高龄尿路感染患者的病原学特征分析

Pathogenic characteristics of elderly patients with urinary tract infection

目的分析高龄尿路感染住院患者的病原学分布特征。方法回顾性分析中国医科大学附属第一医院2019年1月至2023年1月收治的809例年龄≥60岁尿路感染患者的临床资料和病原菌检出情况,比较年龄≥80岁与60~79岁患者的病原学分布。统计学比较采用χ2检验,多因素logistic回归分析细菌产超广谱β-内酰胺酶(ESBL)的危险因素。结果809例尿路感染患者中共分离出914株病原体,584株分离自60~79岁患者,330株分离自年龄≥80岁患者,62例患者存在细菌和真菌混合感染。年龄≥80岁组中,检出革兰阴性菌144株(43.64%),肠杆菌科细菌以大肠埃希菌[16.67%(55/330)]、肺炎克雷伯菌[9.70%(32/330)]和奇异变形杆菌[3.03%(10/330)]为主,非发酵菌以铜绿假单胞菌[5.76%(19/330)]和鲍曼不动杆菌[4.55%(15/330)]为主;检出革兰阳性菌104株(31.52%),以屎肠球菌[21.21%(70/330)]为主;检出真菌63株(19.09%),以白念珠菌[9.09%(30/330)]为主。与60~79岁组相比,年龄≥80岁组的大肠埃希菌检出率较低(χ2=35.78,P<0.001),而屎肠球菌(χ2=4.91,P=0.027)和真菌(χ2=10.03,P=0.002)检出率较高,差异均有统计学意义。375株肠杆菌科细菌中ESBL阳性株190株(50.67%),其中大肠埃希菌127株,肺炎克雷伯菌46株,奇异变形杆菌17株。多因素logistic回归分析提示住院前有抗菌药物使用史[比值比(OR)=18.528,95%可信区间(95%CI)3.893~88.171,P<0.001]、合并肺部感染(OR=4.182,95%CI 1.387~12.611,P=0.011)是细菌产ESBL的独立危险因素。结论年龄≥80岁的高龄尿路感染患者的病原体以革兰阴性菌为主,肠球菌和真菌的检出率也较高,且有相当数量患者存在细菌、真菌混合感染。住院前抗菌药物使用史和合并肺部感染是细菌产ESBL的独立危险因素。

Objective To analyze the pathogenic distribution characteristics of elderly inpatients with urinary tract infection(UTI).Methods Retrospective analysis of the clinical data and pathogen detection of 809 patients with UTI aged≥60 years admitted to The First Affiliated Hospital of China Medical University from January 2019 to January 2023 was performed.The differences in the pathogen distribution of patients with UTI were compared between groups of 60 to 79 years old and≥80 years old.The chi-square test was used for statistical analysis.Multivariate logistic regression analysis was used to analyze the risk factors for bacterial production of extended spectrumβlactamase(ESBL).Results A total of 914 strains of pathogens were isolated from 809 patients,including 584 strains isolated from 60 to 79 years old patients,330 strains isolated from≥80 years old patients,and 62 patients had mixed infections with bacteria and fungi.In the group of patients≥80 years old,there were 144(43.64%)Gram-negative bacteria.Escherichia coli(16.67%(55/330)),Klebsiella pneumoniae(9.70%(32/330))and Proteus mirabilis(3.03%(10/330))were the main members in Enterobacteriaceae.Pseudomonas aeruginosa(5.76%(19/330))and Acinetobacter baumannii(4.55%(15/330))were main members of non-fermentive bacteria.There were 104 strains(31.52%)of Gram-positive bacteria detected in the group of patients≥80 years old,mainly Enterococcus faecium(21.21%(70/330)),and 63 strains(19.09%)of fungi were detected,mainly Candida albicans(9.09%(30/330)).Compared with the group of 60 to 79 years old,the detection rate of Escherichia coli was lower(χ2=35.78,P<0.001),but Enterococcus faecium(χ2=4.91,P=0.027)and fungi(χ2=10.03,P=0.002)were higher in the group of patients≥80 years old.Among the 375 strains of Enterobacteriaceae,190 strains(50.67%)were ESBL positive,including 127 strains of Escherichia coli,46 strains of Klebsiella pneumoniae and 17 strains of Proteus mirabilis.Multivariate logistic analysis found that the use of antibiotic before hospitalization(odds ratio(OR)=18.528,95%confidence interval(95%CI)3.893 to 88.171,P<0.001),complicated with pulmonary infection(OR=4.182,95%CI 1.387 to 12.611,P=0.011)were independent risk factors for bacterial production of ESBL.Conclusions The pathogens of elderly patients(aged≥80 years old)with UTI are mainly Gram-negative bacteria,and the detection rates of Enterococcus and fungi are also high.A considerable number of patients have mixed bacterial and fungal infections.The use of antibiotic before hospitalization and complicated with pulmonary infection are independent risk factors for bacterial production of ESBL.