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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 the distribution characteristics and drug resistance of pathogens in elderly patients with urinary tract infection in intensive care unit (ICU). Methods: Urine samples from 214 elderly patients with urinary tract infection in ICU from January 2012 to December 2014 in our hospital were collected and 330 pathogens were isolated. The pathogens were tested using VITEK 2 Compact automatic microbial identification device and its related reagents Identification, parallel drug sensitivity test. RESULTS: Of 214 urinary tract infections, 64 were caused by a single bacterium, 34 were caused by a single fungus, 71 were caused by bacteria associated with fungi, 36 were caused by mixed bacteria, and 9 were caused by mixed fungi. Of the 330 pathogenic bacteria isolated, 157 strains of Gram-negative bacilli were Escherichia coli and Klebsiella pneumoniae; 50 strains of Gram-positive cocci were Enterococcus faecalis; 123 were fungi, of which Candida albicans was the Lord. Acinetobacter baumannii cefoperazone / sulbactam, cotrimoxazole, tobramycin and Pseudomonas aeruginosa cefoperazone / sulbactam, ceftazidime, imipenem, piperacillin / The antibiotic resistance of tazobactam and other antibiotics showed an upward trend (P <0.05). There was no significant difference in the susceptibility of fungi (P> 0.05), and the antifungal agents such as fluconazole still maintained high sensitivity. Elderly patients with urinary tract infections isolated from multiple drug-resistant bacteria (MDRO) a larger proportion, and a higher rate of resistance. Conclusion: The drug resistance rate of pathogens isolated from elderly patients with urinary tract infection in ICU is high, and communication should be strengthened between laboratories and clinics to select antibiotics reasonably so as to reduce the outbreak of nosocomial infections caused by MDRO.