老年患者尿路感染病原菌分布及耐药性分析

Distribution and Drug Resistance of Urinary Tract Pathogens in Elderly Patients

目的探讨老年患者尿路感染常见病原菌及其分布特点,并分析其耐药情况,为临床合理用药提供指导。方法选择2017年1—12月在南昌大学第一附属医院住院治疗、年龄≥60岁且尿培养阳性患者438例,采用VITEK2全自动细菌鉴定仪和MIC法对阳性尿液标本进行病原菌的鉴定及药敏试验,并参考CLSI(美国临床实验室标准化协会)2015年标准报告药敏试验结果。结果阳性尿液标本共检测出病原菌438株,其中革兰阳性菌89株(20.32%),革兰阴性菌344株(78.54%),真菌5株(1.14%);主要来源于泌尿外科97株(22.14%)、肾内科42株(9.59%)、神经外科41株(9.36%)、老年科21株(4.79%)等。革兰阳性菌主要为屎肠球菌(31株,7.08%),革兰阴性菌主要为大肠埃希菌(179株,40.87%);药敏试验结果显示,屎肠球菌对环丙沙星、左氧氟沙星、青霉素耐药达90%以上;大肠埃希菌对氨曲南、氨苄西林、环丙沙星的耐药率在60%以上。结论住院老年患者尿路感染病原菌以革兰阴性菌为主,不同病原菌耐药性有显著差异,呈普遍高耐药现象。因此,临床上治疗老年患者尿路感染的同时应完善尿培养,医师需根据药敏试验合理有效的选用抗生素,以达到满意的治疗效果,同时避免病原菌产生耐药。

Objective To analyze the distribution characteristics and drug resistance of pathogens causing urinary tract infections in elderly patients,and to provide guidance for rational drug use.Methods A total of 438 patients aged 60 years or older who were treated in the First Affiliated Hospital of Nanchang University from January to December 2017 for urinary tract infections were selected in this study.Pathogen identification and drug susceptibility testing were performed using VITEK2 automated system and MIC method,respectively.The results were analyzed according to the Clinical and Laboratory Standards Institute(CLSI)guideline(2015).Results A total of 438 strains of pathogens were isolated,including 89 strains of gram-positive cocci(20.32%),334 strains of gram-negative bacilli(78.54%)and 5 strains of fungi(1.14%).Of these strains,97(22.14%)were found in the department of urinary surgery,42(9.59%)in the department of nephrology,41(9.36%)in the department of neurosurgery,and 21(4.79%)in the department of geriatrics.Gram-positive bacteria were mainly Enterococcus faecium(31 strains,7.08%),Gram-negative bacteria were mainly Escherichia coli(179 strains,40.87%).Enterococcus faecium showed over 90% resistance to ciprofloxacin,levofloxacin and penicillin,and Escherichia coli had over 60% resistance to aztreonam,ciprofloxacin and ampicillin.Conclusion Gram-negative bacteria were the main pathogens causing urinary tract infections in elderly patients.There pathogens were highly resistant to antibiotics and showed significant differences in drug resistance.In order to achieve satisfactory therapeutic effect and to avoid drug resistance,urine culture should be improved and antibiotics should be rationally chosen according to the drug susceptibility testing results.