细菌生物膜的形成与导管相关性尿路感染的关系

发布时间：2018-03-30 14:22

  本文选题：尿管相关性尿路感染　切入点：生物膜　出处：《中华医院感染学杂志》2017年18期

【摘要】：目的观察留置导尿患儿导尿管表面细菌生物膜的形成过程,探讨形成的影响因素及其与导管相关性尿路感染的相关性。方法选取2016年9-12月某儿童医院泌尿外科留置导尿患儿27例为研究对象,使用扫描电镜(SEM)观察27例留置导尿患儿导尿管表面细菌生物膜(BF)的结构;比较7例CAUTIs患者与20例非CAUTI患者导尿管BF的形成率,并进行影响导尿管管壁形成生物膜的多因素logistic回归分析。结果尿培养阳性尿管表面均观察到BF形成,形成率为100%;9例(69.23%)导管培养阳性的导管表面形成生物膜,微生物培养阳性组生物膜的形成率均较阴性组高(P0.01);尿培养和导管培养同时分离出的前三位的细菌为:粪肠球菌、表皮葡萄球菌、凝固酶阴性葡萄球菌。留置10d左右导尿管的管壁在电镜下可观察到逐渐成熟的细菌生物膜。留置导尿时间是影响导尿管管壁形成生物膜的危险因素[P=0.046,OR(95%CI)=3.552(1.021,12.353)];抗菌药物使用超过5d的导尿管管壁形成生物膜的风险是抗菌药物使用天数5d以内的15.34倍(P=0.024)。所有CAUTIs患者尿管管壁均有BF形成,但仅有10%的非CAUTI患者管壁能观察到BF,差异有统计学意义(P0.001)。结论儿童平均留置(9.78±1.20)d的导尿管管壁可观察到成熟的细菌生物膜,留置导尿患儿导尿管管壁细菌生物膜的形成与CAUTIs存在着密切关系,随着留置时间的延长形成生物膜的风险越大,长时间应用抗菌药物并不能降低BF的形成。微生物培养结果与生物膜的形成呈正相关,其中导管培养方法较尿培养更能准确发现管壁内细菌的定植与BF的形成。
[Abstract]:Objective To observe the formation process of indwelling catheter in children with bacterial biofilm on the surface, to explore the factors influencing the formation and its correlation with catheter associated urinary tract infection. Methods from 2016 9-12 months in a children's Hospital Department of Urology catheterization in 27 cases as the research object, using scanning electron microscopy (SEM) observation of 27 cases of patients with indwelling catheter catheter surface bacteria the biofilm (BF) structure; comparison of 7 CAUTIs patients and 20 cases of non CAUTI catheter BF formation rate and influence factors of logistic catheter tube wall biofilm formation by regression analysis. The results of urine culture positive catheter surface were observed in the BF formation, the formation rate was 100%; 9 cases (69.23% the surface of the catheter catheter Culture) positive biofilm formation, microbial culture positive group biofilm formation rate was higher than that of the negative group (P0.01); urine culture and culture at the same time, catheter isolated three bacteria : Enterococcus faecalis, Staphylococcus aureus, coagulase negative staphylococci. Tube indwelling catheter about 10d can be observed in bacterial biofilm gradually mature in the electron microscope. The catheterization time is [P=0.046 risk factors of catheter wall biofilm formation, OR (95%CI) = 3.552 (1.021,12.353)]; antibacterial the risk of drug use over 5D catheter tube wall biofilm formation is used 15.34 times within 5D days of antibiotics (P=0.024). All patients with CAUTIs catheter tube wall BF were formed, but only 10% of the patients with non CAUTI tube wall can be observed by BF, the difference was statistically significant (P0.001). Conclusion the average retention (9.78 + 1.20) d catheter tube wall can be observed in bacterial biofilm formation and mature, CAUTIs children with indwelling catheter catheter tube wall of bacterial biofilm has a close relationship with the formation of biofilm, prolong the indwelling time of the risk The longer the time, the longer the time of application of antibiotics did not reduce the formation of BF. There was a positive correlation between the results of microbial culture and the formation of biofilms. The catheter culture method was more accurate than the urine culture to detect bacterial colonization and BF formation in the tube wall.

【作者单位】： 苏州大学附属儿童医院感染管理科;
【基金】：苏州市科技发展计划基金资助项目(SYSD2015098)
【分类号】：R726.9
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本文编号：1686296