Department of Geriatric Urology, Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan Province, People's Republic of China.
BMC Geriatr. 2022 Mar 12;22(1):195. doi: 10.1186/s12877-022-02886-y.
This study compared the bacterial spectrum and antibiotic susceptibility of uropathogens in older and younger patients with urinary stones to provide appropriate antibiotic management.
We retrospectively reviewed urinary tract infection patients with urolithiasis, presented to Xiangya Hospital from March 2014 to April 2021. Patients were divided into older and younger groups according to 60 years of age. The bacterial spectrum and drug sensitivity of uropathogens were compared.
A total of 542 strains of uropathogens (177 in older and 365 in younger groups) were isolated from 507 patients. E. coli (41.8% vs 43.6%) remains the most common pathogen, followed by E. faecalis (6.2% vs 9.6%) in older and younger groups, respectively. Particularly, K. pneumoniae was significantly more frequent in older (9.6%) than in younger group (4.7%, P < .05). E. faecium was substantially more prevalent in older group (6.2%) than in younger group (2.7%, P < .05). The proportion of males increased in older patients (47.3%) than in younger patients (34.9%, P = 0.007). In both groups, major Gram-negative bacteria (E. coli and K. pneumoniae) revealed a high sensitivity over 70% to piperacillin/tazobactam, imipenem and amikacin, whereas the resistance level was high to penicillin, tetracycline and vancomycin. Major Gram-positive (E. faecalis and E. faecium) isolates demonstrated high sensitivity of over 50% to gentamicin and vancomycin in both groups. Furthermore, uropathogens isolated from younger urolithiasis patients were more susceptible to antimicrobials than those isolated from older patients.
The male increased in the older urolithiasis patients with UTI and uropathogens microbial spectrum in older urolithiasis patients are different from younger. High susceptibility and age should be utilized in empirical antibiotic selection to avoid increased multidrug-resistant bacteria.
本研究比较了老年和年轻尿路结石患者尿源性病原体的细菌谱和抗生素敏感性，为合理使用抗生素提供依据。
我们回顾性分析了 2014 年 3 月至 2021 年 4 月在湘雅医院就诊的尿路结石合并尿路感染患者的临床资料。根据年龄将患者分为老年组（≥60 岁）和年轻组（<60 岁），比较两组患者的尿源性病原体细菌谱和药敏结果。
共分离出 542 株尿源性病原体（老年组 177 株，年轻组 365 株），其中大肠埃希菌（41.8%比 43.6%）仍是最常见的病原体，老年组屎肠球菌（6.2%比 9.6%）和粪肠球菌（9.6%比 4.7%）明显多于年轻组，差异均有统计学意义（均 P<0.05）。老年组屎肠球菌（6.2%）明显多于年轻组（2.7%），差异有统计学意义（P<0.05）。老年组男性比例（47.3%）高于年轻组（34.9%），差异有统计学意义（P=0.007）。两组主要革兰阴性菌（大肠埃希菌和肺炎克雷伯菌）对哌拉西林/他唑巴坦、亚胺培南和阿米卡星的敏感性均在 70%以上，而对青霉素、四环素和万古霉素的耐药率较高。两组主要革兰阳性菌（屎肠球菌和粪肠球菌）对庆大霉素和万古霉素的敏感性均在 50%以上。此外，年轻组尿路结石患者分离出的尿源性病原体对各种抗菌药物的敏感性均高于老年组。
老年尿路结石合并尿路感染患者中男性比例增加，且尿源性病原体的微生物谱与年轻患者不同。在经验性选择抗生素时，应根据药敏结果和患者年龄综合考虑，避免多重耐药菌的增加。
