中老年偏瘫患者尿路感染病原菌与耐药性分析  

Distribution and drug resistance of pathogens causing urinary tract infections in elderly patients with hemiplegia

作　　者：许晓枫 许尤佳 申俊 沈雪丹 耿先龙[2] 

机构地区：[1]无锡市第八人民医院检验科,江苏无锡214000 [2]无锡市人民医院检验科,江苏无锡214000

出　　处：《中华医院感染学杂志》2015年第9期1976-1978,共3页Chinese Journal of Nosocomiology

基　　金：无锡市医院管理中心科技发展基金项目(YGM1001)

摘　　要：目的探讨中老年偏瘫患者尿路感染病原菌的分布及其耐药性,为临床抗感染用药提供参考依据。方法选取2010年1月-2012年12月门诊及住院偏瘫患者256例,收集患者的尿液标本,采用法国生物梅里埃公司VITEK-2全自动细菌鉴定及药敏分析仪进行细菌鉴定及药敏分析。结果 256份标本中共分离出病原菌169株,两种细菌混合感染12例,其中革兰阴性菌102株占60.4%,革兰阳性菌57株占33.7%,真菌10株占5.9%,前3位病原菌依次为大肠埃希菌、肠球菌属及凝固酶阴性葡萄球菌,分别占47.9%、18.9%和10.0%;大肠埃希菌和肺炎克雷伯菌ESBLs的检出率分别为43.2%和40.0%;革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、阿米卡星敏感率较高,耐药率<30.0%;革兰阳性菌中未发现万古霉素、利奈唑胺的耐药菌株。结论中老年偏瘫患者尿路感染病原菌以革兰阴性菌为主,亚胺培南对革兰阴性菌的敏感性高,万古霉素、利奈唑胺对革兰阳性菌的敏感性高,真菌的检出率较低;尿路感染患者在用药前应留取中段尿进行细菌鉴定及药敏分析,在细菌学及药敏试验结果的指导下合理使用抗菌药物,以减少耐药菌株和多药耐药菌株的产生,降低治疗费用,提高治愈率。OBJECTIVE To explore the distribution and drug resistance of pathogens causing urinary tract infections in the elderly patients with hemiplegia so as to provide guidance for clinical treatment of infections .METHODS A total of 256 patients with hemiplegia who were treated in the outpatient and inpatient departments from Jan 2010 to Dec 2012 were enrolled in the study ,then the urine specimens were collected from the patients ,the bacterial iden‐tification was carried out by using VITEK‐2 automatic bacterial identification system of BioMerieux ,France ,and the drug susceptibility testing was performed with the use of drug susceptibility analyzer .RESULTS A total of 169 strains of pathogens have been isolated from 256 specimens ,including 102 （60 .4% ） strains of gram‐negative bac‐teria ,57 （33 .7% ） strains of gram‐positive bacteria ,and 10 （5 .9% ） strains of fungi;the Escherichia coli ,En‐terococcus spp ,and coagulase‐negative Staphylococcus ranked the top three species ,accounting for 47 .9% , 18 .9% ,and 10 .0% ,respectively ;the detection rates of the ESBLs‐producing E .coli and K lebsiella pneumoniae were 43 .2% and 40 .0% ,respectively .There were 12 cases of mixed infections of two species .The gram‐negative bacteria were highly susceptible to cefoperazone‐sulbactam ,piperacillin‐tazobactam ,imipenem ,and amikacin , with the drug resistance rate less than 30 .0% ;no strain of gram‐positive bacteria was found to be resistant to van‐comycin or linezolid .CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing urinary tract infections in the elderly patients with hemiplegia and are highly susceptible to imipenem ;the gram‐positive bacteria are highly susceptible to vancomycin and linezolid .The detection rate of fungi is low .The midstream urine specimens should be collected from the patients with urinary tract infections to carry out the bacterial identification and drug susceptibility testing before the medication .The antibiotics should be re

关 键 词：中老年偏瘫 尿路感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]