分析中山大学附属第三医院岭南医院泌尿外科患者病原菌分布及其耐药性变迁，为指导临床合理用药治疗提供理论依据。

应用WHONET 5.6软件对2014~2024年度泌尿外科患者分离病原菌及药敏试验结果进行分析。

2014~2024年泌尿外科共2035例患者检出病原菌（男51.84%，女48.16%）；不同年龄组病原菌检出略有差异；病原菌标本来源主要是尿液（90.37%），其次为引流液（2.53%）、痰（2.46%）和血液（1.17%）等。泌尿外科患者共分离菌株2 566株，革兰阴性杆菌检出率呈下降趋势，前五位检出菌分别为大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌、铜绿假单胞菌及鲍曼不动杆菌复合体；革兰阳性菌检出率呈上升趋势，前五位分别为粪肠球菌、无乳链球菌、溶血葡萄球菌、屎肠球菌及缓症链球菌/口腔链球菌，真菌的检出率也呈上升趋势，主要为白色念珠菌、光滑念珠菌及热带念珠菌。大肠埃希菌未发现替加环素耐药，对亚胺培南、美罗培南、头孢哌酮/舒巴坦、呋喃妥因、厄他培南、阿米卡星、哌拉西林/他唑巴坦及头孢西丁的耐药率低（<10%）。肺炎克雷伯菌对替加环素、阿米卡星、亚胺培南、美罗培南、厄他培南的耐药率低（<10%）。奇异变形杆菌对美罗培南、厄他培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁、阿米卡星、头孢他啶、阿莫西林/克拉维酸的耐药率低（<10%）。铜绿假单胞菌对阿米卡星、美罗培南、亚胺培南、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、庆大霉素及妥布霉素的耐药率低（<10%）。粪肠球菌对万古霉素、呋喃妥因、氨苄西林、青霉素G及利奈唑胺的耐药率低（<5%）。未发现对万古霉素、利奈唑胺、氨苄西林、头孢曲松及头孢噻肟耐药的无乳链球菌，未发现对万古霉素、利奈唑胺及呋喃妥因耐药的溶血葡萄球菌。屎肠球菌对利奈唑胺（1.4%）及万古霉素（4.3%）的耐药率低，未发现对利奈唑胺及万古霉素耐药的缓症链球菌/口腔链球菌，其对氯霉素的耐药率较低（3.5%）。

泌尿外科患者以男性为主，尿液为最主要标本来源，病原菌以革兰阴性菌为主，但革兰阳性菌及真菌的检出比例逐年上升。检出率最高的大肠埃希菌大部分药物耐药率趋于稳定或呈下降趋势，前五位革兰阴性杆菌对碳青霉烯类抗生素的耐药率低，前五位革兰阳性菌对万古霉素及利奈唑胺的耐药率低，表明临床规范用药有效遏制了细菌耐药率的升高。

To analyze the distribution of pathogenic bacteria and changes in antibiotic resistance among Urology patients in Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University to provide a theoretical basis for guiding rational clinical drug use.

WHONET 5.6 software analyzed non-duplicate bacterial isolates and antimicrobial susceptibility data from Urology patients from 2014 to 2024.

From 2014 to 2024, pathogens were detected in 2035 Urology patients, with 51.84% male and 48.16% female. Pathogen detection rates varied slightly among age groups. The primary source of pathogen specimens was urine samples (90.37%), followed by drainage fluid (2.53%), sputum (2.46%) and blood (1.17%). A total of 2,566 non-duplicate isolates were isolated from urology patients. The detection rate of gram-negative bacilli exhibited a downward trend, with the top five detected bacteria being Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Acinetobacter baumannii. Conversely, the detection rate of gram-positive bacteria increased, with the top five being Enterococcus faecalis, Streptococcus agalactiae, Staphylococcus haemolyticus, Enterococcus faecium, and Streptococcus mitis/streptococcus oralis. Similarly, the detection rate of fungi also increased, with the top three being Candida albicans, Candida glabrata, and Candida tropicalis. No Escherichia coli resistant to tigecycline was detected. The resistance rates of Escherichia coli to imipenem, meropenem, cefoperazone/sulbactam, nitrofurantoin, ertapenem, amikacin, piperacillin/tazobactam, and cefoxitin were low (<10%). The resistance rates of Klebsiella pneumoniae to tigecycline, amikacin, imipenem, meropenem, and ertapenem were also low (<10%). For Proteus mirabilis, the resistance rates to meropenem, ertapenem, piperacillin/tazobactam, cefoperazone/sulbactam, cefoxitin, amikacin, ceftazidime, and amoxicillin/clavulanate were low (<10%). Regarding Pseudomonas aeruginosa, the resistance rates to amikacin, meropenem, imipenem, piperacillin/tazobactam, cefepime, ceftazidime, gentamicin, and tobramycin were low (<10%). Enterococcus faecalis exhibits low resistance rates (<5%) to vancomycin, nitrofurantoin, ampicillin, penicillin, and linezolid. No Streptococcus agalactiae isolates have shown resistance to vancomycin, linezolid, ampicillin, ceftriaxone, or cefotaxime. No vancomycin-, linezolid-, or nitrofurantoin-resistant Staphylococcus haemolyticus isolates were identified. Enterococcus faecium exhibited low resistance rates to linezolid and vancomycin (1.4% and 4.3%, respectively). No linezolid- or vancomycin-resistant Streptococcus mitis/oralis group strains were detected, with chloramphenicol resistance observed in only 3.5% of isolates.

In the urology department, the patient population was predominantly male, with urine specimens constituting the majority of samples. Gram-negative bacteria remained the primary pathogens, however, increasing detection rates of gram-positive bacteria and fungi warrant heightened clinical vigilance. Escherichia coli was the most prevalent isolate, demonstrating stable or declining resistance rates to most antimicrobial agents. Notably, the top five gram-negative bacilli exhibited low resistance to carbapenems, while the leading five gram-positive species showed minimal resistance to vancomycin and linezolid. These findings suggest that standardized antimicrobial stewardship practices have effectively mitigated the escalation of bacterial drug resistance.