老年人尿路感染常见病原菌耐药性分析

Drug resistance of common pathogenic bacteria in elderly patients with urinary tract infection

目的研究老年人尿路感染的常见病原菌及其对常用抗生素的耐药性,以指导临床用药。方法采用Vitek-Ams System和Kirby-Bauer法对267例尿路感染的老年患者标本进行细菌培养并检测其对多种抗生素的耐药性。结果共检出病原菌310株,其中革兰阴性杆菌201株(66.1%),主要为大肠埃希菌137株(45.1%)、铜绿假单胞菌25株(8.2%)、肺炎克雷伯菌19株(6.3%)、变形杆菌13株(4.3%)。革兰阴性杆菌对第3代头孢菌素的耐药率较高,可能与产超广谱β内酰胺酶菌株的增多有关,亚胺培南是治疗革兰阴性杆菌感染最有效的药物。革兰阳性球菌76株(23.0%),层析万古霉素仍然是治疗革兰阳性球菌感染最有效的药物。真菌33株(10.9%),对两性霉素B耐药率为0。结论老年人尿路感染病原菌耐药性严重,持续耐药监测对抗生素的合理应用,提高疗效,减缓耐药菌株的发生与发展有重要意义。

Objective The aim of the study is to investigate the drug resistance of common pathogenic bacteria in elderly patients with urinary tract infection,and to guide the clinical application of antibacterial agents. Methods Vitek-Ams System and Kirby-Bauer method were adopted to perform bacterial culture for samples from 267 elderly patients with urinary tract infection and to analyze the drug resistance to a serial of antibiotics. Results A total of 304 strains of pathogenic bacteria were isolated,among which 66.1% were gram negative bacilli （201/304） ,including Escherichia coli （45.1%, 137/304）, Pseudomonas aeruginosa （8.2%, 25/304）, Klebsiella pneumoniae （6. 3%, 19/ 304）,and Bacillus proteus （4.3 %, 13/304）. The isolated gram negative bacilli were high resistant to cephalosporins Ⅲ perhaps due to the increase of ESBLs-producing strains. Imipenem was still the most effective drug to treat the infection of gram negative bacilli. The detected rate of gram positive cocci account for 23.0% （70/304） ; and vancomycin was still the favorable antibiotic to treat the infection of gram positive cocci. The detected rate of fungi was 10.9% （33/304） ,100% sensitive to amphotericin B. Conclusion The drug resistance of common pathogenic bacteria is serious in elderly patients with urinary tract infection. Continuous monitoring of drug resistance plays an important role in the rational use of antibiotics, enhancement of therapeutic effect and reduction of drug-resistant strains.