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目的分析经尿道膀胱肿瘤切除(TURBT)术后尿路感染患者的病原菌分布及耐药性,探讨诊治的有效方法。方法选择2010年3月-2013年3月62例膀胱肿瘤患者资料进行回顾性分析,所有患者治疗方法均为经尿道膀胱肿瘤切除术,取尿液进行培养及药敏试验,并对诊治方法及效果进行评价。结果 62例TURBT术后尿路感染患者中段尿培养出病原菌71株,其中革兰阴性杆菌50株占70.4%,革兰阳性球菌17株占24.0%,真菌4株占5.6%;前3位的病原菌分别为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌,分别占33.8%、15.5%、9.9%;大肠埃希菌、肺炎克雷伯菌对临床常用的广谱抗菌药物高度耐药,对头孢哌酮/舒巴坦、美罗培南、亚安培南耐药率较低,均<10.0%,革兰阳性菌对临床常用抗菌药物耐药率均>60.0%,未发现耐万古霉素菌株;所有患者在经验用药基础上调整,感染均得到控制,无1例患者死亡。结论经尿道膀胱肿瘤切除术后尿路感染的主要病原菌是革兰阴性杆菌,病原菌耐药现象日趋严重,加强基础疾病的治疗,合理选择抗菌药物,是治疗术后尿路感染的主要策略。
Objective To analyze the distribution and drug resistance of pathogens in patients with urinary tract infection after transurethral bladder tumor resection (TURBT), and to explore effective methods of diagnosis and treatment. Methods The data of 62 patients with bladder cancer from March 2010 to March 2013 were retrospectively analyzed. All the patients were treated by transurethral resection of the bladder tumor, urine culture and drug sensitivity test, and the diagnosis and treatment methods and Effect evaluation. Results Totally 71 pathogenic bacteria were isolated from the urine of 62 patients with urinary tract infection after TURBT. Among them, 50 strains of Gram-negative bacilli accounted for 70.4%, 17 strains of Gram-positive cocci accounted for 24.0% and 4 strains of fungi accounted for 5.6% Pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae, accounting for 33.8%, 15.5% and 9.9% respectively. Escherichia coli and Klebsiella pneumoniae were highly resistant to the broad-spectrum antimicrobial agents commonly used in clinical practice Resistant to cefoperazone / sulbactam, meropenem, and amikacillin were all less than 10.0%, resistant rate of Gram-positive bacteria to commonly used antibiotics was> 60.0%, no vancomycin-resistant Strain; all patients based on empirical medication adjustment, infection were controlled, no one patient died. Conclusions The main pathogen of urinary tract infection after transurethral resection of bladder tumor is Gram-negative bacilli. The pathogenic bacteria are becoming more and more drug-resistant. To strengthen the treatment of basic diseases and choose antibacterial drugs reasonably are the main strategies for postoperative urinary tract infection.