驻马店地区886例泌尿系统感染患者临床特点及病原菌耐药性分析

发布时间：2017-12-26 20:20

本文关键词：驻马店地区886例泌尿系统感染患者临床特点及病原菌耐药性分析　出处：《新乡医学院》2016年硕士论文　论文类型：学位论文

【摘要】：背景泌尿系统感染(Urinary Tract Infection,UTI),是由多种病原菌直接侵入尿路而引起的尿道炎症反应。常见的感染菌包括大肠埃希杆菌和金黄色葡萄球菌等。UTI常见症状有急性单纯性膀胱炎、急性单纯性肾炎和复杂性尿路感染等,已经成为最常见的感染性疾病之一。驻马店地区UTI病例近年逐渐增加,然而针对该地区患者的临床症状和不同病原菌的耐药性仍然缺乏一个系统性认识,严重阻碍了有效治疗方法的开发和应用。目的系统总结、探讨河南省驻马店地区UTI患者的临床发病特点;揭示该地区UTI患者病原菌类型、耐药性及其耐药基因;为指导临床治疗及安全用药、降低病原菌的耐药率、提高患者的疾病治愈率,提供实验数据和科学依据。方法首先收集来自驻马店市中心医院、驻马店市第一人民医院、驻马店市中医院、驻马店市第二人民医院等四家综合医院连续八年(2007年1月~2014年12月)收住的UTI患者886例,统计患者年龄、性别、疾病临床相关诊治等基本信息,并系统分析患者的临床特点、实验室检查结果及患者病情转归。进一步通过患者尿培养检测,探讨患者病原菌分布、耐药性及常见病原菌耐药性变迁情况进行。最后通过PCR和凝胶电泳等技术对UTI患者中产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌进行耐药基因分析。结果1.本次研究资料中,男性患者186例(20.99%),女性患者700例(79.01%),男女患者比例为1:3.76,各年龄段患者女性均高于男性。UTI患者上行性感染843例,占95.15%,血行感染20例,占2.25%,淋巴道感染16例,占1.81%,直接感染7例,占0.79%。上尿路感染354例,占39.95%,以急、慢性肾盂肾炎为主;下尿路感染532例,占60.05%,以急性膀胱炎、前列腺炎、急性尿道炎为主。患者以尿路刺激征(尿频、尿急、尿痛)最多见,其次为下腹痛、腰痛等,无明显症状者30例。UTI患者有合并症的460例,合并症中最多见的是泌尿系结石127例(27.61%),其次是肾积水61例(13.26%)。2.886例患者中有582例检出病原菌,阳性率占65.69%。共检出病原菌768株,以G-菌为主(70.05%),在G-菌中以大肠埃希杆菌(E.Coil)居首位(51.43%);G+菌(28.65%)以屎肠球菌(12.37%)和粪肠球菌(5.73%)为主。G-菌感染率一直较G+菌高,然而后四年(2011~2014)G+菌感染有增高趋势,以屎和粪肠球菌感染增多为主。3.大肠埃希菌、肺炎克雷伯菌等对多种抗菌药物高度耐药,但其对亚胺培南、呋喃妥因、头孢替坦、哌拉西林/他唑巴坦和环丙沙星等高度敏感。屎肠球、粪肠球菌等对青霉素,红霉素、环丙沙星和氨苄西林高度耐药,但对万古霉素、替考拉宁和呋喃妥因高度敏感。4.25株大肠埃希菌中SHV的检出率为40.00%(10/25),TEM的检出率为8.00%(2/25),CTX-M检出率为80.00%(20/25)。15株肺炎克雷伯菌中SHV的检出率为40.00%(6/15),TEM的检出率为26.67%(4/15),CTX-M检出率为73.33%(11/15)。结论1.UTI感染率、并发症在性别、年龄等方面存在差异;UTI患者病原菌仍以G-菌大肠埃希杆菌为最常见,但近年G+菌感染率有上升趋势,以屎和粪肠球菌感染增多为主。2.在检出的病原菌中,大肠埃希菌和肺炎克雷伯菌等对氨苄西林、复方新诺明、哌拉西林等多种抗菌药物高度耐药。屎肠球和粪肠球菌等对青霉素,红霉素、环丙沙星及氨苄西林高度耐药。3.大肠埃希菌和肺炎克雷伯菌产ESBLs的基因型主要为CTX-M型,第二位的是SHV型,TEM型的检出率最低;多数菌株携带有2种甚至多种耐药基因,两种及以上的耐药基因型共存于同一菌株中,导致细菌产生复杂多变的耐药表型。
[Abstract]:Urinary Tract Infection (UTI) is a response to urethritis caused by the direct intrusion of a variety of pathogenic bacteria to the urinary tract. The common infected bacteria include Escherichia coli and Staphylococcus aureus. The common symptoms of UTI are acute simple cystitis, acute simple nephritis and complicated urinary tract infection, which have become one of the most common infectious diseases. UTI cases in Zhumadian area have been increasing in recent years. However, there is still a lack of systematic understanding of the clinical symptoms and drug resistance of different pathogens in this area, which seriously hampers the development and application of effective treatment methods. Objective to summarize the clinical characteristics and explore the system of UTI in Zhumadian area of Henan province; reveal the types and pathogens in patients with UTI in the area of bacteria resistance and resistance gene; drug resistance to guide clinical treatment and medication safety, reduce pathogenic bacteria rate and improve the cure rate of the disease patients, to provide experimental data and scientific basis. First, collected from Zhumadian Central Hospital, four hospitals of Zhumadian city first people's Hospital, Zhumadian city hospital, Zhumadian City Second People's Hospital for eight consecutive years (January 2007 ~2014 December) of 886 UTI patients admitted to the statistical cases, age and gender of patients, clinical diagnosis and treatment of diseases related to the basic information system, and analysis of the disease the clinical characteristics, laboratory results and prognosis of patients. Further through the detection of urine culture, the distribution of pathogenic bacteria, drug resistance and the change of common pathogenic bacteria resistance were investigated. Finally, PCR and gel electrophoresis were used to analyze the resistance genes of Escherichia coli and Klebsiella pneumoniae in UTI patients with extended spectrum beta lactamase (ESBLs). Results 1. of the data in this study, 186 cases (20.99%) were male, 700 cases (79.01%) were female, the ratio of male to female was 1:3.76, and women in all age groups were higher than men. In UTI patients, 843 cases of upper infection, 95.15%, 20 cases of blood infection, 2.25%, 16 cases of lymphatic infection, 1.81%, 7 cases of direct infection, accounting for 0.79%. 354 cases of upper urinary tract infection, accounting for 39.95%, were mainly acute and chronic pyelonephritis. 532 cases of lower urinary tract infection, accounting for 60.05%, were mainly acute cystitis, prostatitis and acute urethritis. Patients with urinary irritation symptoms (frequency, urgency, odynuria) the most common, followed by abdominal pain, back pain, 30 cases had no obvious symptoms. In UTI patients, there were 460 cases of complication. The most common complication was urinary calculi in 127 cases (27.61%), followed by 61 cases of hydronephrosis (13.26%). Among the 2.886 patients, 582 were detected the pathogenic bacteria, and the positive rate was 65.69%. A total of 768 strains of pathogens were detected, mainly G- bacteria (70.05%). Escherichia coli (E.Coil) ranked the top (51.43%) in G- bacteria, and G+ (28.65%) was mainly Enterococcus faecium (12.37%) and Enterococcus faecalis (5.73%). The infection rate of G- bacteria was higher than that of G+ bacteria, but the infection of G+ bacteria increased in the last four years (2011~2014), and increased mainly in the infection of feces and Enterococcus faecalis. 3. Escherichia coli and Klebsiella pneumoniae are highly resistant to various antibiotics, but they are highly sensitive to imipenem, furanitin, cefotidan, piperacillin / tazobactam and ciprofloxacin. E.faecium and Enterococcus faecalis to penicillin, erythromycin, ciprofloxacin and ampicillin but highly resistant to vancomycin, teicoplanin, and highly sensitive to nitrofurantoin. The detection rate of SHV in 4.25 Escherichia coli was 40% (10/25), the detection rate of TEM was 8% (2/25), and the detection rate of CTX-M was 80% (20/25). The detection rate of SHV in 15 strains of Klebsiella pneumoniae was 40% (6/15), the detection rate of TEM was 26.67% (4/15), and the detection rate of CTX-M was 73.33% (11/15). Conclusion 1.UTI infection rate and complications are different in gender and age. The most common pathogens in UTI patients are G-, Escherichia coli, but G+ infection rate is increasing in recent years. 2., among the detected pathogens, Escherichia coli and Klebsiella pneumoniae are highly resistant to ampicillin, compound sulfamethoxazole and piperacillin. Fecal balls and Enterococcus faecalis were highly resistant to penicillin, erythromycin, ciprofloxacin and ampicillin. 3. of Escherichia coli and Klebsiella pneumoniae isolated from genotype ESBLs are mainly CTX-M type, second were type SHV, type TEM, the lowest detection rate; most strains carrying various resistance and 2 genes, two or more resistant genotypes coexist in the same strain, leading to bacterial resistance the complex phenotype.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R691.3;R446.5

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