老年病房尿路感染的病原学检测和抗菌谱分析  

Distribution and Drug Resistance of Pathogens Isolated from Patients with Urinary Tract Infections in Geriatric Wards

作　　者：钟一红[1] 龚劭敏[1] 汤颖[1] 方艺[1] 傅辰生[1] 朱加明[1] 刘红[1] 吉俊[1] 滕杰[1] 周春妹[2] 胡必杰[2] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032 [2]复旦大学附属中山医院临床微生物中心,上海20003

出　　处：《中国临床医学》2009年第4期584-587,共4页Chinese Journal of Clinical Medicine

基　　金：教育部国家重点学科211Ⅱ期重大项目(07TC14007)

摘　　要：目的:研究老年人尿路感染的常见病原菌及其对常用抗生素的耐药性,以及近3年的变化,以期指导抗生素的合理使用。方法:回顾调查2005年1月1日—2007年12月31日复旦大学附属中山医院老年病房真性菌尿的记录和药敏试验的结果。结果:共检出病原菌1010株,其中G-杆菌57.4%(大肠埃希菌25.7%、肺炎克雷伯菌10.8%、铜绿假单胞菌7.3%),G+球菌21.6%,真菌21%。3年来铜绿假单胞菌和真菌的检出率显著上升;大肠埃希菌、肺炎克雷伯菌对环丙沙星和大多数β内酰胺类抗生素都有较高的耐药性,但当这些抗生素与β内酰胺酶抑制剂联合后,细菌对它们的耐药率可有不同程度的下降;铜绿假单胞菌对碳青酶烯类抗生素的耐药性较高;屎肠球菌对万古霉素的耐药性最低,而粪肠球菌除此之外还对呋喃妥因和氨苄西林的耐药性较低;真菌对三唑类抗生素的耐药性较低。结论:G-杆菌仍是老年病房尿路感染的主要病原菌,但铜绿假单胞菌和真菌的检出率显著升高;病原菌的耐药现象较为严重。Objective： To investigate the distribution of pathogens and antibiotic resistance of urinary tract infections （UTIs）in geriatric inpatients through a large sample survey and to provide guidance for reasonable applications of antibiotics. Methods： A retrospective survey was carried out in significant bacteriuria records and their drug sensitive test results taken by microbiology laboratory of Zhongshan Hospital from Jan 1st 20（15 to Dec 31st 2007. Results： A total of 1010 strains of pathogens were found, among them 57.4% were Grammegative bacilli, Escherichia coli（25.7%）, Klehsiella pneumoniae （10. 8% ）, Pseudomonas aeruginosa （7.3%）, others as Gram positive cocci（21.6% ）and fungi（21% ）. Isolation rates of Pseudomonas aeruginosa and fungi increased significantly in the past three years. Resistance rates of these pathogens to ciprofloxacin and most β-lactam antibiotics were high. But the resistances were more or less weakened after combined application of β lactamase inhibitor. Pseudomonas aeruginosa had strong resistance to imipenem and meropenem whose rates were much higher than those of Escherichia coli and pneumonia klebsiella spp, Vancomycin remains the most sensitive antibiotic to Enterocoecus faeeium. Resistance rates of Fungi to fluconazole and voriconazole were low. Except vancomycin, ampicillin and nitrofurantoin were also good choice for the treatment of Enterococcus faecalis. Conclusion：Gram-negative bacilli is still the primary urinary pathogen among geriatric inpatients, but the isolation of Pseudomonas aeruginosa and fungi are on the rise;the drug resistance of pathogens of urinary tract infections in geriatric wards is serious.

关 键 词：老年人 尿路感染 病原菌 耐药性 

分 类 号：R691.3[医药卫生—泌尿科学]