老年危重症患者尿路感染的病原菌分布及大肠埃希菌耐药性分析

Pathogenic bacteria distribution and drug resistance of urinary tract infection in critical ill elderly patients

目的探讨老年危重症患者尿路感染的病原菌分布及其耐药特点。方法选取2014年6月至2016年6月我院收治的老年危重症并发尿路感染患者360例作为研究对象,采集患者清洁中段尿液标本,进行细菌鉴定和药敏试验,筛选大肠埃希菌产ESBLs菌株。结果共分离出病原菌218株,主要为大肠埃希菌(58.26%);产ESBLs菌株对头孢呋辛完全耐药,对环丙沙星、头孢曲松、哌拉西林耐药率均在90%以上,对哌拉西林/他唑巴坦的耐药率在10%以下,对亚胺培南完全敏感,非产ESBLs菌株对绝大多数药物的耐药率显著低于产ESBLs菌株(P<0.05)。结论老年危重症患者尿路感染病原菌以大肠埃希菌为主,产ESBLs是大肠埃希菌耐药的重要原因之一,医务人员应根据药敏试验结果合理选用抗菌药物。

Objective To investigate the distribution of pathogens and drug resistance of Escherichia coli in elderly critically ill patients with urinary tract infection.Methods 360 elderly critically ill patients complicated with urinary tract infection admitted in our hospital from June 2014 to June 2016 were included as the subjects.Their clean midstream urine specimens were collected for bacteria detection drug sensitivity test.The strains of ESBLs-producing Escherichia coli were screened.Results A total of 218 strains of pathogens were isolated,among which Escherichia coli accounted for 58.26%.The ESBLs-producing strains were completely resistant to cefuroxime,and their resistance rates to ceftriaxone,ciprofloxacin and piperacillin were over 90%.They were sensitive to piperacillin/tazobactam,and highly sensitive to imipenem.The resistance rates of non-ESBLs producing strains to most antimicrobial agents were significantly lower than those of the ESBLs producing strains（P〈0.05）.Conclusion The main pathogen of urinary tract infection in elderly critical ill patients is Escherichia coli,the production of ESBLs is one of the important causes of the drug resistance of Escherichia coli.Antibacterial drugs should be used reasonably according to the results of sensitivity test.