3种三代头孢菌素类抗生素治疗老年糖尿病合并泌尿系统感染的效果

Clinical study three kinds of three generations of cephalosporin antibiotics in elderly diabetic patients with urinary tract infection

目的探讨3种三代头孢菌素类抗生素治疗老年糖尿病合并泌尿系统感染的临床效果及安全性。方法选择2013年7月~2015年6月鄄城县第二人民医院收治的糖尿病并发泌尿系统感染的老年患者144例,随机数字表法分为Ⅰ组、Ⅱ组、Ⅲ组,各48例,Ⅰ组给予头孢他啶2 g静滴,每日2次;Ⅱ组给予头孢曲松2 g静滴,每日1次;Ⅲ组给予头孢噻肟2 g静滴,每日2次。观察治疗1个疗程后3组临床疗效和细菌学清除率。结果共检出病原菌179株,革兰阴性菌111株占比为62.01%,革兰阳性菌68株占比为37.99%,以革兰阴性菌为主,主要病原菌为：大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、粪肠球菌。各组病原菌分布比较差异无统计学意义（P〉0.05）。3组总有效率比较差异有统计学意义（P〈0.05）,由高到低依次为Ⅲ组、Ⅱ组、Ⅰ组。三组清除率比较,差异有统计学意义（P〈0.05）,由高到低依次为Ⅲ组、Ⅱ组、Ⅰ组。结论老年糖尿病合并泌尿系统感染病原菌以革兰阴性菌为主,头孢噻肟治疗效果及细菌学清除率优于同代头孢他啶、头孢曲松。

Objective To investigate three kinds of the third generation of cephalosporin antibiotics to treat urinary tract infections in elderly diabetic patients with clinical efficacy and safety. Methods From July 2013 to June 2015, in Second People＇s Hospital of Juancheng County, 144 elderly patients with diabetes complicated urinary tract infection were randomly divided into group Ⅰ, group Ⅱ, group Ⅲ, with 48 cases in each group. Group Ⅰ received intravenous Ceftazidime 2 g intravenously twice daily; group Ⅱ received intravenous Ceftriaxone 2 g once a day; group Ⅲ received intravenous Cefotaxime 2 g twice daily. Clinical and bacterial clearance of three groups for treatment a course were observed. Results A total of 179 pathogens, 111 Gram-negative bacteria accounted for 62.01%, 68 Gram-positive bacteria accounted for 37.99%, Gram-negative bacteria were the main pathogens： E. coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis. Pathogen distribution in each group showed no significant difference（P 0.05）. The total effective rates of three groups were compared, the difference was statistically significant（P 0.05）, followed by group Ⅲ, group Ⅱ, group Ⅰ. Clearance rates of three groups were compared, the difference was statistically significant（P 0.05）, followed by group Ⅲ, group Ⅱ, group Ⅰ. Conclusion The pathogenic bacteria of elderly diabetic patients with urinary tract infection are Gram-negative bacteria, Cefotaxime treatment and bacteriological clearance rate are better than the same generation Ceftazidime, Ceftriaxone.