泌尿系置管患者绿脓杆菌感染危险因素及耐药情况的分析

发布时间：2018-04-16 09:36

本文选题：绿脓杆菌 + 感染　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:分析泌尿系置管患者发生绿脓杆菌感染的相关危险因素,并探讨感染绿脓杆菌患者的耐药情况。方法:统计2015年1月至2017年1月在我科行泌尿系置管的2012例患者的病历资料,其中发生绿脓杆菌感染的患者62例。记录、分析与泌尿系置管后发生绿农杆菌感染的相关的因素,对感染发生有关的各种相关因素进行单因素分析(χ~2检验)和多因素Logistic回归分析,并统计绿脓杆菌感染患者耐药种类及耐药率状况。结果:多因素Logistic回归分析结果显示大于60岁(VS小于等于60岁),OR=3.041,95%CI(1.623-5.699)、留置管时间超过1月(VS留置置管时间小于等于1月),OR=2.889,95%CI(1.380-6.048)、术前肾功能受损(VS术前无肾功能受损),OR=7.111,95%CI(3.470-14.575)、合并低蛋白血症(VS无低蛋白血症OR=5.044),95%CI(2.274-11.187))、糖尿病基础病史(VS无糖尿病基础病史)OR=4.303,95%CI(1.416-13.074)、体外置管方式(VS体内置管方式),OR=12.987,95%CI(6.667-25.000)是泌尿系置管患者发生绿脓杆菌感染的独立危险因素。将留置体外置管三种方式绿脓杆菌感染率进行整体卡方检验及分割卡方检验,结果显示留置肾造瘘管(VS导尿管组,χ~2=15.26,P=0.000);(VS膀胱造瘘管,χ~2=18.41,P=0.000)发生泌尿系绿脓杆菌感染的机会更高。细菌培养+20种抗生素药物敏感试验结果表明:药物耐药情况为绿脓杆菌对头孢类中头孢唑啉(耐药率100%)、头孢呋辛钠(耐药率98%)、头孢呋辛酯(耐药率98%)、头孢曲松(耐药率98%);青霉素类中氨苄西林(耐药率100%)、氨苄西林/舒巴坦(耐药率100%);其他β-内酰胺类中头孢替坦(耐药率90%);硝基呋喃类中呋喃妥因(耐药率90%);磺胺类中复方新诺明(耐药率98%)明显耐药。药物敏感情况为绿脓杆菌仅对氨基糖甙类中的丁胺卡那霉素(敏感率94%)、庆大霉素(敏感率71%)、妥布霉素(敏感率77%);喹诺酮类中环丙沙星(敏感率61%)、左氧氟沙星(敏感率65%);头孢类中的头孢他啶(敏感率84%)、头孢吡肟(敏感率74%);半合成青霉素类中哌拉西林/他唑巴坦(敏感率80%)、氧哌嗪青霉素(敏感率74%)以及碳青酶烯类抗生素中美罗培能(敏感率77%)、亚胺硫霉素(泰能)(敏感率94%)敏感。结论:高龄(大于60岁)、合并肾功能受损、低蛋白血症、糖尿病的患者是泌尿系置管患者发生绿脓杆菌感染的高危人群,行泌尿系体外置管尤其是留置肾造瘘管,且置管时间超过一个月的患者发生绿脓杆菌感染几率显著增加;泌尿系置管患者绿脓杆菌感染的耐药情况极其严峻,临床治疗中务必重视这些危险因素并根据药敏情况合理使用抗生素。
[Abstract]:Objective: to analyze the risk factors of Pseudomonas aeruginosa infection in patients with urinary tract catheterization and to explore the drug resistance of patients with Pseudomonas aeruginosa infection.Methods: the medical records of 2012 patients with urinary tract catheterization in our department from January 2015 to January 2017 were analyzed, including 62 patients with Pseudomonas aeruginosa infection.The factors related to the infection of Agrobacterium aeruginosa after catheterization of urinary system were recorded and analyzed. Univariate analysis (蠂 ~ 2 test) and multivariate Logistic regression analysis were carried out.The drug resistance types and drug resistance rate of patients with Pseudomonas aeruginosa infection were analyzed.The risk factors of infection of Pseudomonas aeruginosa in patients with urinary tract catheterization were as follows: proteinemia: 5.044 / 95CI2.274-11.1877; basic history of diabetes: no basic history of diabetes: OR4.303 ~ 95CI1.416-13.074; in vitro catheterization: OR12.98795CI6.667-25.000) in patients with urinary tract catheterization, the infection of Pseudomonas aeruginosa was found to be an independent risk factor for infection of Pseudomonas aeruginosa in patients with urinary tract catheterization.The infection rate of Pseudomonas aeruginosa in three ways of indwelling external tube was tested by chi-square test and segmented chi-square test. The results showed that there was a higher chance of urinary tract infection caused by Pseudomonas aeruginosa infection in the group of catheterization plus vs urethral catheterization, 蠂 ~ 2 ~ (2 +) ~ (15.26) P ~ (0.000) and vitreostomy (蠂 ~ (2) ~ (2)) ~ (18. 41) P ~ (0.000)).The results of 20 antibiotic susceptibility tests showed that the drug resistance of Pseudomonas aeruginosa to cefazolin (100%), cefuroxime sodium (98%), cefuroxime (98%) and cefuroxime (98%, ceftriaxone)Ampicillin in penicillin, ampicillin in penicillin, ampicillin / sulbactam, ceftitan in other 尾-lactams, nitrofurantoin, sulbactam and sulfamideThe drug resistance rate was 98%.Ceftazidime in ceftazidime, cefepime in ceftazidime, piperacillin / tazobactam in semi-synthetic penicillin, piperacillin / tazobactam in semi-synthetic penicillin.Meropenem (sensitivity: 77g), imidulfycin (tianeng) (sensitivity: 94kb).Conclusion: the patients with advanced age (> 60 years old, complicated with impaired renal function, hypoproteinemia and diabetes mellitus) are the high risk group for infection of Pseudomonas aeruginosa in patients with urinary tract catheterization, especially indwelling renal fistula tube.The incidence of Pseudomonas aeruginosa infection was significantly increased in patients with tube placement for more than one month, and the drug resistance of patients with urinary tract catheterization was extremely severe.These risk factors must be taken seriously in clinical treatment and antibiotics should be used reasonably according to drug sensitivity.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R691.3

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