年龄、性别对泌尿系感染病原菌分布及耐药性的影响分析

Analysis of the Effects of Age and Gender on the Distribution and Drug Resistance of Pathogenic Bacteria in Urinary Tract Infections

为分析贵州省人民医院泌尿外科尿培养细菌分布及其耐药性,并分析年龄和性别对其影响,同时也为泌尿系感染患者临床经验性用药提供依据。本文回顾性分析2017年1月—2019年6月贵州省人民医院泌尿外科中段尿培养结果,对其分离出的细菌及药敏结果进行分析。5226份中段尿标本中检出1256株病原菌,检出率24.0%,平均年龄(52.7±15.6)岁;其中革兰阴性菌699株(55.65%),革兰阳性菌385株(30.65%),真菌172株(13.69%);男性525例(41.8%),平均年龄(54.2±16.4)岁;女性731例(58.2%),平均年龄(51.5±15.0)。分离菌株前五位分别为:大肠埃希菌、粪肠球菌、屎肠球菌、肺炎克雷伯杆菌、白色假丝酵母菌。大肠埃希菌对氨苄西林的耐药率在不同性别分组中差异有统计学意义(χ^(2)=4.64、P=0.03)。大肠埃希菌对头孢唑林的耐药率在年龄≤45岁与45~60岁2组间的差异有统计学意义(χ^(2)=4.60、P=0.03),对哌拉西林的耐药率在年龄≤45岁与>60岁2组间的差异有统计学意义(χ^(2)=4.90、P=0.03);肺炎克雷伯杆菌对环丙沙星的耐药率在年龄≤45岁与45~60岁2组间的差异有统计学意义(χ^(2)=4.24、P=0.04),粪肠球菌对环丙沙星的耐药率在年龄45~60岁与>60岁2组间的差异有统计学意义(χ^(2)=4.40、P=0.04),屎肠球菌对四环素的耐药率在各年龄分组间的差异均有统计学意义(χ^(2)=7.53、P=0.02)。可见年龄和性别对常用抗菌药物耐药性的影响并不显著;大肠埃希菌是泌尿系感染最常见的病原菌,但随着抗菌药物滥用,导致病原菌谱迁移,常用抗菌药物的耐药率逐年变化,临床使用抗菌药物需结合多方面因素综合考虑,科学合理地使用抗菌药物。

To analyze the distribution of urinary culture bacteria and their drug resistance in the Division of Urology,Guizhou Provincial People’s Hospital,and to analyze the influence of age and gender on them,and also to provide a basis for clinical empirical drug use in patients with urinary tract infections.The results of midstream urine culture in the Division of Urology,Guizhou Provincial People’s Hospital were retrospectively analyzed and the isolated bacteria and drug sensitivity results were also analyzed.1256 pathogenic strains were detected in 5226 midstream urine specimens,with a detection rate of 24.0%and an average age of(52.7±15.6) years;699(55.65%) of them were gram-negative,385(30.65%) were gram-positive,and 172(13.69%) were fungi;525(41.8%) were from males,with an average age of(54.2±16.4) years old;731(58.2%) were from females,with an average age of(51.5±15.0) years old. The top five isolated strains were Escherichia coli,Enterococcus faecalis,Enterococcus faecium,Klebsiella pneumoniae,and Candida albicans. There was a statistically significant difference in the resistance rate of Escherichia coli to ampicillin in the different gender groups (χ^(2)=4.64,P=0.03). There was a statistically significant difference in the resistance rate of Escherichia coli to cefazolin between the age group ≤45 years old and 45-60 years old (χ^(2)=4.60,P=0.03) and to piperacillin between the age group ≤45 years old and >60 years old (χ^(2)=4.90,P=0.03). There was a statistically significant difference in the resistance rate of Klebsiella pneumoniae to ciprofloxacin between the age group ≤45 years old and 45-60 years old (χ^(2)=4.24,P=0.04). There was a statistically significant difference in the resistance rate of Enterococcus faecalis to ciprofloxacin between the age group 45-60 years old and >60 years old (χ^(2)=4.40,P=0.04).There were statistically significant differences in the resistance rate of Enterococcus faecium to tetracycline among all age groups (χ^(2)=7.53,P=0.02). The effects of age and gender on the resistance of commonly used antimicrobial drugs are not significant. Escherichia coli is the most common pathogenic bacteria in urinary tract infections. However,with the abuse of antimicrobial drugs,resulting in the migration of the pathogenic spectrum,the resistance rate of commonly used antimicrobial drugs changes year by year,and the clinical use of antimicrobial drugs needs to be considered in combination with various factors and antimicrobial drugs shall be used scientifically and reasonably.