| Objective:The clinical data of urinary tract infection among middle-aged and elderly inpatients were collected from the Second People’s Hospital of Liaocheng.The clinical characteristics,distribution of pathogenic bacteria and drug resistance were analyzed,and the results of gene amplification test of Enterobacter carbapenem-resistant antibiotics were analyzed.These results provide a theoretical basis for clinical prevention of urinary tract infection and using rational drug in the hospital.Methods:Clinical data on 2,188 Middle-aged and elderly patients with urinary tract infection in the Second People’s Hospital of Liaocheng,including age,sex,Department source,basic diseases,operation,and antibiotic application,were collected by retrospective analysis between January 2017 and December 2018.Pathogen spectrum and drug resistance were analyzed in all patients with urinary tract infection according to sex and basic diseases by WHONET5.6 and SPSS19.In addition,10 isolated strains of Carbon-resistant enterobacter were tested for gene amplify and genotyping was performed.Results:From January 2017 to December 2018,patients who met the criteria for admission to the group were sent 2,188 specimens of qualified urine culture,811 pathogens were isolated,and the positive rate of examination was 37.07 %.Among them,1107 were from male patients,361(32.61%)were isolated,and 1081 were from female,450(41.63%)strains were isolated.The positive rate of women was significantly higher than that of men,and the difference was statistically significant(P< 0.01).Of the 811 patients,680 were gram-negative bacteria(83.85%),the most common were E.coli,accounting for 55.12% of the total number of patients,followed by Klebsiella pneumoniae,Pseudomonas aeruginosa,Enterobacter cloacae and Proteus mirabilis,respectively 9.25%,3.95%,3.58%,and 2.96% of the total number of patients.Grampositive bacteria were isolated 102 strains(12.56%),mainly Enterococcus faecium(36,4.44%)and Enterococcus faecalis(30,3.7%).There are 29 fungal strains(3.58%),mainly candida glabrata(14,1.73%)and Candida albicans(10,1.23%).The source departments of positive specimens were respectively from Urological ward,Nephrology ward,Intensive Care Unit,Endocrinology ward,and Neurology ward,accounting for 50.9 %,9.1%,6.9 %,6.3% and 4.6 % of the total number of patients.The resistance of E.coli to simple urinary tract infections was lower than that of complex urinary tract infections,and the difference was statistically significant in ampicillin / Schubatam,ceftriaxone,ciprofloxacin,and levofloxacin(P< 0.05).In different age groups,the resistance rate to ceftitin in E.coli was higher in people over 75 than in people between the ages of 60 and 75,and the furantoin resistance rate increased with age(P< 0.05).In terms of gender,the infection rate of E.coli in women was significantly higher than that of men(P< 0.05),but men resistant rate was higher than women(P< 0.05).In particular,there were significant differences in the resistance rate of ampicillin /sulbatan,cefazolin,ceftriaxone,and aminoglycosides and quinolones antimicrobial drugs(P< 0.05).The top five diseases were prostate disease,type 2 diabetes complications,urinary stones,cerebral infarction,and bladder cancer,respectively 18.75%,16.03%,10.97%,9.62% and 7.52% of the total number of patients.In urinary tract infections caused by different basic diseases,the resistance rate of E.coli to ciprofloxacin,levoflo-xacin,cefazolin,and ampicillin exceeded 50%,and the bactertia had high sensitivity to piperacillin/tazobatam,ceftinil,amikacin and furantoine.The strains of E.coli which produce extended spectrum beta-lactinase(ESBLs)accounted for 58.4%,more than 90% of them were sensitive to carbene antimicrobial drugs and piperac-illin/tazobatam,cefatetotam,Amikacin and furantoin drugs.Klebsiella pneumoniae had a sensitivity of more than 95% to carbene antimicrobial drugs,and a sensitivity rate of 80% to piperacillin/tamazobatam,amikacin,cefpime oxime,and ceftitin.The resistance rate of Enterococcus faecalis was significantly lower than that of Enterococcus faecium.A total of 10 strains were detected by Carbon-resistant enterobacteria,with a detection rate of 1.89%.Four E.coli strains(all NDM-5)and two Klebsiella pneumoniae strains(all NDM-1)were tested by Gene amplification.The remaining 4 strains(2 Escherichia coli,1Klebsiella oxytoca,1 strain of Citrobacter freundii)were amplified negative.Conclusion:Most of the urinary tract infections in middle-aged and elderly patients are complicated,and the main pathogenic bacteria are E.coli.In most departments,the drug resistance of cefazolin,ceftriaxone and quinolones is relatively higher and should be carefully selected.In nephrology,the drug resistance rates of ampicillin/sulbactam and compound neotamine can not be used as empirical drugs.There is no significant difference in the drug resistance rates of commonly used antibiotics between different ages and sexes.For simple urinary tract infections,the resistance rates of commonly used drugs are all the same.Complex urinary tract infections should consider the use of enzyme inhibitors or carbapenems.The proportion of ESBLs produced by E.coli in our hospital has exceeded50%.At the same time,the isolation rate of CRE is increasing,which should be paid attention to clinically. |
