Analysis of bacteria spectrum and drug resistance of urine and stone bacteria in non-infection urinary tract stone patients
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摘要: 目的 探讨非感染性结石患者尿液和结石细菌培养的病原体分布及耐药性特征。 方法 收集2016年9月—2021年9月于广州医科大学附属第二医院行经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)且完成中段尿与结石培养的非感染性结石患者临床资料，分析尿液与结石中致病菌分布与耐药性情况。 结果 共纳入符合标准的792例患者，尿液细菌培养(urine cultures，UC)阳性率为16.3%(129/792)，尿液中共检出21种细菌，主要致病菌为大肠埃希菌(60.5%)、粪肠球菌(9.3%)及肺炎克雷伯菌(4.7%)。结石细菌培养(stone cultures，SC)阳性率为25.1%(199/792)。结石中共检出43种细菌，最常见细菌为大肠埃希菌(51.8%)、表皮葡萄球菌(6.0%)及粪肠球菌(3.0%)。进一步分析显示尿液与结石中常见细菌均呈多重耐药。其中尿液中大肠埃希菌、肺炎克雷伯杆菌对多数头孢菌素、氨苄西林耐药率>40%，但对阿莫西林/克拉维酸、头孢哌酮舒巴坦、哌拉西林他唑巴坦敏感(耐药率均 < 10%)；而粪肠球菌对红霉素、克林霉素、四环素耐药率>40%，但对氨苄西林、呋喃妥因、替加环素、利奈唑胺敏感(耐药率均为0)。尿液与结石中同一种类的细菌的耐药性未见明显差异。 结论 非感染性结石患者尿液与结石中的细菌菌谱复杂，且常见细菌均呈多重耐药，建议临床工作中常规行尿液及结石细菌培养，并根据药敏结果选择抗菌药物。Abstract: Objective To analyze the distribution and drug resistance of pathogenic bacteria of urine and stone bacteria in non-infection stone patients. Methods The clinical data from non-infection stone patients who underwent percutaneous nephrolithotomy (PCNL) and completed midstream urine and stone cultures between Sep. 2016 and Sep. 2021 were collected, and the distribution and antibiotic resistance of pathogens in urine and stones were analyzed. Results A total of 792 patients were included. One hundred and twenty-nine (16.3%) had positive urine cultures (UC+), and 199 (25.1%) had positive stone cultures (SC+). A total of 21 bacterial species were isolated from UC, with the most common being Escherichia coli (60.5%), Enterococcus faecalis (9.3%), and Klebsiella pneumoniae (4.7%). Meanwhile, 43 bacterial species were isolated from SC and the most common isolates were Escherichia coli (51.8%), followed by Staphylococcus epidermidis (6.0%), and Enterococcus faecalis (3.0%). Further analysis showed that the common bacteria isolated from both urine and stones exhibited multidrug resistance. Escherichia coli and Klebsiella pneumoniae in urine exhibited resistance rates >40% to most cephalosporins and ampicillin, but their resistance rates to amoxicillin/clavulanate, cefoperazone/sulbactam, and piperacillin/tazobactam were < 10%. Enterococcus faecalis had a resistance rate of greater than 40% to erythromycin, clindamycin, and tetracycline, but was not resistant to ampicillin, nitrofurantoin, tigecycline, and linezolid. The antibiotic resistance of the same bacterial species isolated from both urine and stones showed no significant differences. Conclusion In patients with non-infection stones, the microbial spectrum of both urine and stones is intricate, and the common bacteria exhibit multidrug resistance. Therefore, it is advisable to conduct routine urine and stone cultures in clinical practice and select antimicrobial agents based on the outcomes of antimicrobial susceptibility testing.
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Key words:
- non-infection stones /
- midstream urine culture /
- stone culture /
- drug resistance
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表 1 非感染性结石患者UC及SC菌谱
例(%) 菌谱 非感染性结石 草酸钙结石 尿酸结石 磷酸钙结石 UC(129例) SC(199例) UC(91例) SC(149例) UC(34例) SC(44例) UC(4例) SC(6例) 大肠埃希菌 78(60.5) 103(51.8) 58(63.7) 80(53.7) 18(52.9) 21(47.7) 2(50.0) 2(33.3) 表皮葡萄球菌 2(1.6) 12(6.0) 1(1.1) 10(6.7) 1(2.9) 2(4.5) - - 无乳链球菌 4(3.1) 1(0.5) 4(4.4) 1(0.7) - - - - 粪肠球菌 12(9.3) 6(3.0) 8(8.8) 2(1.3) 4(11.8) 4(9.1) - - 屎肠球菌 4(3.1) 5(2.5) 1(1.1) 2(1.3) 1(2.9) 2(4.5) 2(50.0) 1(16.7) 奇异变形杆菌 2(1.6) 4(2.0) 2(2.2) 1(0.7) - 3(6.8) - - 鲍曼不动杆菌 1(0.8) 3(1.5) - 3(2.0) 1(2.9) - - - 铜绿假单胞菌 3(2.3) 5(2.5) 3(3.3) 4(2.7) - - - 1(16.7) 肺炎克雷伯菌 6(4.7) 2(1.0) 5(5.5) 2(1.3) 1(2.9) - - - 白色假丝酵母菌 2(1.6) 6(3.0) - 2(1.3) 2(5.9) 4(9.1) - - 热带念珠菌 1(0.8) 3(1.5) 1(1.1) 2(1.3) - - - 1(16.7) 光滑念珠菌 1(0.8) 2(1.0) - 2(1.3) 1(2.9) - - - 近平滑念珠菌 - 2(1.0) - 2(1.3) - - - - 其他a) 14(10.9) 45(22.6) 8(8.8) 36(24.2) 5(14.7) 8(18.2) - 1(16.7) 注：a)其他包括毗邻颗粒链菌、嗜麦芽窄食单胞菌、弗劳地柠檬酸杆菌、洋葱伯克霍尔德菌等。 
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表 2 非感染性结石患者UC及SC检出率前三细菌的耐药率
% 抗菌药物 UC SC 大肠埃希菌 粪肠球菌 肺炎克雷伯菌 大肠埃希菌 表皮葡萄球菌 粪肠球菌 头孢唑啉 61.8(47/76) - 50.0(3/6) 52.4(54/103) - - 头孢西丁 20.0(15/75) - 16.7(1/6) 11.1(11/99) - - 头孢呋辛 60.8(31/51) - - 46.6(34/73) - - 拉氧头孢 0(0/33) - - 2.4(1/42) - - 头孢曲松 48.7(37/76) - 50.0(3/6) 43.1(44/102) - - 头孢噻肟 50.0(38/76) - 50.0(3/6) 45.6(47/103) - - 头孢他啶 26.0(20/77) - 16.7(1/6) 19.4(19/98) - - 头孢哌酮/舒巴坦 8.0(6/75) - 0(0/5) 7.8(8/102) - - 头孢吡肟 18.7(14/75) - 16.7(1/6) 21.4(22/103 - - 青霉素 - 0(0/12) - - 100(11/11) 0(0/5) 氨曲南 32.7(16/49) - 0(0/5) 32.8(24/73) - 氨苄西林 85.4(41/48) 0(0/12) 100.0(5/5) 77.8(56/72) - 0(0/6) 阿莫西林/克拉维酸 6.7(5/75) - 0(0/6) 5.9(6/101) - 哌拉西林/他唑巴坦钠 2.6(2/76) - 0(0/6) 4.9(5/103) - 庆大霉素 44.9(22/49) - 20.0(1/5) 32.4(24/74) 0(0/12) 阿米卡星 5.3(4/75) - 0(0/6) 3.9(4/103) - 妥布霉素 18.0(9/50) - 0(0/5) 10.6(8/75) - 克林霉素 - 100.0(12/12) - - 33.3(4/12) 100.0(6/6) 红霉素 - 58.3(7/12) - - 41.7(5/12) 66.7(4/6) 左氧氟沙星 50.0(37/74) 9.1(1/11) 0(0/6) 41.0(41/100) 16.7(2/12) 33.3(2/6) 环丙沙星 50.0(25/50) 20.0(2/10) 0(0/5) 45.3(34/75) - 40.0(2/5) 莫西沙星 - 16.7(2/12) - - 9.1(1/11) 40.0(2/5) 呋喃妥因 7.7(5/65) 0(0/10) 16.7(1/6) 6.7(6/90) - 0(0/5) 复方新诺明 42.9(33/77) - 33.3(2/6) 53.4(55/103) 33.3(4/12) 四环素 - 90.0(9/10) - - - 替加环素 0(0/75) 0(0/11) 0(0/6) 0(0/102) 0(0/12) 0(0/6) 奎奴普丁/达福普丁 - 100.0(10/10) - - - 替考拉宁 - 0(0/12) - - 0(0/12) 0(0/6) 亚胺培南 0(0/77) - 0(0/6) 1.9(2/103) - 厄他培南 0(0/76) - 0(0/6) 1.9(2/103) - 美罗培南 0(0/74) - 0(0/5) 0(0/61) - 万古霉素 - 8.3(1/12) - - 0(0/12) 0(0/6) 利奈唑胺 - 0(0/12) - - 0(0/12) 0(0/5)
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