老年前列腺增生患者尿路感染病原菌的分布及耐药性  

Analysis on the distribution and drug resistance of pathogenic bacteria in urinary tract infection from elderly patients with benign prostatic hyperplasia

作　　者：邵勇[1] 邵晶莹[2] 祝青国[1] 徐晓刚 

机构地区：[1]哈尔滨医科大学附属第二医院泌尿外科,150086 [2]哈尔滨医科大学附属第二医院检验科,150086 [3]黑龙江省龙江县第一人民医院外科

出　　处：《中华老年医学杂志》2008年第1期29-32,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨老年前列腺增生患者尿路感染病原菌的分布及耐药性,为临床的诊断及合理使用抗生素治疗提供依据。方法对515例住院的老年前列腺增生尿路感染患者及细菌药敏试验结果进行回顾性分析。采用纸片扩散法（K-B法）对546株细菌进行鉴定和耐药性分析。结果515例中,易感因素以留置尿管、尿路结石为主。546株致病菌中,革兰氏阴性杆菌占61.9%.其中大肠杆菌占43.6%,革兰阳性球菌占30.4%,真菌占7.7%。肠杆菌科细菌除对亚胺培南高敏感外,对其他抗生素耐药率均呈上升趋势;革兰阳性球菌耐药率普遍较高,仅对呋喃妥因和万古霉素仍保持较高敏感,重症肠球菌感染可首选万古霉素。有尿路检查或插导尿管等操作者,真菌和变形杆菌感染率明显高于无尿路操作者。结论肠杆菌科细菌（以大肠埃希菌为主）和肠球菌属细菌分别占老年前列腺增生患者尿路感染病原菌的前2位,真菌感染呈上升趋势。由于病原菌耐药性增强,临床医师应结合尿培养和药敏试验结果,合理选用抗生素。Objective To provide reliable evidence for diagnosis and treatment of urinary tract infection from elderly patients with benign prostatic hyperplasia based on investigating the distribution and drug resistance of pathogenic bacteria.Methods Distribution and antibiotics sensitivity test of pathogens in 515 cases with urinary tract infection in elderly benign prostatic hyperplasia patients were retrospectively analyzed.Five hundred and forty-six strains of bacteria were isolated and identified, their drug resistances were analyzed.K-B method was used for analysis of some special strains,such as the methicillin-resistant staphylococcus aureus（MRS）and Extended-Spectrumβ-lactamase（ESBLs） strains.Results In these patients,predisposing factors included indwelling catheter and lithangiuria.The rate of gram-negative bacteria in 546 strains of pathogenic bacteria was 61.9%, including 43.6% E.coli,30.4% gram-positive cocci and 7.7% fungi.The drug resistances of Enterobacteriaceae for antibiotics were all elevated,except for imipenem.The drug resistances of gram positive cocci were generally very high,but the cocci were responsive to nitrofurantoin and vancomycin,and vancomycin is the first choice to treat severe infection with Enterococcus.The incidence of fungi and proteus infection was higher in those with urinary tract operation than in those without operation.Conclusions Enterobacteriaceae（mostly E.coli）and Enterococcus are the 2 most major pathogens in urinary tract infection of elderly patients with benign prostatic hyperplasia. Fungi infection in urinary tract has an increasing tendency.Owing to the elevating drug resistance, doctors should choose antibiotics carefully according to the results of urine culture and drug sensitivity test.

关 键 词：前列腺增生 泌尿道感染 抗药性 

分 类 号：R686[医药卫生—骨科学]