本文選題：尿管相關(guān)性尿路感染　切入點(diǎn)：生物膜　出處：《中華醫(yī)院感染學(xué)雜志》2017年18期

【摘要】：目的觀察留置導(dǎo)尿患兒導(dǎo)尿管表面細(xì)菌生物膜的形成過程,探討形成的影響因素及其與導(dǎo)管相關(guān)性尿路感染的相關(guān)性。方法選取2016年9-12月某兒童醫(yī)院泌尿外科留置導(dǎo)尿患兒27例為研究對象,使用掃描電鏡(SEM)觀察27例留置導(dǎo)尿患兒導(dǎo)尿管表面細(xì)菌生物膜(BF)的結(jié)構(gòu);比較7例CAUTIs患者與20例非CAUTI患者導(dǎo)尿管BF的形成率,并進(jìn)行影響導(dǎo)尿管管壁形成生物膜的多因素logistic回歸分析。結(jié)果尿培養(yǎng)陽性尿管表面均觀察到BF形成,形成率為100%;9例(69.23%)導(dǎo)管培養(yǎng)陽性的導(dǎo)管表面形成生物膜,微生物培養(yǎng)陽性組生物膜的形成率均較陰性組高(P0.01);尿培養(yǎng)和導(dǎo)管培養(yǎng)同時(shí)分離出的前三位的細(xì)菌為:糞腸球菌、表皮葡萄球菌、凝固酶陰性葡萄球菌。留置10d左右導(dǎo)尿管的管壁在電鏡下可觀察到逐漸成熟的細(xì)菌生物膜。留置導(dǎo)尿時(shí)間是影響導(dǎo)尿管管壁形成生物膜的危險(xiǎn)因素[P=0.046,OR(95%CI)=3.552(1.021,12.353)];抗菌藥物使用超過5d的導(dǎo)尿管管壁形成生物膜的風(fēng)險(xiǎn)是抗菌藥物使用天數(shù)5d以內(nèi)的15.34倍(P=0.024)。所有CAUTIs患者尿管管壁均有BF形成,但僅有10%的非CAUTI患者管壁能觀察到BF,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論兒童平均留置(9.78±1.20)d的導(dǎo)尿管管壁可觀察到成熟的細(xì)菌生物膜,留置導(dǎo)尿患兒導(dǎo)尿管管壁細(xì)菌生物膜的形成與CAUTIs存在著密切關(guān)系,隨著留置時(shí)間的延長形成生物膜的風(fēng)險(xiǎn)越大,長時(shí)間應(yīng)用抗菌藥物并不能降低BF的形成。微生物培養(yǎng)結(jié)果與生物膜的形成呈正相關(guān),其中導(dǎo)管培養(yǎng)方法較尿培養(yǎng)更能準(zhǔn)確發(fā)現(xiàn)管壁內(nèi)細(xì)菌的定植與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.

【作者單位】： 蘇州大學(xué)附屬兒童醫(yī)院感染管理科;
【基金】：蘇州市科技發(fā)展計(jì)劃基金資助項(xiàng)目(SYSD2015098)
【分類號(hào)】：R726.9
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本文編號(hào)：1686296