住院期间老年泌尿系统感染患者的病原菌分布及其耐药性特征分析

目的分析老年泌尿系统感染住院患者的病原菌分布特点和耐药情况,为老年性泌尿系统感染的诊疗提供参考依据。方法选取2018年1月-2018年12月期间在复旦大学附属华东医院接受治疗、年龄≥ 60岁、且尿培养阳性的住院患者465例,对泌尿系统感染病原体的分布特点和耐药性进行分析。结果 465例中段尿培养阳性的老年住院患者共检出531株菌株。最常见的革兰阳性菌为屎肠球菌(46株,42.20%)和粪肠球菌(41株,37.61%);最常见的革兰阴性菌为大肠埃希菌(136株,49.64%)和肺炎克雷伯菌(44株,16.06%);最常见的侵袭性真菌为白念珠菌(87株,58.78%)。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)的比例分别为56.62%和56.82%。产ESBLs大肠埃希菌和肺炎克雷伯菌对多种药物的耐药率高于相应的非产SEBLs菌株。屎肠球菌对庆大霉素500和氨苄西林等药物的耐药率高于粪肠球菌。结论该院泌尿系统感染的老年住院患者分离的菌株分布主要以革兰阴性菌为主,其次是真菌和革兰阳性菌,与普通人群相比真菌感染率较高。同时这些病原体耐药率较高,临床应根据病原体分布特点及耐药性采取针对性治疗。

Analysis of characteristics of distribution and drug resistance of pathogens in elderly patients with urinary tract infection during hospitalization

Objective To analyze the characteristics of the distribution and drug resistance of pathogens from elderly inpatients with urinary system infection,and to provide reference basis for diagnosis and treatment of urinary system infection in elderly patients.Methods 465 inpatients aged 60 years or above who were treated in Huadong Hospital Affiliated to Fudan University from January 2018 to December 2018,and had positive urine culture results were selected to analyze the characteristics of distribution and drug resistance of pathogen causing urinary tract infection.Results 531 strains of pathogens were isolated from these patients.The most common gram-positive bacteria were Enterococcus faecium(46 strains,42.20%) and Enterococcus faecalis(41 strains,37.61%).The most common gram-negative bacteria were Escherichia coli(136 strains,49.64%) and Klebsiella pneumoniae(44 strains,16.06%).Candida albicans was the most common invasive fungus(87 strains,58.78%).The proportions of Escherichia coli and Klebsiella pneumoniae that produced extended-spectrum β-lactamases(ESBLs) were56.62% and 56.82%,respectively.The resistance of ESBLs-producing Escherichia coli and Klebsiella pneumonia to multiple drugs were significantly higher than those of non-SEBLs-producing strains.The resistance rate of E.faecium to gentamicin 500 and ampicillin was significantly higher than that of E.faecalis.Conclusion The distribution of pathogens isolated from elderly inpatients with urinary system infections in this hospital is mainly Gram-negative bacteria,followed by fungi and Gram-positive bacteria.Compared with the general population,the fungal infection rate is higher.At the same time,the drug resistance rate of these pathogens is high,and the clinical treatment should be based on the characteristics of the distribution and drug resistance of pathogens.