目的 分析长沙某医院老年患者尿路感染的病原菌分布和耐药情况,为预防感染及临床合理使用抗生素提供依据。方法 回顾性分析2015年1月至2022年12月期间,长沙某医院61岁及以上老年住院尿路感染患者尿液培养的细菌鉴定和药敏结果。结果 在3 187份尿液标本中分离培养出1 409株病原菌,检出率为44.21%,其中革兰氏阴性杆菌检出1 129株（占80.12%）,革兰氏阳性球菌检出195株（占13.84%）,真菌检出85株（占6.03%）;检出率排前6位的细菌分别为大肠埃希菌（41.58%）、奇异变形杆菌（13.13%）、肺炎克雷伯菌（11.28%）、铜绿假单胞菌（5.75%）、粪肠球菌（5.54%）、屎肠球菌（5.32%）。病原菌分布：按性别分布对检出的主要病原菌分别进行统计学分析,显示老年女性患者大肠埃希菌的检出率（22.86%）高于老年男性（14.45%）,而老年男性患者奇异变形杆菌的检出率（6.96%）高于老年女性（4.49%）。按年龄段分性别对病原菌的检出率进行分层Logistic回归分析,女性随着年龄增加检出率基本呈增加趋势,男性在71岁以上年龄段检出率呈小幅度增加;检出的菌株数以81~90岁年龄段最多。药敏分析：大肠埃希菌主要对喹诺酮类和头孢菌素类抗生素耐药明显,达56%~71%;奇异变形杆菌主要对喹诺酮类和氨基糖苷类抗生素耐药明显,达50%~89%,暂未发现对美罗培南耐药。结论 老年患者尿路感染病原菌主要以革兰氏阴性杆菌为主,随着年龄的增加,检出菌株数越多;老年女性更易感大肠埃希菌,老年男性更易感奇异变形杆菌。主要革兰氏阴性杆菌对喹诺酮类、头孢菌素和氨基糖类的耐药较明显。
Abstract
Objective To analyze the pathogenic bacterial distribution and drug resistance of elderly patients with urinary tract infection in Changsha area were analyzed to provide evidence for infection prevention and clinical rational use of antibiotics. Methods From January 2015 to December 2022, The results of bacterial identification and drug sensitivity in urine culture of elderly inpatients aged 61 years and above with urinary tract infection in a hospital in Changsha were retrospectively analyzed. Results 1 409 strains of pathogenic bacteria were isolated and cultured from 3 187 urine samples, the detection rate was 44.21%, among which 1 129 strains of Gram-negative bacillus (80.12%), 195 strains of Gram-positive coccus (13.84%) and 85 strains of fungi (6.03%) were detected. The top 6 bacteria in detection rate were Escherichia coli (41.58%), Proteus Mirabilis (13.13%), Klebsiella pneumoniae (11.28%), Pseudomonas aeruginosa (5.75%), Enterococcus faecalis (5.54%) and Enterococcus faecium (5.32%) respectively. Bacterial distribution: Statistical analysis of the main pathogens detected according to gender distribution showed that the detection rate of Escherichia coli in elderly female patients (22.86%) was higher than that in elderly male patients (14.45%), while the detection rate of Proteus Mirabilis in elderly male patients (6.96%) was higher than that in elderly female patients (4.49%), and there was statistical significance. The stratified logistic regression analysis of the detection rate of pathogenic bacteria by age showed that the detection rate increased with age in women, and increased slightly in men over 71 years old. The number of strains detected was the highest in 81-90 years old age group. The number of strains detected was the highest in 81-90 years old age group. Drug susceptibility analysis: The resistance of Escherichia coli to quinolones and cephalosporins was 56%-71%. Proteus Mirabilis showed obvious resistance to quinolones and aminoglycosides, up to 50%-89%, but no resistance to meropenem was found. Conclusions The pathogenic bacteria of urinary tract infection in elderly patients were mainly Gram-negative bacilli. With the increase of age, the number of strains was more distributed, and the elderly women were more susceptible to Escherichia coli, while the elderly men were more susceptible to Proteus mirabilis. The main Gram-negative bacilli showed obvious resistance to quinolones, cephalosporins and amino sugars.
关键词
老年患者 /
尿路感染 /
细菌分布 /
药敏分析
Key words
elderly patients /
urinary tract infection /
distribution of bacteria /
drug sensitivity analysis
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参考文献
[1] 吴政龙, 张秀红, 董亮, 等. 无锡市某院老年男性患者尿路感染病原菌分布及耐药性[J]. 中国感染控制杂志, 2020, 19(05): 411-416.
[2] DETWEILER K, MAYERS D, FLETCHER SG.Bacteruria and Urinary Tract Infections in the Elderly[J]. Urol Clin North Am, 2015, 42(4): 561-568.
[3] 胡霞, 杨悦, 邓波, 等. 老年患者尿路感染特点对比分析[J]. 中华医院感染学杂志, 2018, 28(08): 1188-1190.
[4] 国家卫生健康委员会.2022 中国卫生健康统计年鉴[M]. 北京: 中国协和医科大学出版社, 2022: 231-235.
[5] BEDENIĆ B, MEŠTROVIĆ T. Mechanisms of Resistance in Gram-Negative Urinary Pathogens: From Country-Specific Molecular Insights to Global Clinical Relevance[J]. Diagnostics (Basel), 2021, 11(5): 800.
[6] HYUN M, LEE JY, KIM HA.Differences of virulence factors, and antimicrobial susceptibility according to phylogenetic group in uropathogenic Escherichia coli strains isolated from Korean patients[J]. Ann Clin Microbiol Antimicrob, 2021, 20(1): 77.
[7] MEDINA M, CASTILLO-PINO E.An introduction to the epidemiology and burden of urinary tract infections[J]. Ther Adv Urol, 2019, 11: 1756287219832172.
[8] CRISTINA ML, SPAGNOLO AM, GIRIBONE L, et al.Epidemiology and Prevention of Healthcare-Associated Infections in Geriatric Patients: A Narrative Review[J]. Int J Environ Res Public Health, 2021, 18(10): 5333.
[9] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[M]. 第4版. 北京: 人民卫生出版社, 2015: 560-790.
[10] CLINICAL AND LABORATORY STANDARDS INSTITUTE. Performance standards for antimicrobial susceptibility testing[S]. M100-S32. Wayne, PA: CLSI, 2022.
[11] DE GAETANO GV, LENTINI G, FAMÀ A, et al.In Vivo Role of Two-Component Regulatory Systems in Models of Urinary Tract Infections[J]. Pathogens, 2023, 12(1): 119.
[12] MCLELLAN LK, HUNSTAD DA, et al.Urinary Tract Infection: Pathogenesis and Outlook[J]. Trends Mol Med, 2016, 22(11): 946-957.
[13] JUSTICE SS, HUNG C, THERIOT JA, et al.Differentiation and developmental pathways of uropathogenic Escherichia coli in urinary tract pathogenesis[J]. Proc Natl Acad Sci U S A, 2004, 101(5): 1333-1338.
[14] MYSOREKAR IU, HULTGREN SJ.Mechanisms of uropathogenic Escherichia coli persistence and eradication from the urinary tract[J]. Proc Natl Acad Sci U S A, 2006, 103(38): 14170-14175.
[15] FLORES-MIRELES AL, WALKER JN, CAPARON M, et al.Urinary tract infections: epidemiology, mechanisms of infection and treatment options[J]. Nat Rev Microbiol, 2015, 13(5): 269-284.
[16] 余枫, 侯铁英, 方晓武, 等. 普通病房与ICU老年患者尿路感染病原菌分布及耐药性分析[J]. 中华医院感染学杂志, 2015, 25(02): 318-320.
[17] 倪桂珍, 吴雄妹. 长期卧床老年患者医院获得性尿路感染的临床分析[J]. 中华医院感染学杂志, 2014, 24(11): 2711-2713.
[18] INGERSOLL MA.Sex differences shape the response to infectious diseases[J]. PLoS Pathog, 2017, 13(12): e1006688.
[19] 梁仙志, 阳益德, 万丽, 等. 长沙地区泌尿生殖道支原体感染的流行病学调查研究[J]. 中国预防医学杂志, 2020, 21(8): 849-853.
[20] TAMADONFAR KO, OMATTAGE NS, SPAULDING CN, et al.Reaching the End of the Line: Urinary Tract Infections[J]. Microbiol Spectr, 2019, 7(3): 10.
[21] YUAN F, HUANG ZY, YANG TX, et al.Pathogenesis of Proteus mirabilis in Catheter-Associated Urinary Tract Infections[J]. Urol Int, 2021, 105(5-6): 354-361.
[22] HODIAMONT CJ, VAN DEN BROEK AK, DE VROOM SL, et al. Clinical Pharmacokinetics of Gentamicin in Various Patient Populations and Consequences for Optimal Dosing for Gram-Negative Infections: An Updated Review[J]. Clin Pharmacokinet, 2022, 61(8): 1075-1094.
[23] FRIMODT-MØLLER N. Correlation between pharmacokinetic/pharmacodynamic parameters and efficacy for antibiotics in the treatment of urinary tract infection[J]. Int J Antimicrob Agents, 2002, 19(6): 546-553.
[24] 李富顺, 陈静静, 田素飞, 等. 2018至2020年沈阳地区肠杆菌目细菌分布及耐药情况分析[J]. 中国医科大学学报, 2022, 51(05): 440-446.
[25] 潘芬, 王春, 张泓, 等. 2015-2021年CHINET儿童患者分离的肠杆菌目细菌耐药性变迁[J]. 中国感染与化疗杂志, 2024, 24(01): 53-63.
[26] 谭志霞, 阳益德, 许龙, 等. 长沙某医院住院患者呼吸道样本的细菌分布及其耐药性[J]. 中华医院感染学杂志, 2023, (9): 1313-1319.
[27] 韩佳运, 王爽, 寇增强, 等. 山东省滨州市某社区来源产ESBLs大肠埃希菌及mcr-1阳性菌株耐药基因分析[J]. 疾病监测, 2023, 38(01): 64-69.
[28] SMITH WPJ, WUCHER BR, NADELL CD, et al.Bacterial defences: mechanisms, evolution and antimicrobial resistance[J]. Nat Rev Microbiol, 2023, 21(8): 519-534.
基金
湖南省卫生健康委员会重点项目“肠道微生物群与帕金森病的相关性研究”（202201065690）; 长沙市卫生健康委员会科学研究项目“益生菌对青少年抑郁障碍的干预及相关研究”（KJ-B2023101）; 长沙市科技局自然科学基金项目“精神分裂症的肠道微生物干预及相关研究”（kq2502320）
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