老年急性肾盂肾炎合并尿路感染致病微生物的特征研究

Characteristics of pathogenic microorganisms in elderly patients with acute pyelonephritis complicated by urinary tract infection

目的探讨老年急性肾盂肾炎合并尿路感染致病微生物的特点。方法选择2017年1月至2021年1月收治的老年急性肾盂肾炎合并尿路感染患者192例,采集患者中段尿液标本,采用全自微生物鉴定系统分离鉴定病原菌,采用纸片扩散法(K-B法)进行药敏试验。结果老年急性肾盂肾炎合并尿路感染患者192例中,共检出病原菌279株。其中包括革兰阴性菌157株,革兰阳性菌95株,真菌27株。主要革兰阴性菌中,大肠埃希菌对氨芐西林、甲氯芐啶和环丙沙星耐药率较高,而对头孢他啶和氨曲南耐药率较低;肺炎克雷伯菌对氨芐西林和哌拉西林耐药率较高,而对氨曲南、阿米卡星和头孢他啶耐药率较低;铜绿假单泡菌对甲氯芐啶、氨曲南和庆大霉素耐药率较高,而对氨芐西林和头孢唑林耐药率较低。主要革兰阳性菌中,粪肠球菌对青霉素和四环素耐药率较高,而对甲氯芐啶和红霉素耐药率较低;金黄色葡萄球菌对青霉素和红霉素耐药率较高,而对氨芐西林和左氧氟沙星耐药率较低;屎肠球菌对左氧氟沙星、青霉素和氨芐西林耐药率较高,而对红霉素和甲氯芐啶耐药率较低。结论老年急性肾盂肾炎合并尿路感染病原菌分布中,以革兰阴性菌为主,其次为革兰阳性菌,其中主要革兰阴性菌对头孢类、喹诺酮类等抗菌药物耐药率较高,而主要革兰阳性菌对青霉素耐药率较高,为降低和预防尿路感染的发生,需严格依据药敏试验合理应用抗菌药物。

Objective To investigate the characteristics of pathogenic microorganisms in elderly patients with acute pyelonephritis complicated by urinary tract infection.Methods A total of 192 elderly patients with acute pyelonephritis complicated by urinary tract infection who were treated in our hospital from January 2017 to April 2021 were enrolled in the study.The medistream urine specimens were collected,and the pathogens were isolated and identified by a self-microbial identification system,and drug susceptibility test was performed by disk diffusion method(K-B method).Results Of the 192 patients,a total of 279 strains of pathogenic bacteria were detected,including 157 strains of Gram-negative bacteria,95 strains of Gram-positive bacteria and 27 strains of fungi.Among the main Gram-negative bacteria,E.coli had higher resistance to aminacillin,methylchlorine and ciprofloxacin,however,which had lower resistance to ceftazidime and aztreonam;Klebsiella pneumoniae had higher resistance to aminacillin and piperacillin,however,which had lower resistance to aztreonam,amikacin and ceftazidime;Pseudomonas aeruginosa had lower resistance to aztreonam,amikacin and ceftazidime.The resistance rate of the bacteria to methamphetamine,aztreonam and gentamicin was higher,but the resistance rate to aminacillin and cefazolin was lower.Among the main Gram-positive bacteria,Enterococcus faecalis had higher resistance to penicillin and tetracycline,but,which had lower resistance to methamphetamine and erythromycin;Staphylococcus aureus had higher resistance to penicillin and erythromycin,however,which had lower resistance to ampicillin and levofloxacin;Enterococcus faecium had lower resistance to levofloxacin,penicillin and ammonia.Conclusion Gram-negative bacteria are the main pathogens in elderly patients with acute pyelonephritis complicated by urinary tract infection,followed by Gram-positive bacteria,in which,the main Gram-negative bacteria are more resistant to cephalosporins,quinolones and other antibiotics,however,the main Gram-positive bacteria are more resistant to penicillin.Therefore,in order to reduce and prevent the occurrence of urinary tract infection,it is necessary to use antibiotics rationally according to drug sensitivity test.