老年人尿路感染常见病原菌耐药性分析

目的]探讨老年尿路感染患者的常见病原菌的耐药性。方法]回顾性分析440例住院尿路感染患者的中段尿标本实验室检验结果。结果]①住院老年患者清洁中段尿的病原菌检出率为82.9%。②检出的365株菌株中,大肠埃希菌占40.5%,奇异变形杆菌占17.8%,肺炎克雷伯菌占12.3%,铜绿假单胞菌占8.5%,肠球菌属占6.0%。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的检出率为51.4%和42.2%。③G-杆菌对氨苄西林、哌拉西林、环丙沙星耐药率高,对头孢哌酮舒巴坦耐药率低,对碳青酶类无耐药;G+球菌对克林霉素、克拉霉素、氧氟沙星耐药率高,对万古霉素无耐药。产ESBLs大肠埃希菌、肺炎克雷伯菌对第二、三代头孢菌素、氨苄西林、环丙沙星耐药率高,对头孢哌酮舒巴坦、丁胺卡那敏感,对碳青酶类无耐药。④添加酶抑制剂的抗生素对大肠埃希菌、肺炎克雷伯菌的药物敏感性极显著高于未添加酶抑制剂者。结论]老年人尿路感染病原菌耐药性高,头孢哌酮舒巴坦是治疗老年人尿路感染较为理想的药物。

Analysis on antibiotic resistance of commom pathogenic bacteria among aged people with urinary tract infection

Objective] To explore the antibiotic resistance of the common pathogenic bacteria among aged people with urinary tract infection （UTI）. Methods ] Specimens of middle section of urine taken from 440 cases of hospitalized patients with urinary tract infection were examined retrospectively. Results] ① The positive rate of clean catch midstream among hospitalized aged people was 82.9%. ② A total of 365 strains of bacteria were isolated and there were 40.5% E. eoli, 17.8% P. mirabilis, 12.3% P. aeruginosa, 8.5% Klebsiella spp, 6.0% enterococcus respectively. ESBLs were isolated from 51.4% E. coli and 42.2% Klebsiella spp. ③The resisitance rate of Gram negative bacilli to ampicillin, piperacillin and eiprofloxaein was higher, to cefoperazone/sulbactam was lower and had no resistance to carbapenems. Gram positive cocci had higher resistance rate to elindamycin, clarithromycin and ofloxacin, but had no resistance to vancomyein. ESBLs were resistante to many antibiotics such as ampicillin, ciprofloxacin, the second and third generation cephalosporin, but had lower resistance to amikacin, cefoperazone/sulbactam and no resistance to carbapenems. ④ The drug sensitivity of E. coli and Klebsiella spp to antibiotics with enzyme inhibitors was significantly higher than those without. Conclusion ] The antibiotic resistance is very serious among the aged with UTI. Cefoperazone sulbactam is an ideal choice for the aged with UTI.