Gravey F, Loggia G, de La Blanchardière A, Cattoir V
Service de microbiologie, CHU de Caen, 14033 Caen, France.
Service de médecine gériatrique, CHU de Caen, 14033 Caen, France.
Med Mal Infect. 2017 Jun;47(4):271-278. doi: 10.1016/j.medmal.2017.03.002. Epub 2017 Apr 10.
Although urinary tract infections are the second leading cause of infections among patients aged above 65 years, data on bacterial epidemiology of urinary specimens in these patients is scarce. Our aim was to describe the main bacterial species found at significant levels in urine specimens of the elderly and to determine their antimicrobial resistance profiles.
From October 2012 to October 2015, all urinary specimens (catheter-related or not) received at the laboratory of microbiology of the university hospital of Caen (France) were retrospectively studied. Results were compared to those of urinary specimens of patients aged 18-64 years. Bacterial identification was performed using MALDI-TOF mass spectrometry and antimicrobial susceptibility testing was performed as per CA-SFM guidelines.
Out of 33,302 urine cytobacteriological examinations (UCBE) performed in patients aged above 65 years, 13,450 microorganisms were identified. Escherichia coli was the most frequent species (41.8%) followed by Enterococcus faecalis (9.7%), Pseudomonas aeruginosa (5.7%), Proteus mirabilis (4.6%), and Klebsiella pneumoniae (4.2%). Around 9% of E. coli isolates were resistant to third-generation cephalosporins, including 8.2% by production of extended-spectrum β-lactamase (ESBL). This prevalence was significantly higher than that observed in urinary specimens of patients aged 18-74 years (4.9%, P<0.001).
The bacterial epidemiology of urines collected from the elderly is diverse and significantly different from that of urine specimens of younger patients, with a higher proportion of multidrug-resistant bacteria (particularly ESBL-producing E. coli).
尽管尿路感染是65岁以上患者中第二大常见感染病因，但关于这些患者尿液标本细菌流行病学的数据却很匮乏。我们的目的是描述在老年人尿液标本中大量发现的主要细菌种类，并确定它们的抗菌药物耐药谱。
回顾性研究2012年10月至2015年10月在法国卡昂大学医院微生物实验室接收的所有尿液标本（无论是否与导尿管相关）。将结果与18 - 64岁患者的尿液标本结果进行比较。使用基质辅助激光解吸电离飞行时间质谱进行细菌鉴定，并按照CA - SFM指南进行抗菌药物敏感性测试。
在65岁以上患者进行的33302次尿细胞细菌学检查（UCBE）中，鉴定出13450种微生物。大肠埃希菌是最常见的菌种（41.8%），其次是粪肠球菌（9.7%）、铜绿假单胞菌（5.7%）、奇异变形杆菌（4.6%）和肺炎克雷伯菌（4.2%）。约9%的大肠埃希菌分离株对第三代头孢菌素耐药，其中8.2%通过产生超广谱β - 内酰胺酶（ESBL）耐药。这一患病率显著高于18 - 74岁患者尿液标本中的观察值（4.9%，P<0.001）。
从老年人中收集的尿液细菌流行病学具有多样性，与年轻患者尿液标本的细菌流行病学显著不同，多重耐药菌（特别是产ESBL的大肠埃希菌）比例更高。
