老年泌尿道感染患者1879例病原菌分布及耐药性分析

Analysis of pathogenic bacteria distribution and drug resistance in 1879 elderly patients with urinary tract infection

目的 分析老年泌尿道感染(UTI)患者中段尿培养病原菌分布及其耐药性,为临床抗生素经验用药提供参考。方法 回顾性选取2019年1—12月就诊于江苏省老年病医院>60岁UTI患者1 879例的临床资料,所有患者均行中段尿培养,分析致病菌分布及耐药性。结果 1 879份中段尿标本中,检出病原菌801株,阳性率为42.63%;主要病原菌:大肠埃希菌、肺炎克雷伯菌、奇异变形菌、金黄色葡萄球菌、屎肠球菌等;革兰阴性杆菌占72.91%(584/801),最常见的为大肠埃希菌;革兰阳性球菌占24.84%(199/801),最常见的为金黄色葡萄球菌;真菌占2.25%(18/801),最常见的为白色念珠菌;多重耐药菌188株占23.47%(188/801)。革兰阴性杆菌对阿米卡星、美罗培南耐药率低,对环丙沙星、左氧氟沙星、氨苄西林耐药率高;革兰阳性球菌对万古霉素、利奈唑胺、达托霉素均敏感,对环丙沙星、左氧氟沙星、红霉素耐药率高;真菌对所测药物均敏感。结论 老年患者病原菌以革兰阴性杆菌为主,以大肠埃希菌多见,多重耐药菌检出率较高,应根据药物敏感试验结果调整治疗方案。

Objective To analyze the distribution and drug resistance of urinary tract infection pathogens in elderly patients with urinary tract infections(UTI), so as to provide reference for clinical antibiotics in these patients. Methods The clinical data of 1 879 UTI patients over 60 years old who visited Jiangsu Province Geriatric Hospital from January to December 2019 were retrospectively selected, all patients were subjected to midstream urine culture, the distribution and drug resistance of pathogens were analyzed. Results 801 strains of pathogenic bacteria were detected in 1 879 middle urine samples, the positive rate was 42.63%;Main pathogens: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Staphylococcus aureus, Enterococcus faecium, etc;Gram negative bacilli accounted for 72.91%(584/801), and the most common was Escherichia coli;Gram positive cocci accounted for 24.84%(199/801), the most common being Staphylococcus aureus;Fungi accounted for 2.25%(18/801), the most common being Candida albicans;188 strains of multidrug resistant bacteria accounted for 23.47%(188/801). The resistance rate of Gram negative bacilli to amikacin, meropenem was low, but to ciprofloxacin, levofloxacin and ampicillin was high;Gram positive cocci were sensitive to vancomycin, linezolid and daltomycin, and resistant to ciprofloxacin, levofloxacin and erythromycin;Fungi were sensitive to all tested drugs. Conclusion The pathogenic bacteria of elderly patients are mainly Gram negative bacilli, most of which are Escherichia coli, the detection rate of multi drug resistant bacteria is high, the treatment plan should be adjusted according to the drug sensitivity test results.