發(fā)布時(shí)間：2018-04-27 17:25

  本文選題：尿路感染 + 住院患者�。� 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：目的分析我院腎內(nèi)科住院患者尿路感染(urinary tract infection, UTI)的臨床特點(diǎn),探討尿路感染易感因素,了解尿路感染病原菌的分布及耐藥情況,了解醫(yī)院內(nèi)尿路感染的特點(diǎn)。方法收集2012.8-2013.8入住我院腎內(nèi)科的156例UTI患者的臨床及實(shí)驗(yàn)室檢查資料,分析其臨床特點(diǎn)、易感因素、病原菌分布及耐藥情況。結(jié)果(1)156例UTI患者中,男性26例,占16.7%；女性130例,占83.3%。年齡最小18歲,最大92歲,平均年齡58.98±18.20歲。各年齡組尿感患者男女比例分別為：≤40歲,1：12.5；41-59歲,1：5.14；≥60歲,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、下尿路感染中的發(fā)生率分別為57.0%和69.8%,二者之間無(wú)顯著差異(p0.05)；發(fā)熱、腰痛、消化道癥狀和乏力均以上尿路感染多見(jiàn)(p0.01),且在上尿路感染中,有發(fā)熱、腰痛者要略多于有尿路刺激征者；肉眼血尿多見(jiàn)于下尿路感染(p0.01)；腎區(qū)叩痛、輸尿管點(diǎn)壓痛等尿感體征多見(jiàn)于上尿路感染(p0.01)。(4)尿白細(xì)胞(white blood cell,WBC)增多者在上、下尿路感染中分別占80.6%和66.7%,且上尿路感染多于下尿路感染(p0.05)；尿亞硝酸鹽在UTI中陽(yáng)性率僅30%左右,且在上、下尿路感染中無(wú)明顯差異(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%,明顯高于下尿路感染(p0.01)。但在下尿路感染中,尿β2-MG增高者也較多,達(dá)33.3%；外周血WBC計(jì)數(shù)增高、紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)增快、C-反應(yīng)蛋白(C-reactive protein,CRP)增高均以上尿路感染多見(jiàn)(p0.01)。(5)93例上尿路感染中,出現(xiàn)并發(fā)癥者共32例,占34.4%。其中,急性腎損傷(acute kidney injury,AKI)18例,敗血癥11例,感染性休克1例,腎周膿腫2例；63例下尿路感染中,出現(xiàn)并發(fā)癥者共2例,占3.2%,均為AKI,未見(jiàn)其他并發(fā)癥。上尿路感染出現(xiàn)并發(fā)癥者明顯多于下尿路感染(p0.01)。(6)復(fù)雜性尿路感染多見(jiàn),共119例,占76.3%。(7)復(fù)雜性尿感中居前5位的易感因素分別為：慢性腎臟病(chronic kidney disease,CKD)(80.7%)、尿路梗阻(62.2%)、絕經(jīng)(56.3%)、貧血(47.9%)、糖尿病(36.1%)。導(dǎo)致尿路梗阻的原因中居前3位的分別為：泌尿系結(jié)石(31.1%)、前列腺增生(15.1%)、膀胱頸梗阻(5.9%)。合并CKD者中,CKD1-3期者占52.1%；CKD4-5期未行腎替代治療者占16.8%；CKD5期行血透或腹透者占11.8%。(8)UTI病原菌仍以革蘭陰性菌為主,占71.9%,其次為革蘭陽(yáng)性菌和真菌,分別占23.6%和4.5%。大腸埃希菌為UTI最主要的致病菌,占39.3%,其次是腸球菌,占20.2%。產(chǎn)超廣譜p-內(nèi)酰胺酶(extended spectrum beta lactamases,ESBLs)大腸埃希菌感染率高,達(dá)68.6%。(9)革蘭陰性菌對(duì)青霉素類及頭孢菌素類耐藥率普遍較高,尤其大腸埃希菌,對(duì)各代頭孢菌素均呈現(xiàn)50%以上的耐藥率。已出現(xiàn)對(duì)碳青霉烯類耐藥的銅綠假單胞菌(耐藥率16.7%)。阿米卡星對(duì)革蘭陰性菌敏感性高,但對(duì)慶大霉素普遍耐藥。磷霉素在革蘭陰性菌和革蘭陽(yáng)性菌中的耐藥率均較低(耐藥率≤16.7%)。腸球菌屬對(duì)氨芐西林和左氧氟沙星的耐藥率均超過(guò)40%,但對(duì)呋喃妥因、萬(wàn)古霉素、替考拉寧、利奈唑胺無(wú)一耐藥。(10)腎內(nèi)科住院患者醫(yī)院內(nèi)尿路感染具有以下特點(diǎn)：①女性多見(jiàn),老年人多見(jiàn),上尿路感染明顯多于下尿路感染(10：1)；②臨床表現(xiàn)不典型,容易漏診；③實(shí)驗(yàn)室指標(biāo)缺乏特異性,應(yīng)以真性菌尿作為診斷的“金標(biāo)準(zhǔn)”；④易感因素多,均為復(fù)雜性尿感；⑤病情嚴(yán)重,并發(fā)癥多。結(jié)論腎內(nèi)科住院患者尿路感染以女性多見(jiàn),老年人多見(jiàn),上尿路感染多見(jiàn)。上尿路感染以全身表現(xiàn)為主,而下尿路感染主要表現(xiàn)為膀胱刺激征。血、尿指標(biāo)異常及尿感并發(fā)癥均多見(jiàn)于上尿路感染。復(fù)雜性尿感比例高,易感因素多。尿路感染致病菌仍以革蘭陰性菌為主,其次為革蘭陽(yáng)性菌和真菌。病原菌耐藥情況不容樂(lè)觀。醫(yī)院內(nèi)尿路感染具有一定的特殊性,需引起臨床重視。
[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.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R691.3

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本文編號(hào)：1811631