肾内科住院患者尿路感染的回顾性研究

发布时间：2018-04-27 17:25

本文选题：尿路感染 + 住院患者　；参考：《复旦大学》2014年硕士论文

【摘要】：目的分析我院肾内科住院患者尿路感染(urinary tract infection, UTI)的临床特点,探讨尿路感染易感因素,了解尿路感染病原菌的分布及耐药情况,了解医院内尿路感染的特点。方法收集2012.8-2013.8入住我院肾内科的156例UTI患者的临床及实验室检查资料,分析其临床特点、易感因素、病原菌分布及耐药情况。结果(1)156例UTI患者中,男性26例,占16.7%；女性130例,占83.3%。年龄最小18岁,最大92岁,平均年龄58.98±18.20岁。各年龄组尿感患者男女比例分别为：≤40岁,1：12.5；41-59岁,1：5.14；≥60岁,1：4.06。(2)156例UTI患者中,上尿路感染93例,占59.6%；下尿路感染63例,占40.4%。(3)尿路刺激征在上、下尿路感染中的发生率分别为57.0%和69.8%,二者之间无显著差异(p0.05)；发热、腰痛、消化道症状和乏力均以上尿路感染多见(p0.01),且在上尿路感染中,有发热、腰痛者要略多于有尿路刺激征者；肉眼血尿多见于下尿路感染(p0.01)；肾区叩痛、输尿管点压痛等尿感体征多见于上尿路感染(p0.01)。(4)尿白细胞(white blood cell,WBC)增多者在上、下尿路感染中分别占80.6%和66.7%,且上尿路感染多于下尿路感染(p0.05)；尿亚硝酸盐在UTI中阳性率仅30%左右,且在上、下尿路感染中无明显差异(p0.05)；尿β2-微球蛋白(β2-microglobulin,β2-MG)增高者在上尿路感染中占77.4%,明显高于下尿路感染(p0.01)。但在下尿路感染中,尿β2-MG增高者也较多,达33.3%；外周血WBC计数增高、红细胞沉降率(erythrocyte sedimentation rate,ESR)增快、C-反应蛋白(C-reactive protein,CRP)增高均以上尿路感染多见(p0.01)。(5)93例上尿路感染中,出现并发症者共32例,占34.4%。其中,急性肾损伤(acute kidney injury,AKI)18例,败血症11例,感染性休克1例,肾周脓肿2例；63例下尿路感染中,出现并发症者共2例,占3.2%,均为AKI,未见其他并发症。上尿路感染出现并发症者明显多于下尿路感染(p0.01)。(6)复杂性尿路感染多见,共119例,占76.3%。(7)复杂性尿感中居前5位的易感因素分别为：慢性肾脏病(chronic kidney disease,CKD)(80.7%)、尿路梗阻(62.2%)、绝经(56.3%)、贫血(47.9%)、糖尿病(36.1%)。导致尿路梗阻的原因中居前3位的分别为：泌尿系结石(31.1%)、前列腺增生(15.1%)、膀胱颈梗阻(5.9%)。合并CKD者中,CKD1-3期者占52.1%；CKD4-5期未行肾替代治疗者占16.8%；CKD5期行血透或腹透者占11.8%。(8)UTI病原菌仍以革兰阴性菌为主,占71.9%,其次为革兰阳性菌和真菌,分别占23.6%和4.5%。大肠埃希菌为UTI最主要的致病菌,占39.3%,其次是肠球菌,占20.2%。产超广谱p-内酰胺酶(extended spectrum beta lactamases,ESBLs)大肠埃希菌感染率高,达68.6%。(9)革兰阴性菌对青霉素类及头孢菌素类耐药率普遍较高,尤其大肠埃希菌,对各代头孢菌素均呈现50%以上的耐药率。已出现对碳青霉烯类耐药的铜绿假单胞菌(耐药率16.7%)。阿米卡星对革兰阴性菌敏感性高,但对庆大霉素普遍耐药。磷霉素在革兰阴性菌和革兰阳性菌中的耐药率均较低(耐药率≤16.7%)。肠球菌属对氨苄西林和左氧氟沙星的耐药率均超过40%,但对呋喃妥因、万古霉素、替考拉宁、利奈唑胺无一耐药。(10)肾内科住院患者医院内尿路感染具有以下特点：①女性多见,老年人多见,上尿路感染明显多于下尿路感染(10：1)；②临床表现不典型,容易漏诊；③实验室指标缺乏特异性,应以真性菌尿作为诊断的“金标准”；④易感因素多,均为复杂性尿感；⑤病情严重,并发症多。结论肾内科住院患者尿路感染以女性多见,老年人多见,上尿路感染多见。上尿路感染以全身表现为主,而下尿路感染主要表现为膀胱刺激征。血、尿指标异常及尿感并发症均多见于上尿路感染。复杂性尿感比例高,易感因素多。尿路感染致病菌仍以革兰阴性菌为主,其次为革兰阳性菌和真菌。病原菌耐药情况不容乐观。医院内尿路感染具有一定的特殊性,需引起临床重视。
[Abstract]:Objective to analyze the clinical characteristics of urinary tract infection (urinary tract infection, UTI) in the hospital of nephrology in our hospital, to explore the susceptibility factors of urinary tract infection, to understand the distribution and drug resistance of pathogenic bacteria of urinary tract infection and to understand the characteristics of urinary tract infection in hospital. Methods to collect the clinical and experimental data of 156 cases of UTI in the nephrology department of our hospital. The clinical characteristics, susceptibility factors, pathogenic bacteria distribution and drug resistance were analyzed. Results (1) among 156 UTI patients, 26 cases were male, 16.7% were male, 130 cases were female, the age of 83.3%. was 18 years old, the maximum was 92 years, and the average age was 58.98 + 18.20 years. The ratio of men and women in all age groups was less than 40 years, 1:12.5; 41-59 years, 1:5.14 In 156 cases of 1:4.06. (2), 156 cases of UTI, 156 cases of upper urinary tract infection, 93 cases of upper urinary tract infection, 59.6%, 63 cases of lower urinary tract infection, 40.4%. (3) urinary tract irritation, 57% and 69.8% in lower urinary tract infection, and no significant difference between two (P0.05), fever, lumbar pain, digestive tract symptoms and fatigue all more common (P0.01), and in the lower urinary tract infection (P0.01) In the upper urinary tract infection, there were more fever and low back pain than those with urinary tract irritation; most of the flesh and urine were found in the lower urinary tract infection (P0.01); the kidney area pain, the ureter point pain and so on were more common in the upper urinary tract infection (P0.01). (4) the number of leukocytes (white blood cell, WBC) increased in the upper, and the lower urinary tract infection accounted for 80.6% and 66.7% respectively. Urinary tract infection was more than that of lower urinary tract infection (P0.05); the positive rate of urinary nitrite in UTI was only about 30%, and there was no significant difference in upper urinary tract infection (P0.05); urinary beta 2- microglobulin (beta, beta 2-MG) increased in upper urinary tract infection (77.4%), significantly higher than that of lower urinary tract infection (P0.01), but in lower urinary tract infection, urinary beta 2-MG increased There were more in the higher, 33.3%, the increase of WBC count in peripheral blood, the increase of erythrocyte sedimentation rate (erythrocyte sedimentation rate, ESR), the increase of C- reactive protein (C-reactive protein, CRP) and higher urinary tract infection (P0.01). (5) in 93 cases of upper urinary tract infection, there were 32 cases of complication. KI) 18 cases, 11 cases of septicaemia, 1 cases of septic shock, 2 cases of perirenal abscess, 63 cases of lower urinary tract infection, 2 cases of complications, 3.2%, all AKI, no other complications. The complication of upper urinary tract infection is more than lower urinary tract infection (P0.01). (6) complex urinary tract infection, 119 cases, accounting for the complexity of 76.3%. (7) in the complex uric feeling in the former 5. The predisposing factors were chronic kidney disease (CKD) (80.7%), urinary tract obstruction (62.2%), menopause (56.3%), anemia (47.9%), diabetes (36.1%). The top 3 causes of urinary tract obstruction were urinary calculi (31.1%), hyperplasia of prostate (15.1%), bladder neck obstruction (5.9%). Among CKD, CKD1-3 stage 52.1%, 16.8% in CKD4-5 stage, and 16.8% for non renal replacement therapy; 11.8%. (8) UTI pathogenic bacteria in phase CKD5 were mainly Gram-negative bacteria, accounting for 71.9%, followed by Gram-positive bacteria and fungi, 23.6% and 4.5%. were the main pathogenic bacteria of UTI, accounting for 39.3%, followed by Enterococcus, accounting for 20.2%. in the super broad-spectrum p-. The infection rate of extended spectrum beta lactamases (ESBLs) Escherichia coli was high, and the resistance rate of 68.6%. (9) Gram-negative bacteria to penicillins and cephalosporins was generally high, especially Escherichia coli, which showed more than 50% resistance rates to each generation of cephalosporins. 6.7%. Amikacin was highly sensitive to Gram-negative bacteria but was generally resistant to gentamicin. The resistance rate of fosfomycin to gram-negative and Gram-positive bacteria was lower (resistance rate less than 16.7%). The resistance rate of Enterococcus to ampicillin and levofloxacin was more than 40%, but no of furamoto, vancomycin, teicoplanin, and linezolid were no more than 40% (10) the following characteristics of hospital urinary tract infection in hospitalized patients in nephrology include: (1) women are more common, older people are more common, upper urinary tract infection is more obvious than lower urinary tract infection (10:1); (2) the clinical manifestations are untypical and easy to leak diagnosis; 3. The lack of specificity in laboratory indicators should be the "gold standard" for diagnosis of true bacteriuria; (4) susceptibility cause Conclusion the urinary tract infection of the hospitalized patients in the nephrology is more common, the elderly are more common, the elderly are more common, the upper urinary tract infection is more common. The upper urinary tract infection is mainly on the whole body, and the lower urinary tract infection mainly manifests the bladder irritation. The blood, the urine index and the complications of the urine are mostly found in the upper urinary tract. The infection. The proportion of complex urine sensation is high and the susceptible factors are more. The pathogenic bacteria of urinary tract infection are mainly Gram-negative bacteria, followed by Gram-positive bacteria and fungi. The drug resistance of pathogenic bacteria is not optimistic. The urinary tract infection in hospital has certain particularity, which needs to be paid more attention to.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R691.3

【参考文献】