摘要
目的研究尿路感染患者携带尿肠球菌流行病学及临床特征,为尿路感染的诊治提供指导。方法收集206例尿路感染患者临床送检尿液标本,分离尿肠球菌,同一患者剔除重复株。采用VITEK32细菌检测分析仪检测菌落,并采用API板条鉴定菌种。药敏试验采用K-B法,结果判定参照CLSI2016版。采用SPSS20.0软件对数据进行统计学分析。结果检出49例尿肠球菌感染者,≤44岁感染者12例,感染率18.46%;45~岁感染者17例,感染率24.64%;≥60岁感染者20例,感染率27.78%。≤44岁和>44岁患者感染率差异无统计学意义(χ2=1.4853,P>0.05);<60岁和≥60岁患者感染率差异有统计学意义(χ2=0.9727,P<0.05)。男性患者19例,感染率17.12%(19/111);女性患者30例,感染率31.58%(30/95);男、女患者感染率差异无统计学意义(χ2=5.9056,P<0.05)。临床表现以怕冷、发热、腰痛等全身症状为主,且无症状性菌尿、尿路刺激、全身症状的患者分别有14、9和22例,感染率28.57%、18.37%和44.90%。实验室检查中,白细胞、血沉、C反应蛋白、降钙素原、IgG、C3、肌酐值、胱蛋白酶抑制剂C、N-乙酰-β-D氨基葡萄糖苷酶、β2-微球蛋白、微量白蛋白以及内毒素异常患者分别为24、9、8、3、7、8、7、8、28、22、29和20例,分别占48.97%、18.37%、16.33%、6.12%、14.29%、16.33%、14.29%、16.33%、57.14%、44.90%、59.18%和40.82%。49株尿肠球菌对诺氟沙星、庆大霉素、利福平、利奈唑胺、万古霉素、替考拉宁的耐药率分别为61.22%、48.98%、32.65%、16.33%、0.00%和0.00%。结论尿肠球菌尿路感染以老年患者常见,女性患者高发,临床表现以全身症状为主,实验室检查以微量白蛋白和白细胞指标异常为主要特征。尿肠球菌尿路感染治疗可合理使用万古霉素和替考拉宁。
Objective To study the epidemiological and clinical features of an enterococcal urinary tract infection in order to guide the prevention and control of that infection. Methods Urine samples were collected from 206 patients with a urinary tract infection.Enterococcus was isolated,and duplicate strains from the same patient were excluded.Colonies were detected using a VITEK32 microbe analyzer,and species were identified using API strips.Drug sensitivity testing was performed using the K-B method,and the results were judged according to the 2016 standards of the CLSI.The software SPSS20.0 was used to statistically analyze data. Results Forty-nine strains of Enterococcus were isolated from patients with a urinary tract infection.Twelve strains were isolated from young patients,17 were isolated from middleaged patients,and 20 were isolated from elderly patients.The rate of infection was 18.46%in young patients,24.64%in middle-aged patients,and 27.78%in elderly patients.Strains infecting patients〈44 years of age and 〉44 years of age and patients〈60 years of age and〉60 years of age did not differ significantly（P〈0.05）.Nineteen strains were isolated from male patients for a rate of infection of 17.12%.Thirty strains were isolated from female patients,for a rate of infection of 31.58%.The rate of infection in male and female patients differed significantly（χ^2=5.9056,P〈0.05）.The main clinical features of infection were general symptoms,such as sensitivity to cold,a fever,and lower back pain.Fourteen patients had asymptomatic bacteriuria,9 had urinary irritation,and 22 had general symptoms.The rate of infection was28.57%in patients with asymptomatic bacteriuria,18.37%in patients with urinary irritation,and 44.90%in patients with general symptoms.Laboratory results revealed that 24 patients had an abnormal white blood cell count,9 had an abnormal erythrocyte sedimentation rate,8 had abnormal levels of C-reactive protein,3 had abnormal levels of calcitonin,7 had abnormal levels of IgG,8 had abnormal levels of C3,7 had abnormal levels of creatinine,8 had abnormal levels of the protease inhibitor cystatin C,28 had abnormal levels of N-acetyl-beta-D amino glycosidase enzymes,22 had abnormal levels of beta 2-microglobulin,29 had trace levels of albumin,and 20 had abnormal levels of endotoxins.Forty-nine strains of Enterococcus were resistant to norfloxacin at a rate of 61.22%,to gentamycin at a rate of 48.98%,to rifampicin at a rate of 32.65%,to linezolid at a rate of 16.33%,to vancomycin at a rate of 0.00%,and to teicoplanin at a rate of0.00%. Conclusion Elderly people often had an enterococcal urinary tract infection,and male patients were a high-risk group.The main clinical features of an enterococcal urinary tract infection were general symptoms,and laboratory results often revealed a trace level of albumin and abnormal white blood cell count.Vancomycin and teicoplanin should be used rationally to treat patients with an enterococcal urinary tract infection.
作者
阎磊
朱清
邵凤民
YAN Lei;ZHU Qin;SHAO Feng-min(Nephrology, Zhengzhou University People＇s Hospital, Henan Province People＇s Hospital, Zhengzhou,450003, Chin)
出处
《中国病原生物学杂志》
CSCD
北大核心
2017年第10期1000-1002,1006,共4页
Journal of Pathogen Biology
关键词
尿路感染
尿肠球菌
临床特征
耐药性
Urinary tract infection
urinary Enterococcus
clinical features
drug resistance
