不同年龄段老年患者医院获得性尿路感染病原菌分布及耐药性分析

Pathogen distribution and drug resistance of hospital-acquired urinary tract infection in elderly patients with different ages

目的对不同年龄段的老年患者医院获得性尿路感染的细菌构成和耐药性进行分析,为临床预防、控制、治疗老年人医院获得性尿路感染提供实验室依据。方法收集医院获得性尿路感染患者尿液样本,共分离菌株2 145例。采用ATB鉴定仪鉴定菌株,采用纸片扩散法进行药物敏感性试验,按美国临床实验室标准化协会（CLSI）M100-S24标准判断药物敏感性结果。结果 2 145株病原菌中有374株（17.4%）分离自≤60岁的患者,有263株（12.3%）分离自61~70岁的患者,有443株（20.7%）分离自71~80岁的患者,有1 065株（49.6%）分离自〉80岁的患者。随着年龄的增长,屎肠球菌、粪肠球菌的检出率呈增长趋势。大肠埃希菌对哌拉西林、氨苄西林-舒巴坦、哌拉西林-他唑巴坦、头孢唑啉、头孢克洛、头孢呋辛、头孢噻肟、头孢他啶、头孢吡肟、厄他培南、环丙沙星、复方磺胺甲噁唑的耐药率随年龄增长逐渐增高。肺炎克雷伯菌对头孢吡肟、阿米卡星的耐药率随年龄增长逐渐增高。粪肠球菌对氨苄西林、环丙沙星、左氧氟沙星的耐药率随年龄增长而逐渐增高。屎肠球菌对环丙沙星、左氧氟沙星的耐药率随年龄增长逐渐增高。结论老年人医院获得性尿路感染病原菌的耐药率较为严重。

Objective To analyze the pathogen distribution and drug resistance of hospital-acquired urinary tract infection in elderly patients with different ages,in order to provide a reference for clinical prevention,control and treatment of hospital-acquired urinary tract infection in elderly patients. Methods A total of 2 145 isolates were collected from urine samples of patients with hospital-acquired urinary tract infection. These isolates were identified by ATB identification analyzer. Kirby-Bauer method was used for analyzing drug resistance,according to the Clinical and Laboratory Standards Institute（CLSI） M100-S24. Results A total of 374 isolates（17.4%）were collected from urine samples of patients with ≤60 years old,263 isolates（12.3%）were collected from urine samples of patients with 61-70 years old,443 isolates（20.7%）were collected from urine samples of patients with 71-80 years old,and 1 065 isolates（49.6%）were collected from urine samples of patients with 〉80 years old. The detection rates of Enterococcus faecium and Enterococcus faecalis increased with ages. The drug resistance rates of Escherichia coli increased with ages against piperacillin,ampicillin-sulbactam,piperacillin-tazobactam,cefazolin,cefaclor,cefuroxime,cefotaxime,ceftazidime,cefepime,ertapenem,ciprofloxacin and compound sulfamethoxazole. The drug resistance rates of Klebsiella pneumoniae increased with ages against cefepime and amikacin. The drug resistance rates of Enterococcus faecalis increased with ages against ampicillin, ciprofloxacin and levofloxacin. The drug resistance rates of Enterococcus faecium increased with ages against ciprofloxacin and levofloxacin. Conclusions The drug resistance of pathogens in elderly patients with hospital-acquired urinary tract infection is serious.