老年患者泌尿系统感染的菌群分布及耐药性分析

Pathogens from Senile Patients with Urinary Tract Infection:Distribution and Drug Tolerance Analysis

目的调查老年患者泌尿系统感染致病菌的菌群分布及耐药性,为合理使用抗菌药物提供依据。方法采用法国生物梅里埃公司VITEK2-COMPACT微生物自动鉴定与药敏系统,对医院1年来>70岁泌尿系感染住院患者,尿培养所得细菌进行鉴定及药敏检测。结果由尿液标本中共分离致病菌319株,273株细菌中革兰阴性菌198株,以铜绿假单胞菌(27.27%)和大肠埃希菌(15.99%)为主;革兰阳性菌75株,以屎肠球菌(13.17%)和粪肠球菌(5.64%)为主,凝固酶阴性的葡萄球菌只占少数;真菌46株,以白色假丝酵母菌为主(6.27%);药敏检测发现,铜绿假单胞菌和大肠埃希菌对青霉素类,一～三代头孢菌素类,喹诺酮类抗菌药物均表现出高耐药性;粪肠球菌对氨苄西林非常敏感(100.00%),而屎肠球菌对其耐药(97.62%),另外屎肠球菌对喹诺酮类药物、克林霉素、红霉素100.00%耐药,而对利奈唑胺、喹奴普汀/达福普汀、四环素耐药率分别为4.76%、11.90%、21.40%;粪肠球菌对克林霉素100.00%耐药,对其他大多数药物的敏感性都比较高。结论老年患者泌尿系统感染病原菌耐药情况较为严重,在临床上应严格掌握抗菌药物的适应证,合理使用抗菌药物,避免多重感染和医院感染。

OBJECTIVE To investigate the distribution and drug tolerance of pathogens from senile patients with urinary tract infection, and provide reliable reference for rational clinical therapy. METHODS Urine samples from senile patients with urinary tract infection were collected and cultured. Isolated bacteria and their antibiotics resistance profiles were identified and analyzed with VITEK2-COMPACT system and NCCLS standards. RESULTS Isolated 319 bacterial strains were consisted with 198 Gram^＋ , 75 Gram^- bacteria and 46 fungi strains. Results from antibiotics sensitive tests suggested that Pseudornonas aeruginosa and Escherichia coli strongly resist to penicillins, cephalosporins, and quinolones, while Enterococcus faecalis was resistant to clindamycin, but sensitive to ampicillin （100. 00%） and most of other antibiotics, E. faecium （100. 00%） was resistant to ampicillin, quinolones, clindamycin（100.00%） and erythromyein（100.00%） and sensitive to linezolid（4.76%） and tetracycline（21.40%）. CONCLUSIONS Pathogens isolated from senile patients with urinary tract infection display strong drug tolerance. Strict control must be taken in antibiotics application in clinical therapy, to avoid multiple and nosocomial infection.