摘要
目的探讨基层医院糖尿病患者尿路感染(UTIs)患病率、病原菌及其影响因素和药敏特点.方法回顾性分析医院2016年1月-2020年12月收治的2857例糖尿病患者的病历资料.收集患者年龄、性别、身高、体质量指数、是否有尿路感染症状、糖尿病病程等临床资料.分析患者入院时糖代谢相关指标和肝功及肾功等实验室检查结果,单因素及多因素Logistic回归分析糖尿病患者尿路感染的影响因素,并对尿培养检出病原菌及其对常用抗菌药物的耐药性进行分析.结果2857例糖尿病患者发生UTIs 305例,感染率为10.68%,女性患者UTIs感染率为19.80%(254/1283)高于男性患者(P<0.001).单因素及多因素Logistic回归分析结果,性别、年龄、随机血糖、胰岛素自身抗体是糖尿病患者发生UTIs的影响因素(P<0.05).2857例糖尿病患者中,中段尿培养结果阳性率为14.95%(427/2857);305例UTIs患者中段尿培养病原菌检出率为86.89%(265/305);2552例非UTIs患者中,中段尿培养病原菌检出率为6.35%(162/2552).尿培养共检出病原菌427株,以大肠埃希菌、凝固酶阴性葡萄球菌、肠球菌属、金黄色葡萄球菌和白假丝酵母为主.大多数革兰阴性菌分离株对妥布霉素、呋喃妥因、庆大霉素、环丙沙星、头孢噻肟、头孢他啶和头孢曲松敏感,氨苄西林耐药率较高,阿莫西林-克拉维酸耐药率中等.金黄色葡萄球菌对氨苄西林和青霉素耐药率100.0%,对呋喃妥因和环丙沙星的敏感率为100.0%;凝固酶阴性葡萄球菌对阿莫西林克拉维酸、环丙沙星、头孢噻肟、头孢他啶、呋喃妥因高度敏感;环丙沙星、氨苄西林和万古霉素是治疗肠球菌属分离株的首选抗菌药物.结论UTIs可能影响糖尿病患者的胰岛功能或血糖控制,尿路病原菌的分离率和多药耐药率在基层医院逐渐增加,应进行药敏试验,以指导临床用药.
OBJECTIVE To investigate the prevalence rates of urinary tract infections(UTIs)among the diabetes mellitus patients in a grassroot hospital and observe the distribution of pathogens,inflammatory factors and characteristics of drug susceptibility.METHODS The medical data of 2857 diabetes mellitus patients who were treated in the hospital from Jan 2016 to Dec 2020 were retrospectively analyzed.The clinical data,including age,gender,height,body mass index,symptoms of urinary tract infection and course of diabetes mellitus,were collected from the patients,the laboratory test indexes such as glucose metabolism-related indicators and liver and kidney function indicators were analyzed at the admission to hospital,univariate analysis and multivariate logistic regression analysis were performed for influencing factors for UTIs,and the pathogens cultured from urine specimens and the drug resistance to commonly used antibiotics were observed.RESULTS Of the 2857 diabetes mellitus patients,305 had UTIs,with the infection rate 10.68%;the incidence of UTIs of the female patients was 19.80%(254/1283),significantly higher than that of the male patients(P<0.001).The result of univariate analysis and multivariate logistic regression analysis showed that gender,age,random blood glucose and insulin autoantibodies were the influencing factors for UTIs in the diabetes mellitus patients(P<0.05).Among the 2857 diabetes mellitus patients,14.95%(427/2857)were positive for culture of midstream urine;the isolation rate of pathogens from midstream urine was 86.89%(265/305)among the 305 patients with UTIs;the isolation rate of pathogens from midstream urine was 6.35%(162/2552)among 2552 non-UTIs patients.Totally 427 strains of pathogens were isolated from urine specimens;Escherichia coli,coagulase-negative Staphylococcus,Enterococcus spp,Staphylococcus aureus and Candida albicans were the predominant species of pathogens.Most of the gram-negative bacteria isolates were susceptible to tobramycin,nitrofurantoin,gentamicin,ciprofloxacin,cefotaxime,ceftazidime and ceftriaxone,the drug resistance rate to ampicillin was relatively high,and the drug resistance rate to amoxicillin-clavulanic acid was moderately high.The drug resistance rates of S.aureus strains to ampicillin and penicillin were 10.0%,and the drug susceptibility rates to nitrofurantoin and ciprofloxacin were 100%;the coagulase-negative Staphylococcus strains were highly susceptible to amoxicillin-clavulanic acid,ciprofloxacin,cefotaxime,ceftazidime and nitrofurantoin;ciprofloxacin,ampicillin and vancomycin were the preferred antibiotics for treatment of the Enterococcus spp isolates.CONCLUSION The UTIs may affect the islet function and blood glucose control of the patients with diabetes mellitus,the isolation rate of pathogens and multidrug-resistant rates are increasingly high in the grassroot hospital.It is necessary to carry out the drug susceptibility testing so as to provide guidance for clinical use of antibiotics.
作者
李继芬
郭晓东
马文秀
闫中强
LI Ji-fen;GUO Xiao-dong;MA Wen-xiu;YAN Zhong-qiang(People's Hospital of Pinyao County,Pingyao,Shanxi 031100,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第10期1542-1546,共5页
Chinese Journal of Nosocomiology
基金
国家“十三五”科技重大专项基金资助项目(2018ZX10733402-001-002)。
关键词
尿路感染
无症状菌尿
糖尿病
多药耐药
Urinary tract infection
Asymptomatic bacteriuria
Diabetes mellitus
Multidrug-resistant
