老年患者尿路感染常见病原菌分布和耐药性分析

目的:了解老年尿路感染患者主要病原菌分布及耐药情况及变迁,为临床合理选用抗菌药物提供依据。方法:选取老年尿路感染患者中段尿液标本5010例,经培养分离后行细菌鉴定和药敏试验,并进行分析。结果:5010份标本共分离出细菌2757株,检出率为60.6%,在分离出的菌株中,以革兰阴性菌最为常见,最常见的病原菌为大肠埃希菌,所占比例呈逐年下降趋势。最常见的革兰阳性菌为粪肠球菌,所占比例呈逐年上升趋势。大肠埃希菌、肺炎克雷伯菌ESBLs检出率分别为23.78%和28.95%。产ESBLs的菌株仅对美罗培南、阿米卡星以及头孢哌酮/舒巴坦有较低的耐药率。对肠球菌而言,替考拉宁及万古霉素有较好的疗效。结论:老年患者尿路感染以大肠埃希菌为主,近年来肠球菌属有增加趋势。临床上若考虑为革兰阴性菌感染,对于具有产ESBLs肠杆菌尿路感染危险因素的患者,经验性用药时应谨慎选择抗生素,尽量避免使用第三代头孢类抗菌药,可选用头孢哌酮/舒巴坦等加入β-内酰胺酶抑制剂的抗生素。若考虑革兰阳性菌感染,可选用替考拉宁及万古霉素。

Drug Resistance and Proportion of Common Pathogens Isolated from Aged People with Urinary Tract Infection

Objective To investigate the pathogen and antibiotic resistance in the aged people with urinary tract infection from 2008 to 2011. Methods Bacteria were isolated and identified, antibiotic resistance was detected. Results the positive rate of catch midstream among hospitalized aged people was 60. 6%. Escherichia coli （E. coli） was the major pathogen, but there is a downward trend in recent years. Enterococeus faeealis was primary pathogens in Gram positive cocci in urinary tract infection, and there is a upward trend in recent years. 23.78% Of E. coli and 28. 95% of K. pn isolates produced ESBLs. The resistance rates of ESBLs - producing strains to levofloxacin, meropenem and ceftazidime were low. The resistance rates of ESBLs - producing E. coli and K. pn to meropenem, amikacin and cefoperazone/sulbactam were low. There were significant differences between the resistance tates of ESBLs - producing strains and no ESBLs - producing strains. The resistance rates of enterococcus to teicoplanin and vancomycin were low. Conclusion E. coli and enterococcus were primary pathogens causing urinary tract infection of aged people. The resistance rates of those pathogens were high. More attention should be paid on rational selection and application of antibiotics.