老年患者尿路感染菌群分布及其耐药性分析

Analysis of Pathogen Spectrum and Drug Resistance in Urinary Tract Infection of Senile Patients

目的 :了解老年患者尿路感染致病菌的菌群分布及其对抗生素的耐药情况 ,为临床合理使用抗生素提供依据。方法 :收集湖北省 15所三级甲等医院 2 0 0 2年尿路感染老年患者清洁中段尿细菌培养分离的 5 34株致病菌 ,对其进行耐药性监测。药敏采用K B法 ,用WHONET 5软件进行数据分析。结果 :共收集致病菌 5 34株 ,其中革兰阴性菌 4 0 9株 (76 .6 % ) ,革兰阳性菌 12 5株(2 3.4 % )。革兰阴性菌中大肠埃希菌检出率最高 (2 6 4株 ,4 9.4 % ) ,其次为克雷白杆菌 (44株 ,8.2 % )。 16 .7%的大肠埃希菌和 2 2 .7%的克雷白杆菌产超广谱 β 内酰胺酶。亚胺培南、阿米卡星、头孢他啶对革兰阴性菌的抗菌活性最强 ,而革兰阴性菌对环丙沙星、庆大霉素、哌拉西林的耐药率均在 5 0 %以上。革兰阳性菌以肠球菌最多见 (6 4株 ,12 % ) ,其次为葡萄球菌属 (43株 ,8.1% )。革兰阳性菌对SMZco、红霉素等的耐药率均在 4 0 %以上 ,但对万古霉素均敏感。结论 :老年患者尿路感染以革兰阴性菌为优势菌株 ,且耐药性日益严重 ,对亚胺培南、阿米卡星、头孢他啶最为敏感。革兰阳性菌宜以万古霉素为首选。

Objective: To guide the clinical drug use by studying the spectrum of pathogens isolated from urinary tract infection in senile patients and the drug resistance to antibiotics.Methods:All the pathogens isolated from urine in senile patients from 15 hospitals of Hubei province during 2002.Bacterial susceptibility test was carried out by using Kirby-Bauer method.A WHONET-5 computer software was used to analyze the results.Results:Five hundred and thirty-four strains including 409 strains ( 76.6%) of Gram negative bacilli and 125 strains ( 23.4%) of gram positive cocci were collected. E.coli, Klebsiella and Staphylococcus were the main microorganisms. 16.7% of E.coli and 22.7% of Klebsiella were suspected to produce extended-spectrum β-lactamase. The effective agents against Gram negative organisms were imipenem,amikacin,ceftazidine.While the drug resistance rate of G- bacilli to ciprofloxacin,gentamycin and piperacillin were above 50%. The drug resistance rate of gram positive cocci to SMZCO and erythromycin were above 40%,but the vancomycin resistant strain had not been found.Conclusions:The drug resistance of bacteria in senile patients , urinary tract infections is increasing. Gram negative bacilli were the main pathogen, and were susceptible to imipenen,amikacin and cefatazidine.Vancomycin is the first choice to treat infection with Gram positive cocci.