细菌生物膜的形成与导管相关性尿路感染的关系  

Relationship between the formation of bacterial biofilm and catheter-associated urinary tract infections

作　　者：赵旭[1] 赵璐 严向明[1] 王秀珍[1] 彭寒玲[1] 张志勤[1] 

机构地区：[1]苏州大学附属儿童医院感染管理科,江苏苏州215000

出　　处：《中华医院感染学杂志》2017年第18期4154-4158,共5页Chinese Journal of Nosocomiology

基　　金：苏州市科技发展计划基金资助项目(SYSD2015098)

摘　　要：目的观察留置导尿患儿导尿管表面细菌生物膜的形成过程,探讨形成的影响因素及其与导管相关性尿路感染的相关性。方法选取2016年9-12月某儿童医院泌尿外科留置导尿患儿27例为研究对象,使用扫描电镜(SEM)观察27例留置导尿患儿导尿管表面细菌生物膜(BF)的结构;比较7例CAUTIs患者与20例非CAUTI患者导尿管BF的形成率,并进行影响导尿管管壁形成生物膜的多因素logistic回归分析。结果尿培养阳性尿管表面均观察到BF形成,形成率为100%;9例(69.23%)导管培养阳性的导管表面形成生物膜,微生物培养阳性组生物膜的形成率均较阴性组高(P<0.01);尿培养和导管培养同时分离出的前三位的细菌为:粪肠球菌、表皮葡萄球菌、凝固酶阴性葡萄球菌。留置10d左右导尿管的管壁在电镜下可观察到逐渐成熟的细菌生物膜。留置导尿时间是影响导尿管管壁形成生物膜的危险因素[P=0.046,OR(95%CI)=3.552(1.021,12.353)];抗菌药物使用超过5d的导尿管管壁形成生物膜的风险是抗菌药物使用天数5d以内的15.34倍(P=0.024)。所有CAUTIs患者尿管管壁均有BF形成,但仅有10%的非CAUTI患者管壁能观察到BF,差异有统计学意义(P<0.001)。结论儿童平均留置(9.78±1.20)d的导尿管管壁可观察到成熟的细菌生物膜,留置导尿患儿导尿管管壁细菌生物膜的形成与CAUTIs存在着密切关系,随着留置时间的延长形成生物膜的风险越大,长时间应用抗菌药物并不能降低BF的形成。微生物培养结果与生物膜的形成呈正相关,其中导管培养方法较尿培养更能准确发现管壁内细菌的定植与BF的形成。OBJECTIVE To observe the formation of bacterial biofilm on the surface of urinary catheter in children with indwelling catheterization,explore the influencing factors of formation and the correlation between formation of bacterial biofilm and catheter-associated urinary tract infections（CAUTI）.METHODS A total of 27 children with urinary catheterization were selected as the study subjects in a children′s hospital from Sep.to Dec.in 2016.The structure of bacterial biofilm（BF）on the surface of catheter was observed by scanning electron microscopy（SEM）.The formation of BF on urinary catheter was compared between 7 cases of CAUTIs and 20 cases of nonCAUTI patients,and the influencing factors of formation of BF were analyzed by multivariate logistic regression analysis.RESULTS BF on urinary catheter was detected in all culture positive cases and the formation rate was 100% .Bacterial biofilm was observed under electron microscopy in 9 cases（69.23% ）of catheter-positive catheter surfaces.The formation rate of biofilm in microbial culture positive groups was higher than that in negative group（P〈0.01）.The top three bacteria isolated in urine culture and catheter culture at the same time were Enterococcus faecalis,Staphylococcus epidermidis and coagulase-negative Staphylococcus.Gradually mature bacterial biofilm could be observed on the wall of urinary catheter with catheter indwelling about 10 days.The duration of catheterization was a risk factor for the formation of biofilm on the catheter wall[P= 0.046,OR（95% CI）= 3.552（1.021,12.353）].There was 15.34 times of risk of biofilm formation in patients using antibiotics more than 5days than those within 5 days of antibiotic use（P= 0.024）.All CAUTIs patients were observed BF formation on the urinary catheter wall,whereas only 10% of the non-CAUTI patients were observed.There was a statistically significant difference（P〈0.001）.CONCLUSION Mean duration of catheterization after which mature bacterial could be detected was（9.78±1.20）

关 键 词：尿管相关性尿路感染 生物膜 扫描电镜 影响因素 儿童 

分 类 号：R691.3[医药卫生—泌尿科学]