217例尿路感染住院患者的临床分析

发布时间：2019-06-24 11:52

【摘要】：[目的]通过分析玉溪市人民医院肾内科尿路感染(urinary tract infection,UTI)住院患者的发病特点、主要病原菌的情况以及对常用抗菌药物的耐药性分析,为指导以后本中心尿路感染的治疗和提高抗菌药物使用的规范性提供临床依据。[方法]回顾性分析玉溪市人民医院肾内科2013年1月至2015年12月住院的217例尿路感染患者的一般资料、临床表现和实验室检查、易感因素、病原菌的分布情况以及耐药性的变化趋势。[结果]1.217例尿路感染患者中女性患者165例(76.04%);男性患者52例(23.96%),女性明显多于男性;最小年龄14岁,最大90岁,平均49.99±19.60岁。不同年龄阶段,性别构成有显著差异,具有统计学意义(p0.05)。2.本研究住院患者以复杂性尿路感染为主(75.58%),其中女性复杂性尿路感染发生率高于男性,差异有统计学意义(p0.05)。最主要的易感因素为尿路梗阻80例(48.78%),其次为泌尿系统结构异常27例(16.46%),糖尿病24例(14.63%),妊娠期妇女19例(11.56%),慢性肾脏病16例(9.76%),留置导尿管8例(4.89%),长期院外使用免疫抑制剂4例(2.44%)3.217例患者的尿培养标本中,分离出病原菌的86例,检出率为39.6%。以革兰阴性菌为主65株(75.58%),其中大肠埃希菌(Escherichiacoli,E.coli)检出率最高,其中产超广谱β-内酰胺酶(extend spectrum beta-lactamases,ESBLs)菌株数超过一半为36株(60%)。革兰阳性菌16株(18.60%),其中以屎肠球菌最多见;近3年革兰阳性菌的检出率分别为14.29%、16.31%、30.43%,呈上升趋势。真菌5株(5.82%),白假丝酵母菌最多见。4.革兰阴性菌对一、二代头孢耐药率超过50%,而对于本中心常用的三代头孢中头孢噻肟的耐药率已高达62.5%。对青霉素类也高度耐药,氨苄西林的耐药率已超过了 80%,复方新诺明、左氧氟沙星及环丙沙星的耐药率均大于50%,阿米卡星高度敏感,无耐药菌株;其次对呋喃妥因、莫西沙星、头孢哌酮/舒巴坦、美罗培南、亚胺培南较为敏感;革兰阳性球菌对青霉素、红霉素、克林霉素、阿莫西林等耐药率均超过80%,对环丙沙星及左氧氟沙星的耐药率超过70%,而对奎奴普汀/达福普汀、利奈唑胺、万古霉素及替加环素无一耐药。真菌共有5例,全部对5-氟胞嘧啶、两性霉素B敏感。5.大肠埃希菌在阿米卡星和莫西沙星中无耐药菌株,对亚胺培南、呋喃妥因、美罗培南的耐药率也偏低。然而头孢曲松、氨苄西林的耐药率已高达100%,左氧氟沙星、环丙沙星的耐药率也已超过60%。产ESBLs菌对多种抗菌药物的耐药率高且普遍高于非产ESBLs菌,尤其在复方新诺明、左氧氟沙星及环丙沙星中最为明显,具有统计学意义(p0.05)。各年龄组之间大肠埃希菌对抗菌药物的耐药情况不同,其中对复方新诺明、氨苄西林、环丙沙星和左氧氟沙星的耐药率随年龄的增长而增加。6.217例患者中在入院以前使用过抗菌药物的占60.37%;其中尿培养阳性的患者中,使用过抗生素占55.81%;经统计分析得出结果,入院前使用抗菌药物对尿培养结果没有影响(p0.05)。7.经单因素回归分析得出年龄、既往尿路感染史、经产及流产情况,均为妊娠期尿路感染发生的危险因素,再通过logistic回归分析发现,年龄≥35岁是妊娠期尿路感染发生的独立危险因素(p0.05)。[结论]1、近3年尿路感染住院患者中,女性患者多见,在不同年龄阶段中,性别构成有显著差异,40岁以下的女性人群和55岁以上的男性人群均为尿路感染发生的高危人群。2、大肠埃希菌仍是尿路感染的主要病原菌,而且不同年龄阶段的致病菌也都以大肠埃希菌为主,其中产ESBLs的菌株高达60%,较近年研究有升高趋势;革兰阳性菌这三年的检出率虽呈现较低水平,但表现为上升趋势。3、大肠埃希菌对复方新诺明、氨苄西林、左氧氟沙星和环丙沙星的耐药性随年龄的增长而升高。对抗菌药物的高度耐药性主要取决于产ESBLs的菌株,而非产ESBLs菌株对经验使用的喹诺酮类和三代头孢仍敏感。4、目前传统推荐使用的抗菌药物均对尿路感染病原菌表现出较高的耐药性,如头孢噻肟、左氧氟沙星、环丙沙星及氨苄西林等临床一线经验性使用的药物,耐药率均较高。可考虑将呋喃妥因、阿米卡星、头孢哌酮/舒巴坦作为本中心治疗尿路感染抗菌药物的新选择。5、年龄≥35岁是妊娠期尿路感染发生的独立危险因素。
[Abstract]:[Objective] To analyze the incidence of urinary tract infection (UTI) in the patients with urinary tract infection (UTI) in the People's Hospital of Yuxi City. And provides a clinical basis for guiding the treatment of the urinary tract infection in the center and the normalization of the use of the antibacterial medicament. [Methods] The general data, clinical and laboratory tests, susceptibility factors, distribution of pathogenic bacteria and the trend of drug resistance of 217 patients with urinary tract infection from January 2013 to December 2015 were analyzed retrospectively. [Results] There were 165 female patients (76.04%) in 1.217 patients with urinary tract infection (76.04%),52 (23.96%) of male patients and more than male; the minimum age was 14 years, with a maximum of 90 years and an average of 49.99 to 19.60 years. There was a significant difference in the sex composition in different age groups (p0.05). In this study, the incidence of complicated urinary tract infection was the main (75.58%), among which the incidence of complicated urinary tract infection was higher than that of men (p0.05). Among the most susceptible factors,80 (48.78%) of urinary tract obstruction,27 (16.46%) of urinary system,24 (14.63%) of diabetes,19 (11.56%) of pregnant women,16 (9.76%) of chronic kidney disease and 8 (4.89%) of indwelling catheter. In the urine culture of 4 (2.44%) patients with immunosuppressants (2.44%) in the long-term hospital,86 cases of the pathogenic bacteria were isolated and the detection rate was 39.6%. The detection rate of Escherichia coli (E. coli) was the highest among the 65 (75.58%) strains of Gram-negative bacteria. The positive rate of gram-positive bacteria was 14.29%, 16.31% and 30.43%, respectively. 5 strains of fungi (5.82%) and Candida albicans at most. The resistance of gram-negative bacteria to one and second-generation cephalosporin was over 50%, and the drug-resistance rate of cefixime was as high as 62.5% for the three-generation cefixime commonly used in the center. the drug resistance rate of the ampicillin is more than 80 percent, the drug resistance rate of the compound new norming, levofloxacin and ciprofloxacin is more than 50 percent, the amikacin is highly sensitive and has no drug resistance strain, Meropenem and imipenem are more sensitive; the resistance rate of gram-positive cocci to penicillin, erythromycin, clindamycin, amoxicillin and the like is more than 80%, the drug resistance rate of ciprofloxacin and levofloxacin is more than 70%, Vancomycin and tigecycline were not resistant to one drug. There were 5 fungi in total,5-fluorophonate and amphotericin B were all sensitive. There were no drug-resistant strains of E. coli in amikacin and Moxifloxacin, and the resistance of imipenem to imipenem and meropenem was also low. However, the resistance rate of ceftriaxone and methicillin is as high as 100%, and the resistance rate of levofloxacin and ciprofloxacin has also exceeded 60%. The resistance rate of ESBLs to various antibacterial drugs was higher and higher than that of the non-producing ESBLs, especially in the compound Xinnoming, levofloxacin and ciprofloxacin, and it was of statistical significance (p0.05). The resistance of E. coli to antibiotics was different among all age groups, among which, the resistance rate of the compound, Xenoming, methicillin, ciprofloxacin and levofloxacin increased with the increase of age. In the patients with positive urine culture, the use of antibiotics was 55.81%, and the results of the statistical analysis showed no effect on the results of the urine culture before admission (p0.05). The risk factors of the occurrence of urinary tract infection during pregnancy were analyzed by single factor regression analysis. The risk factors of the occurrence of urinary tract infection during pregnancy were analyzed by logistic regression, and the age was 35 years old, which was an independent risk factor for the occurrence of urinary tract infection in pregnancy (p0.05). [Conclusion] 1. In the patients with urinary tract infection in the last 3 years, the number of female patients is more common. In the different age groups, the sex composition has a significant difference, and the female population under the age of 40 and the male population over 55 years of age are the high-risk groups of the urinary tract infection. Escherichia coli is still the main pathogenic bacteria of the urinary tract infection, and the pathogenic bacteria in different age groups are mainly Escherichia coli, in which the strain producing ESBLs is as high as 60%, and the recent research has an increasing trend; and the detection rate of the gram-positive bacteria in the three years is low, However, the resistance of E. coli to compound neomycin, methicillin, levofloxacin and ciprofloxacin increased with age. the high drug resistance to the antibacterial drug mainly depends on the strain producing the ESBLs, and the non-producing ESBLs strain is still sensitive to the experience of the noonone and the third generation of the cefaclor, and 4, the antibacterial drugs currently recommended for use have higher resistance to the pathogenic bacteria of the urinary tract infection, such as cefmenoxime, The drug and drug resistance rate of levofloxacin, ciprofloxacin and methicillin were higher. The new selection of the antibacterials of urinary tract infection in the center can be considered.5. The age of 35 is an independent risk factor for the occurrence of urinary tract infection in pregnancy.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R691.3

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