背景:尿路感染(UTI)是全球最常见的感染之一。随着抗生素耐药性的持续趋势,病原学分布和抗生素药敏监测对于经验性抗菌治疗具有重要意义.不同年龄段UTI的危险因素和临床情况各不相同;因此,UTI的病原体和抗菌敏感性也可能随着年龄的增长而变化。这项研究的目的是比较三级综合医院在12年期间按不同年龄分类的UTI的病原学特征和抗生素耐药性模式。
方法:回顾性收集2009年1月至2020年12月我院非重复性尿路感染患者尿培养阳性结果。采用WHONET5.6软件分析微生物的分布和耐药率。按不同年龄类别分类的病因学概况(新生儿,儿科,成人,和老年病)和前五名病原体的抗生素耐药率进行分析。
结果:本研究共纳入13,308例非重复性UTI患者。新生儿屎肠球菌占优势(45%,n=105),并在儿科被大肠杆菌取代(34%,n=362),成人(43%,n=3,416),和老年病(40%,n=1,617),分别。不同年龄类别的病因学概况是不同的,按性别(男性和女性)和病房类型(门诊患者,住院,ICU,和紧急情况)。大肠杆菌,肺炎克雷伯菌,粪肠球菌,E.屎肠,铜绿假单胞菌是所有年龄段的前五名病原体。头孢哌酮-舒巴坦和哌拉西林-他唑巴坦在大肠杆菌中的耐药率在所有年龄类别中均较低。其他头孢菌素的耐药率,碳青霉烯类,肺炎克雷伯菌和氟喹诺酮类药物在老年患者中总体较高。在所有年龄类别中,屎肠球菌的抗性均高于粪肠球菌。多药耐药性随着年龄的增长而增加,这在老年患者中更为严重。
结论:不同年龄类别的UTI病原学特征和抗生素耐药性模式各不相同,特别是在儿科和老年患者中;因此,在开始经验性抗菌治疗时,应考虑针对不同年龄段的不同抗生素治疗.
BACKGROUND: Urinary tract infections (UTIs) are among the most common infections worldwide. With continuing trends of antibiotic resistance, the etiological distribution and antibiotic susceptibility surveillance are of great importance for empirical antimicrobial therapy. The risk factors and clinical circumstances of UTI among different age categories varied; thus, the pathogens and antimicrobial susceptibilities of UTI may also change with age. The aim of this
study was to compare the etiological profiles and antibiotic resistance patterns of UTIs sorted by different age categories from a tertiary general hospital during a 12-year period.
METHODS: All positive urine culture results from non-repetitive UTI patients in our hospital from January 2009 to December 2020 were collected retrospectively. The microbial distribution and antibiotic resistance rates were analyzed by WHONET 5.6 software. The etiological profiles sorted by different age categories (newborn, pediatric, adult, and geriatric) and antibiotic resistance rates of the top five pathogens were analyzed.
RESULTS: A total of 13,308 non-repetitive UTI patients were included in our
study. Enterococcus faecium was dominant in newborn (45%, n = 105), and replaced by Escherichia coli in pediatric (34%, n = 362), adult (43%, n = 3,416), and geriatric (40%, n = 1,617), respectively. The etiological profiles of different age categories were divergent, sorted by genders (male and female) and ward types (outpatient, inpatient, ICU, and emergency). E. coli, Klebsiella pneumoniae, Enterococcus faecalis, E. faecium, and Pseudomonas aeruginosa were the top five pathogens in all age categories. The resistance rates of cefoperazone-sulbactam and piperacillin-tazobactam in E. coli were low in all age categories. The resistance rates of other cephalosporins, carbapenems, and fluoroqinolones in K. pneumoniae were higher in geriatric patients overall. E. faecium was more resistant than E. faecalis in all age categories. Multidrug resistance increased with age, which was more serious in geriatric patients.
CONCLUSIONS: The UTI etiological profiles and antibiotic resistance patterns varied among different age categories, especially in pediatric and geriatric patients; thus, a different antibiotic therapy for various age categories should be considered when initiating empirical antimicrobial therapies.