老年急性肾盂肾炎患者感染危险因素及病原菌耐药情况分析

目的探讨老年患者急性肾盂肾炎的危险因素、病原菌的分布和耐药性。方法选取2014年1月至2018年12月就诊的98例≥65岁的急性肾盂肾炎患者作为急性肾盂肾炎组,选取同期≥65岁的急性下尿路感染患者64例作为对照组,采用Logistic回归分析老年患者发生急性肾盂肾炎的危险因素,并总结病原菌分布及其耐药情况。结果多因素分析显示,随机血糖≥11.0 mmol/L、低蛋白血症(血清清蛋白<35 g/L)、尿路结石为急性肾盂肾炎的危险因素(P<0.05)。急性肾盂肾炎组分离出52株病原菌(53.06%),其中大肠埃希菌45株(86.54%),产超广谱β-内酰胺酶(ESBLs)大肠埃希菌15株(28.85%)。大肠埃希菌对氨苄西林、哌拉西林、四环素、复方磺胺甲噁唑、头孢唑林的耐药率较高(>47.00%),而对头孢西丁、哌拉西林/他唑巴坦、哌拉西林/三唑巴坦、头孢哌酮/舒巴坦、亚胺培南、美罗培南、阿米卡星的耐药率较低(<5.00%)。产ESBLs大肠埃希菌对哌拉西林、四环素、头孢唑林、头孢噻肟、头孢呋辛、头孢曲松、头孢哌酮、氨曲南、头孢吡肟及头孢他啶的耐药率较非产ESBLs大肠埃希菌明显升高(P<0.05)。结论合并随机血糖升高、低蛋白血症、尿路结石的老年尿路感染患者,需高度警惕发生急性肾盂肾炎的可能性,做到及早识别、诊断及治疗,改善总体预后。大肠埃希菌是老年患者急性肾盂肾炎的最主要致病菌,具有较高的耐药率,应积极行尿培养检查以指导临床合理用药。

Risk factors of infection and drug resistance analysis of acute pyelonephritis in elderly patients

Objective To investigate the risk factors of acute pyelonephritis in elderly patients,as well as the distribution and drug resistance of pathogenic bacteria.Methods A total of 98 patients with acute pyelonephritis who aged 65 years old or above and came to the hospital from January 2014 to December 2018 were taken as the acute pyelonephritis group and 64 patients with acute lower urinary tract infection were enrolled as the control group.Logistic regression was used to analyze the risk factors of acute pyelonephritis in elderly patients,and the distribution and drug resistance of pathogens were summarized.Results Multiple regression analysis revealed that the risk factors of acute pyelonephritis were random blood glucose≥11.0 mmol/L,serum albumin<35 g/L and urinary calculi(P<0.05).In acute pyelonephritis group,bacteria were isolated from 52 cases(53.06%).Escherichia coli(E.coli)was found in 45 cases(86.54%)and Escherichia coli producing Extended spectrum beta lactamase(ESBLs)was found in 15 cases(28.85%).The resistance rates of E.coli to ampicillin,piperacillin,tetracycline,compound sulfamethoxazole and cefazolin were relatively high(>47.00%),while those to cefoxitin,piperacillin/tazobactam,piperacillin/trizobactam,cefoperazone/sulbactam,imipenem,meropenem,amikacin were relatively low(<5.00%).The resistance rates of E.coli producing ESBLs to piperacillin,tetracycline,cefazolin,cefotaxime,cefuroxime,ceftriaxone,cefoperazone,amtronine,cefepime and ceftaidime were significantly higher than those of E.coli which did not produce ESBLs(P<0.05).Conclusion Elderly patients with urinary tract infection complicated with random hyperglycemia,hypoproteinemia and urinary calculi should be highly alert to the possibility of acute pyelonephritis,so as to achieve early identification,diagnosis and treatment,and improve the overall prognosis.E.coli is the most important pathogenic bacteria in elderly patients with acute pyelonephritis,which has a high drug resistance rate.Urine culture should be actively carried out to guide clinical rational drug use.