泌尿系统结石伴尿路感染患者病原菌分布、耐药性及危险因素分析

Pathogen distribution and drug resistance and risk factors of urinary tract infection in patients with urinary calculi

摘要:

目的 分析泌尿系统结石伴尿路感染患者病原菌分布、耐药性及危险因素。方法 该研究为前瞻性研究，选取2017年1月—2020年2月就诊于唐山市工人医院的600例泌尿系统结石患者。根据是否发生尿路感染分为非感染组、感染组。分析感染组病原菌分布、耐药性。对比两组患者临床特征，分析影响泌尿系统结石伴尿路感染发生的危险因素。结果 124例（20.67%）发生尿路感染，剔除重复感染菌种，尿液标本共培养出病原菌114株，其中革兰阴性菌、革兰阳性菌、真菌占比分别为68.42%（78/114）、28.07%（32/114）、3.51%（4/114）。革兰阴性菌以大肠埃希菌、铜绿假单胞菌为主，革兰阳性菌以粪肠球菌、屎肠球菌为主。主要革兰阴性菌中，大肠埃希菌对氨苄西林、头孢唑林、头孢他啶耐药率高，分别为84.62%、76.92%、69.23%，对亚胺培南敏感；铜绿假单胞菌对头孢唑林、氨苄西林、头孢曲松耐药率高，分别为100.00%、89.47%、52.63%，对亚胺培南敏感。主要革兰阳性菌中，粪肠球菌对庆大霉素、青霉素G、红霉素耐药率高，分别为100.00%、76.92%、61.54%，对万古霉素、替考拉宁敏感；屎肠球菌对庆大霉素、红霉素、青霉素G耐药率高，分别为100.00%、77.78%、66.67%，对万古霉素、氨苄西林、替考拉宁敏感。多因素Logistic回归分析结果显示：肾积水［O^R=4.371（95% CI：2.421，7.889）］、尿路梗阻［O^R=3.791（95% CI：2.262，6.354）］、尿pH ≥ 7.0［O^R=2.073（95% CI：1.373，3.128）］、结石直径≥ 3 mm ［O^R=2.118（95% CI：1.395，3.214）］是泌尿系统结石伴尿路感染发生的危险因素（P <0.05）。结论 泌尿系统结石伴尿路感染患者病原菌以革兰阴性菌为主，不同病原菌耐药性存在明显差异，应定期观察病原菌分布、监测耐药性，根据药敏试验选择合理抗菌药物治疗；临床应重点观察伴有肾积水、尿路梗阻患者的病情发展，以预防尿路感染。

关键词:尿路感染;泌尿系统结石;病原菌分布;耐药性;危险因素

Abstract:

Objective To analyze the pathogen distribution and drug resistance and risk factors of urinary tract infection in patients with urinary calculi.Methods This study was a prospective study, where 600 patients with urinary calculi in Tangshan Workers Hospital from January 2017 to February 2020 were enrolled. According to the occurrence of urinary tract infection, these patients were divided into non-infection group and infection group. The pathogen distribution and drug resistance were analyzed. The clinical characteristics of the two groups of patients were compared. In addition, the risk factors of urinary tract infection in patients with urinary calculi were analyzed.Results A total of 124 cases (20.67%) had urinary tract infection, and 114 pathogenic strains were detected. The proportions of gram-negative bacteria, gram-positive bacteria, and fungi were 68.42% (78/114), 28.07% (32/114) and 3.51% (4/114). Among the gram-negative bacteria, Escherichia coli and Pseudomonas aeruginosa were the major pathogens, while Enterococcus faecalis and Enterococcus faecium were the major pathogens among the gram-positive bacteria. Of the major gram-negative bacteria, Escherichia coli showed high resistance to ampicillin, cefazolin, and ceftazidime, with resistance rates being 84.62%, 76.92% and 69.23%, respectively, but was susceptible to imipenem. Pseudomonas aeruginosa showed high resistance to cefazolin, ampicillin and ceftriaxone, with resistance rates being 100.00%, 89.47% and 52.63%, respectively, but was susceptible to imipenem. Of the major gram-positive bacteria, Enterococcus faecalis showed high resistance to gentamicin, penicillin G and erythromycin, with resistance rates being 100.00%, 76.92% and 61.54%, respectively, but was susceptible to vancomycin and teicoplanin. Enterococcus faecium showed high resistance to gentamicin, erythromycin and penicillin G, with resistance rates being 100.00%, 77.78% and 66.67%, respectively, but was susceptible to vancomycin, ampicillin and teicoplanin. The multivariable Logistic regression analysis revealed that hydronephrosis [O^R = 4.371 (95% CI: 2.421, 7.889) ], urinary tract obstruction [O^R = 3.791 (95% CI: 2.262, 6.354) ], urinary pH ≥ 7.0 [O^R = 2.073 (95% CI: 1.373, 3.128) ], the diameter of urinary calculi ≥ 3 mm [O^R = 2.118 (95% CI: 1.395, 3.214) ] were risk factors for the occurrence of urinary tract infection in patients with urinary calculi (P < 0.05).Conclusions Gram-negative bacteria are the major pathogens in patients with urinary calculi complicating urinary tract infection. There are obvious differences in drug resistance among the pathogens. The distribution of pathogens should be observed and the drug resistance of these pathogens should be monitored regularly, and the rational use of antibiotics should be achieved according to the results of drug susceptibility testing. The conditions of patients with hydronephrosis and urinary tract obstruction should be especially paid attentions to for preventing the urinary tract infection.

Key words:urinary tract infection;urinary calculi;pathogen distribution;drug resistance;risk factors