摘要
目的:了解本地区前列腺病原体感染的流行病学状况及抗菌药物耐药率趋势,为临床治疗前列腺感染提供参考依据。方法:收集2008~2012年常熟地区综合医院诊断为前列腺炎并进行病原体学检测标本2 306例。淋病奈瑟菌、解脲支原体、沙眼衣原体经核酸扩增仪ABI 7500检测分析。一般细菌培养经全自动微生物鉴定分析仪VITEK 2 Compact检测分析。抗菌药物耐药率以WHONET分析结果,数据以统计软件SPSS 19.0卡方检验线性趋势分析。结果:前列腺感染主要病原体为溶血葡萄球菌(30%),表皮葡萄球菌(12%),粪肠球菌(9%),大肠埃希菌(6%),沃氏葡萄球菌与金黄色葡萄球菌各占3%,解脲支原体(8%),沙眼衣原体(5%),淋病奈瑟菌(6%)。其中大肠埃希菌(χ2=17.56,P【0.05)、支原体(χ2=8.73,P【0.05)、衣原体(χ2=13.813,P【0.05)和肠球菌属(χ2=8.22,P【0.05)感染呈上升趋势,其它病原体检出率无显著性变化。革兰阳性菌对红霉素、青霉素G耐药率较严重,均值达45%以上,趋势稳定。苯唑西林(χ2=10.06,P【0.05)与头孢西丁(χ2=9.89,P【0.05)耐药率增高。而喹诺酮类抗生素、庆大霉素、克林霉素、利福平等保持较低耐药率。除利福平有所增高(χ2=11.09,P【0.05)外,革兰阴性杆菌对头孢唑林、氨苄西林耐药率较高(均值57.3%),头孢曲松(χ2=11.26,P【0.05)与复方新诺明(χ2=11.00,P【0.05)耐药率增高趋势达显著水平,对阿米卡星、头孢吡肟、哌拉西林/他唑巴坦、亚胺培南等保持较低耐药率,趋势分析不显著。解脲支原体对环丙沙星(χ2=11.18,P【0.05)、阿奇霉素(χ2=9.89,P【0.05)耐药率呈增高趋势。结论:前列腺病原体感染以革兰阳性球菌为主。大肠埃希菌、性传播类病原体与肠球菌属检出率近年呈上升趋势。一般性革兰阳性菌治疗宜以喹诺酮类、氨基糖苷类为主。治疗前列腺炎感染有必要根据本地区致病菌及其耐药谱合理选择用药。
Objective: To investigate the epidemiological features of the pathogens responsible for prostatitis in the Changshu area,and offer some evidence for the clinical treatment of prostatitis. Methods: This study included 2 306 cases of prostatitis that were all clinically confirmed and subjected to pathogenic examinations in 3 hospitals of Changshu area from 2008 to 2012. Neisseria gonorrhoeae,mycoplasma urealytium and chlamydia trachomatis were detected by nucleic acid amplification ABI 7500,the bacterial data analyzed by VITEK-2 Compact,the drug-resistance to antibacterial agents determined using the WHONET 5. 6 software,and the enumeration data processed by chi-square test and curvilinear regression analysis using SPSS 19. 0. Results: The main pathogens responsible for prostatitis were found to be staphylococcus haemolyticus( 30%),staphylococcus epidermidis( 12%),enterococcus faecalis( 9%),Escherichia coli( 6%),staphylococcus warneri and staphylococcus aureus( 3%),mycoplasma urealytium( 8%), chlamydia trachomatis( 5%) and neisseria gonorrhoeae( 6%). Statistically significant increases were observed in the detection rates of Escherichia coli( χ2= 17. 56,P < 0. 05),mycoplasma urealytium( χ2= 8. 73,P < 0. 05),chlamydia trachomatis( χ2= 8. 73, P < 0. 05) and enterococcus( χ2= 8. 22,P < 0. 05),but not in other pathogens. The resistance rates of Gram-positive bacteria to erythromycin and benzylpenicillin G were both above 45%,but with no significant difference between the two,those of Oxacillin( χ2= 10. 06,P < 0. 05) and Cefoxitin( χ2= 9. 89,P < 0. 05) were markedly increased,but those of quinolones,gentamycin and clindamycin remained low,except rifampicin( χ2= 11. 09,P < 0. 05). The resistance rates of Gram-negative bacteria to cefazolin and ampicillin were relatively high( mean 57. 3%),and those to ceftriaxone( χ2= 11. 26,P < 0. 05) and trimethoprim sulfamethoxazole( χ2 = 11. 00,P < 0. 05) significantly high; those to amikacin,cefepime,piperacillin / tazobactam and imipenem remained at low levels with no significant changes. However,the resistance rates of mycoplasma urealytium to ciprofloxacin( χ2= 11. 18,P < 0. 05) and azithromycin( χ2= 9. 89,P < 0. 05) were remarkably increased. Conclusion: Gram-positive bacteria are the major pathogens responsible for prostatitis,but Escherichia coli,enterococcus and sexually transmitted disease pathogens are found to be involved in recent years. Quinolones and aminoglycosides are generally accepted as the main agents for the treatment of Gram-positive bacterial infection. However,rational medication for prostatitis should be based on the results of pathogen isolation and drug sensitivity tests in a specific area.
出处
《中华男科学杂志》
CAS
CSCD
2013年第10期912-917,共6页
National Journal of Andrology
关键词
前列腺炎
病原体
耐药率
流行病学
prostatitis
pathogen
drug resistant rate
epidemiology
