老年女性泌尿系统感染患者的病原菌分布及耐药情况研究

Distribution of pathogens and their drug resistance in elderly women with urinary tract infection

目的通过对老年女性泌尿系统感染患者病原菌类型和耐药情况进行研究,为临床合理、安全、有效使用抗菌药物提供依据。方法收集2014年9月至2017年7月在我院进行诊治的661例老年女性泌尿系统感染患者,对其清晨清洁中段尿进行细菌培养并进行耐药试验。结果 661例样本中共分离出病原菌255株,其中革兰阴性菌165株,占64.7%,以大肠埃希菌为主,构成比为45.5%;革兰阳性菌77株,占30.2%,以屎肠球菌为主,构成比为10.2%;真菌13株,占5.1%。G-菌中检出率排在前三的依次是大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌。大肠埃希菌、肺炎克雷伯菌对氨苄西林、复方新诺明耐药性较高,奇异变形杆菌对头孢唑啉耐药性较高,三者均对亚胺培南敏感性较高。G+菌中检出率排在前三的依次是屎肠球菌、表皮葡萄球菌、粪肠球菌。三种病原菌对青霉素、氨苄西林、环丙沙星耐药性较高,对万古霉素、替考拉宁敏感性较高。结论老年女性泌尿系统感染患者的病原菌多数为革兰阴性菌,且以大肠埃希菌为主,病原菌培养和耐药试验对于临床合理有效地使用抗菌药物具有重要的指导意义。

Objective To learn the distribution and drug resistance of pathogenic bacteria in elderly women with urinary tract infection,and provide reference for rational,safe and effective use of antibiotics.Methods 661 elderly women with urinary tract infections in our hospital from September 2014 to July 2017 were included.The specimens of clean midstream urine were collected in early morning for bacteria culturing and drug resistance test.Results 255 strains of pathogenic bacteria were isolated.There were 165 strains（64.7%）of Gram negative bacteria,among which Escherichia coli was predominant with the composition ratio of 45.5%.There were 77 strains（30.2%）of Gram positive bacteria,among which Enterococcus faecium was predominant with the composition ratio at 10.2%.There were 13 strains of fungi,accounting for5.1%.The top three Gram negative bacteria were Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis.Klebsiella pneumoniae was highly resistant to ampicillin and SMZ-TMP,while Proteus mirabilis was highly resistant to cefazolin;all the three bacteria were sensitive to imipenem.The top three Gram positive bacteria were Enterococcus faecium,Staphylococcus epidermidis and Enterococcus faecalis,which were highly resistant to penicillin,ampicillin and ciprofloxacin,while highly sensitive to vancomycin and teicoplanin.Conclusion The majority of pathogens in elderly women with urinary tract infections are Gram negative bacteria,mainly Escherichia coli.Pathogen culturing and drug sensitivity test are important for rational and effective use of antibiotics in clinical practice.