217例尿路感染住院患者的臨床分析
發(fā)布時(shí)間：2019-06-24 11:52
【摘要】：[目的]通過(guò)分析玉溪市人民醫(yī)院腎內(nèi)科尿路感染(urinary tract infection,UTI)住院患者的發(fā)病特點(diǎn)、主要病原菌的情況以及對(duì)常用抗菌藥物的耐藥性分析,為指導(dǎo)以后本中心尿路感染的治療和提高抗菌藥物使用的規(guī)范性提供臨床依據(jù)。[方法]回顧性分析玉溪市人民醫(yī)院腎內(nèi)科2013年1月至2015年12月住院的217例尿路感染患者的一般資料、臨床表現(xiàn)和實(shí)驗(yàn)室檢查、易感因素、病原菌的分布情況以及耐藥性的變化趨勢(shì)。[結(jié)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%),女性明顯多于男性;最小年齡14歲,最大90歲,平均49.99±19.60歲。不同年齡階段,性別構(gòu)成有顯著差異,具有統(tǒng)計(jì)學(xué)意義(p0.05)。2.本研究住院患者以復(fù)雜性尿路感染為主(75.58%),其中女性復(fù)雜性尿路感染發(fā)生率高于男性,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。最主要的易感因素為尿路梗阻80例(48.78%),其次為泌尿系統(tǒng)結(jié)構(gòu)異常27例(16.46%),糖尿病24例(14.63%),妊娠期婦女19例(11.56%),慢性腎臟病16例(9.76%),留置導(dǎo)尿管8例(4.89%),長(zhǎng)期院外使用免疫抑制劑4例(2.44%)3.217例患者的尿培養(yǎng)標(biāo)本中,分離出病原菌的86例,檢出率為39.6%。以革蘭陰性菌為主65株(75.58%),其中大腸埃希菌(Escherichiacoli,E.coli)檢出率最高,其中產(chǎn)超廣譜β-內(nèi)酰胺酶(extend spectrum beta-lactamases,ESBLs)菌株數(shù)超過(guò)一半為36株(60%)。革蘭陽(yáng)性菌16株(18.60%),其中以屎腸球菌最多見(jiàn);近3年革蘭陽(yáng)性菌的檢出率分別為14.29%、16.31%、30.43%,呈上升趨勢(shì)。真菌5株(5.82%),白假絲酵母菌最多見(jiàn)。4.革蘭陰性菌對(duì)一、二代頭孢耐藥率超過(guò)50%,而對(duì)于本中心常用的三代頭孢中頭孢噻肟的耐藥率已高達(dá)62.5%。對(duì)青霉素類(lèi)也高度耐藥,氨芐西林的耐藥率已超過(guò)了 80%,復(fù)方新諾明、左氧氟沙星及環(huán)丙沙星的耐藥率均大于50%,阿米卡星高度敏感,無(wú)耐藥菌株;其次對(duì)呋喃妥因、莫西沙星、頭孢哌酮/舒巴坦、美羅培南、亞胺培南較為敏感;革蘭陽(yáng)性球菌對(duì)青霉素、紅霉素、克林霉素、阿莫西林等耐藥率均超過(guò)80%,對(duì)環(huán)丙沙星及左氧氟沙星的耐藥率超過(guò)70%,而對(duì)奎奴普汀/達(dá)福普汀、利奈唑胺、萬(wàn)古霉素及替加環(huán)素?zé)o一耐藥。真菌共有5例,全部對(duì)5-氟胞嘧啶、兩性霉素B敏感。5.大腸埃希菌在阿米卡星和莫西沙星中無(wú)耐藥菌株,對(duì)亞胺培南、呋喃妥因、美羅培南的耐藥率也偏低。然而頭孢曲松、氨芐西林的耐藥率已高達(dá)100%,左氧氟沙星、環(huán)丙沙星的耐藥率也已超過(guò)60%。產(chǎn)ESBLs菌對(duì)多種抗菌藥物的耐藥率高且普遍高于非產(chǎn)ESBLs菌,尤其在復(fù)方新諾明、左氧氟沙星及環(huán)丙沙星中最為明顯,具有統(tǒng)計(jì)學(xué)意義(p0.05)。各年齡組之間大腸埃希菌對(duì)抗菌藥物的耐藥情況不同,其中對(duì)復(fù)方新諾明、氨芐西林、環(huán)丙沙星和左氧氟沙星的耐藥率隨年齡的增長(zhǎng)而增加。6.217例患者中在入院以前使用過(guò)抗菌藥物的占60.37%;其中尿培養(yǎng)陽(yáng)性的患者中,使用過(guò)抗生素占55.81%;經(jīng)統(tǒng)計(jì)分析得出結(jié)果,入院前使用抗菌藥物對(duì)尿培養(yǎng)結(jié)果沒(méi)有影響(p0.05)。7.經(jīng)單因素回歸分析得出年齡、既往尿路感染史、經(jīng)產(chǎn)及流產(chǎn)情況,均為妊娠期尿路感染發(fā)生的危險(xiǎn)因素,再通過(guò)logistic回歸分析發(fā)現(xiàn),年齡≥35歲是妊娠期尿路感染發(fā)生的獨(dú)立危險(xiǎn)因素(p0.05)。[結(jié)論]1、近3年尿路感染住院患者中,女性患者多見(jiàn),在不同年齡階段中,性別構(gòu)成有顯著差異,40歲以下的女性人群和55歲以上的男性人群均為尿路感染發(fā)生的高危人群。2、大腸埃希菌仍是尿路感染的主要病原菌,而且不同年齡階段的致病菌也都以大腸埃希菌為主,其中產(chǎn)ESBLs的菌株高達(dá)60%,較近年研究有升高趨勢(shì);革蘭陽(yáng)性菌這三年的檢出率雖呈現(xiàn)較低水平,但表現(xiàn)為上升趨勢(shì)。3、大腸埃希菌對(duì)復(fù)方新諾明、氨芐西林、左氧氟沙星和環(huán)丙沙星的耐藥性隨年齡的增長(zhǎng)而升高。對(duì)抗菌藥物的高度耐藥性主要取決于產(chǎn)ESBLs的菌株,而非產(chǎn)ESBLs菌株對(duì)經(jīng)驗(yàn)使用的喹諾酮類(lèi)和三代頭孢仍敏感。4、目前傳統(tǒng)推薦使用的抗菌藥物均對(duì)尿路感染病原菌表現(xiàn)出較高的耐藥性,如頭孢噻肟、左氧氟沙星、環(huán)丙沙星及氨芐西林等臨床一線(xiàn)經(jīng)驗(yàn)性使用的藥物,耐藥率均較高。可考慮將呋喃妥因、阿米卡星、頭孢哌酮/舒巴坦作為本中心治療尿路感染抗菌藥物的新選擇。5、年齡≥35歲是妊娠期尿路感染發(fā)生的獨(dú)立危險(xiǎn)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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R691.3
本文編號(hào)：2505042
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R691.3
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