathogenic bacteria were isolated, including 567(88.2%) Gram-negative (G^-) and 76(11.8%) Gram-positive (G⁺ ) bacteria strains. The most common G^- uropathogens were Escherichia coli (70.3%), followed by Klebsiella pneumonia (6.2%). Enterococcus faecalis (2.6%, 17/643), Streptococcus agalactiae (1.9%, 12/643) and Enterococcus faecium (1.7%, 11/643) were found to be the predominant G⁺ strains. ②Escherichia coli and Klebsiella pneumoniae sustained high susceptibility to cefoperazone-sulbactam, amikacin, piperacillin-tazobactam and imipenem, Escherichia coli remained high susceptibility to nitrofurantoin as well. However, Escherichia coli were highly resistant to ciprofloxacin, ceftriaxone and trimethoprim-sulfamethoxazole. Klebsiella pneumoniae were highly resistant to ceftriaxone and nitrofurantoin. ③42.0% (190/452) Escherichia coli strains and 40.0% (16/40) Klebsiella pneumoniae strains were extended-spectrum-lactamase-producing (ESBLs) strains. ④The main pathogenic bacteria in both groups were Escherichia coli (68.0%, 72.1%) and Klebsiella pneumoniae (6.4%, 6.1%). There was no significant difference in the distribution proportion of main pathogenic bacteria between two groups (P>0.05). ⑤ The resistance rate of Escherichia coli to ciprofloxacin was higher in menopausal group (69.7%, 166/238) than that of non-menopausal group (54.0%, 95/176), and the difference was significant (P<0.05). ⑥ The drug resistance rates of Klebsiella pneumoniae in menopausal group to ceftriaxone and cefepime were 66.7%(14/21) and 45.0%(9/20), respectively, which were significantly higher than those in non-menopausal group (33.3%, 6/18; 5.6%, 1/18), and the differences were statistically significant (P<0.05).

Conclusions

Escherichia coli is the most common uropathogens obtained from female with UTI in outpatient clinic. The isolated Escherichia coli remain high resistance rate to fluoroquinolones in postmenopausal patients. Escherichia coli sustain highly sensitive to nitrofurantoin which can be recommended as an empirical treatment for uncomplicated UTI in outpatient clinic.

Key words: Menopause, Urinary tract infections, Microbial sensitivity tests, Escherichia coli, Klebsiella pneumoniae, Drug resistance, Female

表1 643例UTI患者尿液培养、分离643株病原菌分布

病原菌种类		菌株数量(株)	菌株占比(%)
G^-杆菌
	大肠埃希菌	452	70.3
	肺炎克雷伯菌	40	6.2
	奇异变形杆菌	28	4.4
	铜绿假单胞菌	15	2.3
G⁺球菌
	粪肠球菌	17	2.6
	无乳链球菌	12	1.9
	屎肠球菌	11	1.7
其他^a		68	10.6
合计		643	100.0

表1 643例UTI患者尿液培养、分离643株病原菌分布

病原菌种类		菌株数量(株)	菌株占比(%)
G^-杆菌
	大肠埃希菌	452	70.3
	肺炎克雷伯菌	40	6.2
	奇异变形杆菌	28	4.4
	铜绿假单胞菌	15	2.3
G⁺球菌
	粪肠球菌	17	2.6
	无乳链球菌	12	1.9
	屎肠球菌	11	1.7
其他^a		68	10.6
合计		643	100.0

表2 本组452株大肠埃希菌和40株肺炎克雷伯菌的药物敏感性结果比较[%(n/n′)]

抗菌药物	大肠埃希菌耐药	肺炎克雷伯菌耐药
阿莫西林/克拉维酸	27.9(24/86)	37.5(3/8)
阿米卡星	3.5(16/452)	12.5(5/40)
氨曲南	28.8(119/413)	33.3(13/39)
头孢他啶	21.0(93/442)	26.3(10/38)
环丙沙星	63.0(261/414)	33.3(13/39)
头孢曲松	45.3(203/448)	51.3(20/39)
头孢哌酮/舒巴坦	18.1(58/320)	48.1(13/27)
头孢吡肟	29.0(128/441)	26.3(10/38)
庆大霉素	43.2(177/410)	21.1(8/38)
亚胺培南	0.2(1/452)	2.5(1/40)
哌拉西林/他唑巴坦	2.7(12/447)	15.0(6/40)
呋喃妥因	13.7(49/357)	78.1(25/32)
磺胺甲唑/甲氧苄啶	52.1(213/409)	37.1(13/35)

表2 本组452株大肠埃希菌和40株肺炎克雷伯菌的药物敏感性结果比较[%(n/n′)]

抗菌药物	大肠埃希菌耐药	肺炎克雷伯菌耐药
阿莫西林/克拉维酸	27.9(24/86)	37.5(3/8)
阿米卡星	3.5(16/452)	12.5(5/40)
氨曲南	28.8(119/413)	33.3(13/39)
头孢他啶	21.0(93/442)	26.3(10/38)
环丙沙星	63.0(261/414)	33.3(13/39)
头孢曲松	45.3(203/448)	51.3(20/39)
头孢哌酮/舒巴坦	18.1(58/320)	48.1(13/27)
头孢吡肟	29.0(128/441)	26.3(10/38)
庆大霉素	43.2(177/410)	21.1(8/38)
亚胺培南	0.2(1/452)	2.5(1/40)
哌拉西林/他唑巴坦	2.7(12/447)	15.0(6/40)
呋喃妥因	13.7(49/357)	78.1(25/32)
磺胺甲唑/甲氧苄啶	52.1(213/409)	37.1(13/35)

表3 2组UTI患者尿液培养、分离的主要病原菌占比比较[株数(%)]

组别	菌株数量	G^-				G⁺			其他^a
组别	菌株数量	大肠埃希菌	肺炎克雷伯菌	奇异变形杆菌	铜绿假单胞菌	粪肠球菌	无乳链球菌	屎肠球菌	其他^a
绝经组	362	261(72.1)	22(6.1)	16(4.4)	11(3.0)	8(2.2)	5(1.4)	8(2.2)	31(8.6)
非绝经组	281	191(68.0)	18(6.4)	12(4.3)	4(1.4)	9(3.2)	7(2.5)	3(1.1)	37(13.1)
χ²值		1.291	0.029	0.008	1.811	0.606	1.064	—	1.037
P值		0.256	0.864	0.927	0.178	0.436	0.302	0.364	0.352

表3 2组UTI患者尿液培养、分离的主要病原菌占比比较[株数(%)]

组别	菌株数量	G^-				G⁺			其他^a
组别	菌株数量	大肠埃希菌	肺炎克雷伯菌	奇异变形杆菌	铜绿假单胞菌	粪肠球菌	无乳链球菌	屎肠球菌	其他^a
绝经组	362	261(72.1)	22(6.1)	16(4.4)	11(3.0)	8(2.2)	5(1.4)	8(2.2)	31(8.6)
非绝经组	281	191(68.0)	18(6.4)	12(4.3)	4(1.4)	9(3.2)	7(2.5)	3(1.1)	37(13.1)
χ²值		1.291	0.029	0.008	1.811	0.606	1.064	—	1.037
P值		0.256	0.864	0.927	0.178	0.436	0.302	0.364	0.352

表4 2组UTI患者尿液培养、分离的大肠埃希菌对不同抗菌药物耐药率比较[%(n/n′)]

抗菌药物	例数	阿米卡星	氨曲南	头孢他啶	环丙沙星	头孢曲松	头孢吡肟	庆大霉素
绝经组	362	3.8(10/261)	31.5(75/238)	24.0(61/254)	69.7(166/238)	43.8(113/258)	31.3(80/256)	39.8(94/236)
非绝经组	281	3.1(6/191)	25.1(44/175)	17.0(32/188)	54.0(95/176)	47.4(90/190)	25.9(48/185)	47.7(83/174)
χ²值		0.154	1.995	3.181	10.801	0.563	1.467	2.529
P值		0.695	0.158	0.074	0.001	0.453	0.226	0.112
抗菌药物	例数	阿莫西林/克拉维酸	头孢哌酮/舒巴坦	哌拉西林/他唑巴坦	亚胺培南	呋喃妥因	磺胺甲唑/甲氧苄啶
绝经组	362	24.0(12/50)	18.7(34/182)	3.1(8/258)	0.4(1/261)	13.6(28/206)	49.8(118/237)
非绝经组	281	33.3(12/36)	17.4(24/138)	2.1(4/189)	0(0/191)	13.9(21/151)	55.2(95/172)
χ²值		0.906	0.088	—	—	0.007	1.183
P值		0.341	0.767	0.571	>0.999	0.932	0.277

表4 2组UTI患者尿液培养、分离的大肠埃希菌对不同抗菌药物耐药率比较[%(n/n′)]

抗菌药物	例数	阿米卡星	氨曲南	头孢他啶	环丙沙星	头孢曲松	头孢吡肟	庆大霉素
绝经组	362	3.8(10/261)	31.5(75/238)	24.0(61/254)	69.7(166/238)	43.8(113/258)	31.3(80/256)	39.8(94/236)
非绝经组	281	3.1(6/191)	25.1(44/175)	17.0(32/188)	54.0(95/176)	47.4(90/190)	25.9(48/185)	47.7(83/174)
χ²值		0.154	1.995	3.181	10.801	0.563	1.467	2.529
P值		0.695	0.158	0.074	0.001	0.453	0.226	0.112
抗菌药物	例数	阿莫西林/克拉维酸	头孢哌酮/舒巴坦	哌拉西林/他唑巴坦	亚胺培南	呋喃妥因	磺胺甲唑/甲氧苄啶
绝经组	362	24.0(12/50)	18.7(34/182)	3.1(8/258)	0.4(1/261)	13.6(28/206)	49.8(118/237)
非绝经组	281	33.3(12/36)	17.4(24/138)	2.1(4/189)	0(0/191)	13.9(21/151)	55.2(95/172)
χ²值		0.906	0.088	—	—	0.007	1.183
P值		0.341	0.767	0.571	>0.999	0.932	0.277

表5 2组UTI患者肺炎克雷伯菌耐药率比较[%(n/n′)]

抗菌药物	例数	阿米卡星	氨曲南	头孢他啶	环丙沙星	头孢曲松	头孢吡肟	庆大霉素
绝经组	362	22.7(5/22)	38.1(8/21)	38.1(8/21)	42.9(9/21)	66.7(14/21)	45.0(9/20)	30.0(6/20)
非绝经组	281	0(0/18)	27.8(5/18)	11.8(2/17)	22.2(4/18)	33.3(6/18)	5.6(1/18)	11.1(2/18)
χ²值		—	0.464	—	1.857	4.311	—	—
P值		0.053	0.469	0.136	0.173	0.038	0.009	0.238
抗菌药物	例数	阿莫西林/克拉维酸	头孢哌酮/舒巴坦	哌拉西林/他唑巴坦	亚胺培南	呋喃妥因	磺胺甲唑/甲氧苄啶
绝经组	362	50.0(3/6)	64.3(9/14)	22.7(5/22)	4.5(1/22)	75.0(12/16)	38.9(7/18)
非绝经组	281	0(0/2)	30.8(4/13)	5.6(1/18)	0(0/18)	81.3(13/16)	35.3(6/17)
χ²值		—	3.033	—	—	—	0.048
P值		0.464	0.082	0.197	>0.999	>0.999	0.826

表5 2组UTI患者肺炎克雷伯菌耐药率比较[%(n/n′)]

抗菌药物	例数	阿米卡星	氨曲南	头孢他啶	环丙沙星	头孢曲松	头孢吡肟	庆大霉素
绝经组	362	22.7(5/22)	38.1(8/21)	38.1(8/21)	42.9(9/21)	66.7(14/21)	45.0(9/20)	30.0(6/20)
非绝经组	281	0(0/18)	27.8(5/18)	11.8(2/17)	22.2(4/18)	33.3(6/18)	5.6(1/18)	11.1(2/18)
χ²值		—	0.464	—	1.857	4.311	—	—
P值		0.053	0.469	0.136	0.173	0.038	0.009	0.238
抗菌药物	例数	阿莫西林/克拉维酸	头孢哌酮/舒巴坦	哌拉西林/他唑巴坦	亚胺培南	呋喃妥因	磺胺甲唑/甲氧苄啶
绝经组	362	50.0(3/6)	64.3(9/14)	22.7(5/22)	4.5(1/22)	75.0(12/16)	38.9(7/18)
非绝经组	281	0(0/2)	30.8(4/13)	5.6(1/18)	0(0/18)	81.3(13/16)	35.3(6/17)
χ²值		—	3.033	—	—	—	0.048
P值		0.464	0.082	0.197	>0.999	>0.999	0.826

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