脑卒中患者无症状菌尿症与有症状尿路感染的病原菌分布及耐药特征  

Pathogenic bacteria distribution and characteristics of drug resistance of stroke patients with asymptomatic bacteriuria and symptomatic urinary tract infection

作　　者：杨萍[1] 袁华兵[2] Yang Ping;Yuan Huabing(Department of Nosocomial Infection Control,Tianmen the First People’s Hospital,Tianmen 431700,China;Departmen of Pharmacy,Tianmen the First People’s Hospital,Tianmen 431700,China)

机构地区：[1]湖北省天门市第一人民医院院感科,天门市431700 [2]湖北省天门市第一人民医院药剂科,天门市431700

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第2期150-156,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的比较脑卒中患者无症状菌尿症与有症状尿路感染的病原菌分布及耐药特征,为临床诊治提供依据。方法选取2016年1月1日至2018年月12月30日天门市第一人民医院收治的287例尿微生物培养阳性的脑卒中患者为研究对象,分为无症状菌尿症组(192例)和有症状尿路感染组(95例),分析两组患者病原菌分布及耐药特点、血清降钙素原、尿白细胞计数和抗菌药物使用。结果287例患者共检出细菌323株,其中以大肠埃希菌(48.92%、158/323)、肺炎克雷伯杆菌(7.12%、23/323)、屎肠球菌(12.07%、39/323)和粪肠球菌(4.64%、15/323)为主。无症状菌尿组与有症状尿路感染组患者尿微生物培养显示,大肠埃希菌(40.68%vs.53.66%)、阴沟肠杆菌(9.32%vs.3.41%)和屎肠球菌(18.64%vs.8.29%)构成比差异均有统计学意义(χ^2=-5.050、P=0.025,χ^2=4.915、P=0.027,χ^2=7.559、P=0.006)。287例患者尿微生物培养病原菌中大肠埃希菌对左氧氟沙星、环丙沙星、头孢噻肟和头孢呋辛耐药率分别为46.20%(73/158)、51.27%(81/158)、55.70%(88/158)和57.59%(91/158)。屎肠球菌对庆大霉素、呋喃妥因、左氧氟沙星、青霉素、氨苄西林和环丙沙星耐药率分别为54.55%(18/33)、71.79%(28/39)、94.87%(37/39)、97.37%(37/38)、97.44%(38/39)和97.44%(38/39)。无症状菌尿组与有症状尿路感染组患者尿白细胞异常比例(57.81%vs.87.37%)、尿白细胞计数中位数(35.70个/μl vs.547.60个/μl)差异均有统计学意义(χ^2=25.346、P<0.001,Z=-9.246、P<0.001)。ROC曲线显示两组患者尿白细胞的Cut-off值为261.34,95%CI为0.78~0.89。无症状组与有症状尿路感染组患者导管留置率(50.52%vs.80.00%)、抗菌药物使用率(61.46%vs.91.58%)以及使用天数中位数(4 d vs.9 d)差异均有统计学意义(χ^2=23.067、P<0.001,χ^2=28.253、P<0.001,Z=7.110、P<0.001)。结论脑卒中患者尿白细胞数对无症状菌尿和有症状泌尿道感染的鉴别诊断具有一定价值。应根据病原Objective To compare the Pathogenic bacteria distribution and characteristics of drug resistance of asymptomatic bacillus urine and symptomatic urinary tract infection in patients with stroke,and to provide basis for the clinical diagnosis and treatment.Methods Total of 287 stroke patients with positive urinary microbial culture were selected from January 1 st,2016 to December 30 th,2018 in the First people’s Hospital of Tianmen City,and were divided into two groups:asymptomatic bacteriuria group(192 cases)and symptomatic urinary tract infection group(95 cases).The pathogen distribution and drug resistance characteristics,serum procalcitonin,urine leukocyte count and antimicrobial use in both groups were analyzed,respectively.Results A total of 323 strains of bacteria were isolated from 287 patients,including Escherichia coli(48.92%,158/323),Klebsiella pneumoniae(7.12%,23/323),Enterococcus faecium(12.07%,39/323)and Enterococcus faecalis(4.64%,15/323).The composition ratios of Escherichia coli(40.68%vs.53.66%),Enterobacter cloacae(9.32%vs.3.41%)and Enterococcus faecium(18.64%vs.8.29%)in urine cultures of asymptomatic group and symptomatic urinary tract infections group were significantly different(χ^2=-5.050,P=0.025;χ^2=4.915,P=0.027;χ^2=7.559,P=0.006).The resistance rates of Escherichia coli to levofloxacin,ciprofloxacin,cefotaxime and cefuroxime were 46.20%(73/158),51.27%(81/158),55.70%(88/158)and 57.59%(91/158),respectively,of pathogens from 287 patients.The resistance rates of Enterococcus faecium to gentamicin,furantoin,levofloxacin,penicillin,ampicillin and ciprofloxacin were 54.55%(18/33),71.79%(28/39),94.87%(37/39),97.37%(37/38),97.44%(38/39)and 97.44%(38/39),respectively.The proportion of abnormal urine leukocytes(57.81%vs.87.37%)and median urine leukocyte count(35.70 cells/μl vs.547.60 cells/μl were significantly different between urine cultures of asymptomatic group and symptomatic urinary tract infections group(χ^2=25.346,P<0.001;Z=-9.246,P<0.001).ROC curves of urine leukocytes showed the Cut-o

关 键 词：脑卒中 无症状菌尿 抗菌药物 药敏试验 

分 类 号：R446.5[医药卫生—诊断学] R691.3[医药卫生—临床医学] R743.3