老年患者泌尿道感染病原菌分布及耐药性分析

Distribution and drug resistance analysis of pathogenic bacteria of urinary tract infection in elderly patients

目的调查西安地区泌尿道感染老年患者的病原菌分布及耐药特点。方法回顾性分析2012年11月至2017年3月在西安市某三甲医院就诊的2475例65岁及以上泌尿道感染患者的尿标本病原菌信息及其药敏试验数据。结果从1465例女性标本和1010例男性标本中共分离出2475株非重复病原菌,其中革兰阴性杆菌1594株(64.40%),以大肠埃希菌为主,为1230株(49.70%);革兰阳性球菌452株(18.26%),以屎肠球菌为主,为294株(11.88%)。大肠埃希菌是导致老年女性泌尿道感染的主要病原菌,其感染率(61.98%)明显高于男性(31.88%),差异有统计学意义(χ^2=216.643,P<0.001)。病原菌对抗菌药物的耐药率:氨苄西林为82.76%,环丙沙星为69.68%,左氧氟沙星为65.52%,呋喃妥因为20.33%。女性分离株对氨苄西林的耐药率(84.08%)高于男性(80.45%),差异有统计学意义(χ^2=4.210,P=0.040);男性分离株对呋喃妥因的耐药率(28.07%)明显高于女性(15.92%),差异有统计学意义(χ^2=41.550,P<0.001)。女性产超广谱β-内酰胺酶的大肠埃希菌的耐药率(52.75%)低于男性(79.19%),差异有统计学意义(χ^2=69.051,P<0.001);女性耐碳青霉烯类肠杆菌科细菌的耐药率(0.22%)低于男性(0.62%),但差异无统计学意义(χ^2=1.178,P=0.278)。结论该地区老年泌尿道感染患者以女性为主,病原菌除大肠埃希菌外,应重视对抗菌药物耐药程度较高的屎肠球菌。老年男性泌尿道感染患者,应避免过量使用氨苄西林、环丙沙星和左氧氟沙星进行经验性治疗。

Objective To investigate the distribution and drug resistance analysis of pathogenic bacteria of urinary tract infection in elderly patients in Xi′an.Methods From November 2012 to March 2017,pathogenic bacteria information and drug sensitivity test data of a total of 2475 patients with urinary tract infection aged 65 years and over who were treated in a top three hospital in Xi′an were analyzed.Results 2475 strains of non repetitive pathogens were isolated from 1465 female specimens and 1010 male specimens.There were 1594 strains(64.40%)of gram-negative bacteria,mainly Escherichia coli,accounting for 49.70%(1230 strains).There were 452 strains(18.26%)of gram-positive bacteria,mainly Enterococcus faecium,accounting for 11.88%(294 strains).Escherichia coli was the main pathogen of urinary tract infection in elderly women,and its infection rate(61.98%)was significantly higher than that in men(31.88%),and the difference was statistically significant(χ^2=216.643,P<0.001).The resistance rate of pathogens to antibiotics was 82.76%for ampicillin,69.68%for ciprofloxacin,65.52%for levofloxacin and 20.33%for furantoin.The resistance rate of female isolates to ampicillin(84.08%)was higher than that of male isolates(80.45%),and the difference was statistically significant(χ^2=4.210,P=0.040).The resistance rate of male isolates to furantoin(28.07%)was significantly higher than that of female isolates(15.92%),and the difference was statistically significant(χ^2=41.550,P<0.001).The drug resistance rate of Escherichia coli producing ESBLs in women(52.75%)was lower than that in men(79.19%),and the difference was statistically significant(χ^2=69.051,P<0.001).The resistance rate of carbapenem resistant Enterobacteriaceae in women(0.22%)was lower than that in men(0.62%),and the difference was not statistically significant(χ^2=1.178,P=0.278).Conclusion In this area,the elderly female patients over 65 years old with urinary tract infection are the dominant.Except Escherichia coli,Enterococcus faecium with high resistance to antibiotics should be paid more attention.The elderly male patients with UTI should avoid excessive use of ampicillin,ciprofloxacin and levofloxacin for empirical treatment.