ICU老年患者尿路感染病原菌特点与耐药性分析  

Analysis of distribution characteristics and drug resistance of pathogens of urinary tract infection in ICU elderly patients

作　　者：赵越[1] 陈莲[2] 陈晓丽[1] 邱芳华[3] 凌勇[1] 张莉滟[1] ZHAO Yue CHEN Lian CHEN XiaoZi QIU Fanghua LING Yong ZHANG Liyan(Clinical Microbiology Laboratory, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China Department of Clinical Laboratory, Affiliated Orthopedic Hospital of Guangzhou University of Chinese Medicine Department of Clinical La- boratory, Guangzhou Hospital of Tradional Chinese Medicine)

机构地区：[1]广东省人民医院,广东省医学科学院临床微生物室,广州510080 [2]广州中医药大学附属骨伤科医院检验科 [3]广州市中医医院检验科

出　　处：《临床泌尿外科杂志》2016年第11期1002-1005,1011,共5页Journal of Clinical Urology

基　　金：广州市医药卫生科技项目(编号20141A-011016)

摘　　要：目的：探讨危重监护病房（ICU）老年尿路感染患者病原菌分布特点与耐药性特征。方法：收集我院2012年1月-2014年12月ICU的214例老年尿路感染患者的尿液标本,共分离出病原菌330株,采用VITEK 2Compact全自动微生物鉴定仪及其配套试剂对病原菌进行鉴定,并行药敏试验。结果：214例尿路感染患者中,64例为单一细菌引起,34例为单一真菌引起,71例为细菌合并真菌引起,36例为混合细菌引起,9例为混合真菌引起。所分离330株病原菌中,革兰阴性杆菌157株,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性球菌50株,以肠球菌为主;真菌123株,以白色念珠菌为主。其中鲍曼不动杆菌对头孢哌酮/舒巴坦、复方新诺明、妥布霉素以及铜绿假单胞菌对头孢哌酮/舒巴坦、头孢他啶、亚胺培南、哌拉西林/他唑巴坦等抗菌药物的耐药性呈上升趋势（P〈0.05）。真菌药敏情况变化无显著性差异（P〉0.05）,且对氟康唑等抗真菌药物依然维持较高敏感性。老年尿路感染患者所分离多重耐药菌（MDRO）比重较大,且耐药率较高。结论：ICU老年尿路感染患者所分离出病原菌耐药率具有较高水平,实验室与临床间应加强沟通,合理选择抗菌药物,以减少由MDRO所引发的医院感染的暴发。Objective：To investigate distribution and drug resistance of pathogens of urinary tract infection in ICU elderly patients.Method：Distribution characteristics and drug resistance of pathogens of urinary tract infection in ICU elderly patients were retrospectively analyzed from January 2012 to December 2014.Pathogens were identified by VITEK 2 Compact and drug sensitive tests were done.Result：Sixty-four cases with urinary tract infection were caused by a single bacterium.Thirty-four cases were caused by a single fungus.Seventy-one cases with mixed infection were caused by bacteria and fungi.Thirty-six cases with mixed infection were caused by bacteria and nine cases were mixed fungi.One hundred and fifty-seven negative bacilli were found mainly as Escherichia coli and Klebsiella pneumoniae.Fifty gram positive cocci were mainly as Enterococcus faecium.One hundred and twenty-three fungi were mainly as Candida albicans.The drug resistance of Acinetobacter baumannii to cefoperazone/sulbactam,sulfamethoxazole/trimethoprim,tobramycin had upward trend（P〈0.05）.Besides,the drug resistance of Pseudomonas aeruginosas to cefoperazone/sulbactam,ceftazidime,imipenem,piperacillin/tazobactam had upward trend（P〈0.05）.However,drug susceptibility of fungi had no significant difference（P〈0.05）and maintained higher sensitivity to antifungal drugs such as fluconazol.The isolating ratio of multidrug-resistant organism（MDRO）were high.Conclusion：The resistance rate of pathogens isolated from the ICU elderly patients by urinary tract infection was a high level.Laboratory should strengthen communication with clinicians further so as to select antimicrobial agents reasonably and avoid causing outbreaks of nosocomial infection by MDRO.

关 键 词：尿路感染 危重监护病房 病原菌 耐药性 

分 类 号：R695[医药卫生—泌尿科学]