老年人尿路感染大肠埃希菌的药敏结果及耐药危险因素分析

Analysis of drug susceptibility and risk factors for drug resistance of Escherichia coli in elderly patients with urinary tract infection

目的探讨老年人群(≥65岁)尿路感染产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的危险因素及致病菌的耐药特性,为临床抗菌药物的合理应用提供依据。方法回顾性分析北京朝阳医院2016年1月至2017年12月诊断为尿路感染的老年患者的临床资料,根据尿液标本分离的大肠埃希菌是否产ESBLs分为产ESBLs组和对照组,采用χ2检验进行单因素分析,在有统计学意义的基础上采用多因素Logistic回归分析产ESBLs大肠埃希菌尿路感染的危险因素。结果共分离出大肠埃希菌452株,产ESBLs菌株253株(55.97%),非产ESBLs菌株199株(44.03%)。输尿管结石(OR=2.675,95%CI:1.129~6.341)、尿路梗阻疾病≥2种(OR=8.680,95%CI:2.508~30.040)、留置导尿管(OR=5.762,95%CI:2.698~12.155)、1年内因尿路感染使用抗生素治疗>2周(OR=3.461,95%CI:1.766~6.784)是产ESBLs大肠埃希菌泌尿系统感染的独立危险因素。老年患者尿路感染大肠埃希菌对多种抗生素耐药率均显著高于非老年患者。结论患有尿路梗阻性疾病、留置导尿管以及反复长期使用广谱抗生素的老年患者易分离出产ESBLs大肠埃希菌,老年患者大肠埃希菌致尿路感染存在ESBLs比例较高,抗菌药物宜选择碳青霉烯类或哌拉西林/他唑巴坦,而氨苄西林、哌拉西林、左氧氟沙星、环丙沙星不宜再作为治疗尿路感染的首选用药。

Objective To investigate the risk factors for drug resistance of urinary tract infections-causing Escherichia coli producing extended spectrum beta-Lactamases(ESBLs)in elderly people(≥65 years old),in order to provide evidence for rational use of antibiotics in clinic.Methods Clinical data of elderly patients diagnosed as urinary tract infections in Beijing Chao-Yang Hospital from January 2016 to December 2017 were retrospectively analyzed.According to whether ESBLs were produced by Escherichia coli isolated from urine samples,the patients were divided into the ESBLs-producing E.Coli group(ESBLs group)and the control group.Single factor analysis was performed by Chi-square test.Logistic regression analysis was used to analyze the risk factors for ESBLs-producing Escherichia coli infections in urinary tract on the basis of statistical significance.Results A total of 452 strains of Escherichia coli were isolated,including 253 strains(55.97%)producing ESBLs,and 199 strains(44.03%)not producing ESBLs.The ureteral calculi(OR=2.675,95%CI:1.129-6.341),urinary obstructive diseases(≥2 kinds)(OR=8.680,95%CI:2.508-30.040),indwelling catheters(OR=5.762,95%CI:2.698-12.155),antibiotic treatment more than 2 weeks for urinary tract infections within one year(OR=3.461,95%CI:1.766-6.784)were independent risk factors for ESBLs-producing Escherichia coli urinary tract infections.The incidence rate of Escherichia coli resistance to various antibiotics was higher in elderly patients with urinary tract infection than in non-elderly patients.Conclusions Escherichia coli producing ESBLs can be easily isolated from elderly patients with urinary tract obstructive diseases,indwelling catheters and repeated long-term administration of broad-spectrum antibiotics.The proportion of ESBLs Escherichia coli-caused urinary tract infections is higher in elderly patients.Thereby,carbapenems or piperacillin/tazobactam is the reasonable antibiotics.Ampicillin,piperacillin,levofloxacin and ciprofloxacin should not be the first choice for the treatment of urinary tract infections in the elderly.